在乌干达疟疾低流行地区发热患者中抗生素的使用情况。
Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda.
机构信息
Department of Community Health, Mbarara University of Science & Technology P, O, Box 1410, Mbarara, Uganda.
出版信息
Malar J. 2011 Dec 20;10:377. doi: 10.1186/1475-2875-10-377.
BACKGROUND
Uganda embraced the World Health Organization guidelines that recommend a universal 'test and treat' strategy for malaria, mainly by use of rapid diagnostic test (RDT) and microscopy. However, little is known how increased parasitological diagnosis for malaria influences antibiotic treatment among patients with febrile illness.
METHODS
Data collection was carried out within a feasibility trial of presumptive diagnosis of malaria (control) and two diagnostic interventions (microscopy or RDT) in a district of low transmission intensity. Five primary level health centres (HCs) were randomized to each diagnostic arm (diagnostic method in a defined group of patients). All 52,116 outpatients (presumptive 16,971; microscopy 17,508; and RDT 17,638) aged 5 months to ninety five years presenting with fever (by statement or measured) were included. Information from outpatients and laboratory registers was extracted weekly from March 2010 to July 2011. The proportion of patients who were prescribed antibiotics was calculated among those not tested for malaria, those who tested positive and in those who tested negative.
RESULTS
Seven thousand and forty (41.5%) patients in the presumptive arm were prescribed antibiotics. Of the patients not tested for malaria, 1,537 (23.9%) in microscopy arm and 810 (56.2%) in RDT arm were prescribed antibiotics. Among patients who tested positive for malaria, 845 (25.8%) were prescribed antibiotics in the RDT and 273(17.6%) in the microscopy arm. Among patients who tested negative for malaria, 7809 (61.4%) were prescribed antibiotics in the RDT and 3749 (39.3%) in the microscopy arm. Overall the prescription of antibiotics was more common for children less than five years of age 5,388 (63%) compared to those five years and above 16798 (38.6%).
CONCLUSION
Prescription of antibiotics in patients with febrile illness is high. Testing positive for malaria reduces antibiotic treatment but testing negative for malaria increases use of antibiotics.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT00565071.
背景
乌干达采纳了世界卫生组织（WHO）的建议，即推行针对疟疾的普遍“检测和治疗”策略，主要采用快速诊断检测（RDT）和显微镜检查。然而，人们对寄生虫学诊断检测增加对发热患者抗生素治疗的影响知之甚少。
方法
在低传播强度地区开展了疟疾（对照）和两种诊断干预（显微镜检查或 RDT）的预试验中开展了数据收集。将 5 家初级保健中心（HC）随机分配到每个诊断组（在特定组患者中采用特定的诊断方法）。2010 年 3 月至 2011 年 7 月期间，共纳入 52116 名 5 月龄至 95 岁的发热（自述或测量）门诊患者（预试验组 16971 例，显微镜检查组 17508 例，RDT 组 17638 例）。每周从门诊和实验室登记册中提取信息。计算未进行疟疾检测、检测阳性和检测阴性患者中使用抗生素的比例。
结果
预试验组中，7040 例（41.5%）患者开具了抗生素处方。在未进行疟疾检测的患者中，显微镜检查组 1537 例（23.9%）和 RDT 组 810 例（56.2%）开具了抗生素处方。在疟疾检测阳性的患者中，RDT 组 845 例（25.8%）和显微镜检查组 273 例（17.6%）开具了抗生素处方。在疟疾检测阴性的患者中，RDT 组 7809 例（61.4%）和显微镜检查组 3749 例（39.3%）开具了抗生素处方。总体而言，5 岁以下儿童抗生素处方更为常见（63%，5388 例），5 岁及以上儿童抗生素处方较少（38.6%，16798 例）。
结论
发热患者抗生素处方较多。疟疾检测阳性可减少抗生素治疗，但疟疾检测阴性可增加抗生素使用。
试验注册
ClinicalTrials.gov：NCT00565071。
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