| Francois Kiemde, Daniel Valia, Berenger Kabore, Toussaint Rouamba, Alima Nadine Kone, Seydou Sawadogo, Adelaide Compaore, Olawale Salami, Philip Horgan, Catrin E. Moore, Sabine Dittrich, Juvenal Nkeramahame, Piero Olliaro, Halidou Tinto A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso Journal Article In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 77, iss. Suppl 2, pp. S134-S144, 2023, ISSN: 1537-6591. @article{Kiemde2023,
title = {A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso},
author = {Francois Kiemde and Daniel Valia and Berenger Kabore and Toussaint Rouamba and Alima Nadine Kone and Seydou Sawadogo and Adelaide Compaore and Olawale Salami and Philip Horgan and Catrin E. Moore and Sabine Dittrich and Juvenal Nkeramahame and Piero Olliaro and Halidou Tinto},
url = {https://pubmed.ncbi.nlm.nih.gov/37490742/},
doi = {10.1093/CID/CIAD331},
issn = {1537-6591},
year = {2023},
date = {2023-01-01},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
volume = {77},
issue = {Suppl 2},
pages = {S134-S144},
publisher = {Clin Infect Dis},
abstract = {Background: Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes. Methods: Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0. Results: Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P =. 135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P \<. 001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P \<. 001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P \<. 001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P \<. 001). Except for the period July-September, the reduction was consistent across the other quarters (P \<. 001). Conclusions: The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes. Clinical Trials Registration: clinicaltrials.gov; NCT04081051.},
keywords = {Adolescent, Algorithms, Anti-Bacterial Agents* / therapeutic use, Burkina Faso, Child, Daniel Valia, doi:10.1093/cid/ciad331, Francois Kiemde, Halidou Tinto, Health Facilities, Humans, Infant, Malaria* / drug therapy, MEDLINE, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, PMC10368409, pmid:37490742, Preschool, Prescriptions, PubMed Abstract, Randomized controlled trial, Research Support},
pubstate = {published},
tppubtype = {article}
}
Background: Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes. Methods: Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0. Results: Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P =. 135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P <. 001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P <. 001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P <. 001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P <. 001). Except for the period July-September, the reduction was consistent across the other quarters (P <. 001). Conclusions: The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes. Clinical Trials Registration: clinicaltrials.gov; NCT04081051. |
| Piero Olliaro, Juvenal Nkeramahame, Philip Horgan, Halidou Tinto, François Kiemde, Rita Baiden, Alexander Adjei, James Kapisi, Heidi Hopkins, Olawale Salami, Catrin E. Moore, Sabine Dittrich, Stephan Weber, Stefano Ongarello Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients <18 Years of Age With Acute Febrile Illness Journal Article In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 77, iss. Suppl 2, pp. S199-S205, 2023, ISSN: 1537-6591. @article{Olliaro2023,
title = {Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients \<18 Years of Age With Acute Febrile Illness},
author = {Piero Olliaro and Juvenal Nkeramahame and Philip Horgan and Halidou Tinto and Fran\c{c}ois Kiemde and Rita Baiden and Alexander Adjei and James Kapisi and Heidi Hopkins and Olawale Salami and Catrin E. Moore and Sabine Dittrich and Stephan Weber and Stefano Ongarello},
url = {https://pubmed.ncbi.nlm.nih.gov/37490743/},
doi = {10.1093/CID/CIAD324},
issn = {1537-6591},
year = {2023},
date = {2023-01-01},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
volume = {77},
issue = {Suppl 2},
pages = {S199-S205},
publisher = {Clin Infect Dis},
keywords = {{Algorithms, Anti-Bacterial Agents* / therapeutic use, Author(firstnames='Ad\'{e}la\"{i}de', Author(firstnames='Alexander', Author(firstnames='Asadu', Author(firstnames='Daniel', Author(firstnames='David', Author(firstnames='Deborah', Author(firstnames='Elizeus', Author(firstnames='Fran\c{c}ois', Author(firstnames='Freddy Eric', Author(firstnames='Halidou', Author(firstnames='Heidi', Author(firstnames='James', Author(firstnames='Rita', Author(firstnames='Vida', Burkina Faso, CollabAuthor(name='ADIP study group', Diagnostic Tests, Ghana, Humans, Juvenal Nkeramahame, MEDLINE, Meta-Analysis, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, Piero Olliaro, PMC10368413, Point-of-Care Testing*, Prescriptions, PubMed Abstract, Randomized Controlled Trials as Topic, Research Support},
pubstate = {published},
tppubtype = {article}
}
|
| Adelaïde Compaore, Deborah Ekusai-Sebatta, David Kaawa-Mafigiri, Vida Kukula, Selase Odopey, James Kapisi, Heidi Hopkins, François Kiemde, Halidou Tinto, Rita Baiden, Piero Olliaro, Juvenal Nkeramahame, Sabine Dittrich, Philip Horgan Viewpoint: Antimicrobial Resistance Diagnostics Use Accelerator: Qualitative Research on Adherence to Prescriptions Journal Article In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 77, iss. Suppl 2, pp. S206-S210, 2023, ISSN: 1537-6591. @article{Compaore2023,
title = {Viewpoint: Antimicrobial Resistance Diagnostics Use Accelerator: Qualitative Research on Adherence to Prescriptions},
author = {Adela\"{i}de Compaore and Deborah Ekusai-Sebatta and David Kaawa-Mafigiri and Vida Kukula and Selase Odopey and James Kapisi and Heidi Hopkins and Fran\c{c}ois Kiemde and Halidou Tinto and Rita Baiden and Piero Olliaro and Juvenal Nkeramahame and Sabine Dittrich and Philip Horgan},
url = {https://pubmed.ncbi.nlm.nih.gov/37490738/},
doi = {10.1093/CID/CIAD323},
issn = {1537-6591},
year = {2023},
date = {2023-01-01},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
volume = {77},
issue = {Suppl 2},
pages = {S206-S210},
publisher = {Clin Infect Dis},
abstract = {In this Viewpoint, the authors explore the determinants of patients' prescription adherence behaviors as part of FIND's Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Research findings from Burkina Faso, Ghana, and Uganda show that basic knowledge and understanding of prescription instructions are essential for adherence and can be improved through better communication. However, there are a range of other factors that influence adherence, some of which can be influenced through tailored communication messages from healthcare workers. These messages may contribute to changes in adherence behavior but may require other reinforcing interventions to be effective. Finally, there are some drivers of nonadherence centered around costs and time pressure that require other forms of intervention.},
keywords = {{Ad\'{e}la\"{i}de Compaor\'{e}, Anti-Bacterial Agents* / therapeutic use, Author(firstnames='Ad\'{e}la\"{i}de', Author(firstnames='Alexander', Author(firstnames='Asadu', Author(firstnames='Daniel', Author(firstnames='David', Author(firstnames='Deborah', Author(firstnames='Elizeus', Author(firstnames='Fran\c{c}ois', Author(firstnames='Freddy Eric', Author(firstnames='Halidou', Author(firstnames='Heidi', Author(firstnames='James', Author(firstnames='Rita', Author(firstnames='Vida', Bacterial*, Clinical Trial, CollabAuthor(name='ADIP study group', Communication, Deborah Ekusai-Sebatta, Drug Resistance, Humans, MEDLINE, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, PMC10368411, Prescriptions, PubMed Abstract, Qualitative research, Research Support},
pubstate = {published},
tppubtype = {article}
}
In this Viewpoint, the authors explore the determinants of patients' prescription adherence behaviors as part of FIND's Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Research findings from Burkina Faso, Ghana, and Uganda show that basic knowledge and understanding of prescription instructions are essential for adherence and can be improved through better communication. However, there are a range of other factors that influence adherence, some of which can be influenced through tailored communication messages from healthcare workers. These messages may contribute to changes in adherence behavior but may require other reinforcing interventions to be effective. Finally, there are some drivers of nonadherence centered around costs and time pressure that require other forms of intervention. |
