Brecht Ingelbeen1, Kanika D Koirala2, Kristien Verdonck3, Barbara Barbé4, Déby Mukendi5, Phe Thong6, Sayda El Safi7, Lukas Van Duffel8, Emmanuel Bottieau4, Marianne A B van der Sande9, Marleen Boelaert3, François Chappuis10, Jan Jacobs11. 1. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Electronic address: bingelbeen@itg.be. 2. B.P. Koirala Institute of Health Science, Dharan, Nepal; Institute of Global Health, University of Geneva, Geneva, Switzerland. 3. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. 4. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. 5. Institut National de Recherche Biomédicale, Kinshasa, the Democratic Republic of the Congo; Département de Neurologie Tropicale, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo. 6. Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia. 7. Faculty of Medicine, University of Khartoum, Khartoum, Sudan. 8. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Infectious Diseases Operative Unit, S. Maria delle Croci Hospital, Ravenna, Italy. 9. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Julius Centre for Health Sciences and Primary Care, Utrecht University, the Netherlands. 10. Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland. 11. Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Abstract
OBJECTIVES: Community-level antibiotic use contributes to antimicrobial resistance, but is rarely monitored as part of efforts to optimize antibiotic use in low- and middle-income countries (LMICs). We investigated antibiotic use in the 4 weeks before study inclusion for persistent fever. METHODS: The NIDIAG-Fever (Neglected Infectious diseases DIAGnosis-Fever) study investigated aetiologies of infections in patients ≥5 years old with fever ≥1 week in six healthcare facilities in Cambodia, the Democratic Republic of the Congo (DRC), Nepal, and Sudan. In the present nested cross-sectional study, we describe prevalence and choice of antibiotics before and at study inclusion, applying the Access/Watch/Reserve (AWaRe) classification of the WHO List of Essential Medicines. Factors associated with prior antibiotic use were analysed. RESULTS: Of 1939 participants, 428 (22.1%) reported the prior use of one or more antibiotics, ranging from 6.3% (24/382, Cambodia) to 35.5% (207/583, Nepal). Of 545 reported antibiotics, the most frequent were Watch group antibiotics (351/545, 64.4%), ranging from 23.6% (DRC) to 82.1% (Nepal). Parenteral administration ranged from 5.9% to 69.6% between study sites. Antibiotic use was most frequent among young patients (5-17 years of age; risk ratio 1.42, 95%CI 1.19-1.71) and men (RR 1.29; 95%CI 1.09-1.53). No association was found with specific symptoms. Of 555 antibiotics started before study inclusion, 275 (49.5%) were discontinued at study inclusion. CONCLUSIONS: Watch antibiotics were frequently used, and discontinued upon study inclusion. The antibiotic use frequency and choice varied importantly between LMICs. Data on local antibiotic use are essential to guide efforts to optimize antibiotic use in LMICs, should not be restricted to hospitals, and need to take local healthcare utilization into account.
OBJECTIVES: Community-level antibiotic use contributes to antimicrobial resistance, but is rarely monitored as part of efforts to optimize antibiotic use in low- and middle-income countries (LMICs). We investigated antibiotic use in the 4 weeks before study inclusion for persistent fever. METHODS: The NIDIAG-Fever (Neglected Infectious diseases DIAGnosis-Fever) study investigated aetiologies of infections in patients ≥5 years old with fever ≥1 week in six healthcare facilities in Cambodia, the Democratic Republic of the Congo (DRC), Nepal, and Sudan. In the present nested cross-sectional study, we describe prevalence and choice of antibiotics before and at study inclusion, applying the Access/Watch/Reserve (AWaRe) classification of the WHO List of Essential Medicines. Factors associated with prior antibiotic use were analysed. RESULTS: Of 1939 participants, 428 (22.1%) reported the prior use of one or more antibiotics, ranging from 6.3% (24/382, Cambodia) to 35.5% (207/583, Nepal). Of 545 reported antibiotics, the most frequent were Watch group antibiotics (351/545, 64.4%), ranging from 23.6% (DRC) to 82.1% (Nepal). Parenteral administration ranged from 5.9% to 69.6% between study sites. Antibiotic use was most frequent among young patients (5-17 years of age; risk ratio 1.42, 95%CI 1.19-1.71) and men (RR 1.29; 95%CI 1.09-1.53). No association was found with specific symptoms. Of 555 antibiotics started before study inclusion, 275 (49.5%) were discontinued at study inclusion. CONCLUSIONS: Watch antibiotics were frequently used, and discontinued upon study inclusion. The antibiotic use frequency and choice varied importantly between LMICs. Data on local antibiotic use are essential to guide efforts to optimize antibiotic use in LMICs, should not be restricted to hospitals, and need to take local healthcare utilization into account.
Authors: Daniel Valia; Brecht Ingelbeen; Bérenger Kaboré; Ibrahima Karama; Marjan Peeters; Palpouguini Lompo; Erika Vlieghe; Annelies Post; Janneke Cox; Quirijn de Mast; Annie Robert; Marianne A B van der Sande; Hector Rodriguez Villalobos; Andre van der Ven; Halidou Tinto; Jan Jacobs Journal: Antimicrob Resist Infect Control Date: 2022-04-13 Impact factor: 4.887
Authors: Lukas Van Duffel; Cedric P Yansouni; Jan Jacobs; Marjan Van Esbroeck; Kadrie Ramadan; Jozefien Buyze; Achilleas Tsoumanis; Barbara Barbé; Marleen Boelaert; Kristien Verdonck; Francois Chappuis; Emmanuel Bottieau Journal: Open Forum Infect Dis Date: 2022-08-24 Impact factor: 4.423
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