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Antibiotic use prior to seeking medical care in patients with persistent fever: a cross-sectional study in four low- and middle-income countries
- Source :
- Clinical Microbiology and Infection, Vol. 27, No 9 (2020) pp. 1293-1300
- Publication Year :
- 2021
- Publisher :
- ELSEVIER SCI LTD, 2021.
-
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. ispartof: CLINICAL MICROBIOLOGY AND INFECTION vol:27 issue:9 pages:1293-1300 ispartof: location:England status: published
- Subjects :
- Male
0301 basic medicine
Microbiology (medical)
Drug Utilization
medicine.medical_specialty
Healthcare utilization
Adolescent
Fever
medicine.drug_class
Cross-sectional study
030106 microbiology
Antibiotics
Antimicrobial stewardship
Antimicrobial resistance
Community-level antibiotic use
Essential medicines
Antimicrobial Stewardship
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Internal medicine
Health care
medicine
Drug utilization
Humans
030212 general & internal medicine
Child
Persistent fever
Developing Countries
Poverty
ddc:613
Low- and middle-income countries
business.industry
General Medicine
Primary care
Anti-Bacterial Agents
Cross-Sectional Studies
Infectious Diseases
Antibacterial agents
Child, Preschool
Relative risk
Female
business
Subjects
Details
- Language :
- English
- ISSN :
- 1198743X
- Database :
- OpenAIRE
- Journal :
- Clinical Microbiology and Infection, Vol. 27, No 9 (2020) pp. 1293-1300
- Accession number :
- edsair.doi.dedup.....333b4c0283db1322f93fa73230829069