Antibiotic Prescribing
malaria, Febrile Illness, pneumonia, febrile illness
MALARIA, PNEUMONIA, MALARIA, FEBRILE ILLNESS
Overall, there was no difference in antibiotic prescriptions between arms, with a relative risk (RR) of 1.03 (95% CI: .96–1.11); however, the size and direction of effects varied across sites and in different subpopulations ( Proportion of Participants Who Were Prescribed Any Antibiotic in a Randomized Controlled Trial That Introduced Point-of-Care Tests to Guide Management of Outpatients With Febrile Illness at 3 Clinical Sites in UgandaAbbreviations: CI, confidence interval; RDT, rapid diagnostic test; RR, relative risk.As indicated by the managing clinician based on symptoms and signs, before performance of diagnostic tests.No significant differences in antibiotic prescribing were observed between study arms for patients who presented with respiratory symptoms, or for those who presented without respiratory symptoms and signs (In contrast, malaria status was significantly associated with prescribing at all 3 sites. In the intervention arm, patients with positive mRDTs had a higher RR of being prescribed antibiotics than those with negative mRDT results ( Prescribing That Should Have Resulted if the Diagnostic and Treatment Algorithm Were Strictly Followed, for Intervention-Arm Patients by Malaria Rapid Diagnostic Test ResultAbbreviations: mRDT, malaria rapid diagnostic test; Neg, negative; Pos, positive.If clinically indicated in the clinician's judgment and/or if the patient was aged <5 years and met World Health Organization (WHO) pneumonia criteria. Prescribing That Should Have Resulted if the Diagnostic and Treatment Algorithm Were Strictly Followed, for Intervention-Arm Patients by Malaria Rapid Diagnostic Test Result, Among Patients Who Actually Received an Antibiotic Prescription and Those Who Did NotAmong those who actually received an antibiotic prescription, the top row (“Don’t prescribe antibiotic”; bold values), shows over-prescription (ie, patients for whom strict adherence to the algorithm would have resulted in no antibiotic, but who in fact were prescribed an antibiotic). Among those who did not receive an antibiotic prescription, the third row (“Prescribe antibiotic”, bold values) shows under-prescription (ie, patients for whom strict adherence to the algorithm would have resulted in an antibiotic, but who in fact were not prescribed one).Abbreviations: CBC, complete blood count; CRP, C-reactive protein; mRDT, malaria rapid diagnostic test; Neg, negative; Pos, positive.If clinically indicated in the clinician's judgment and/or if the patient was aged <5 years and met World Health Organization (WHO) pneumonia criteria. Prescribing That Would Have Resulted if the Diagnostic and Treatment Algorithm Were Modified So That CRP and/or CBC and Differential Were Prioritized for All Patients Regardless of Malaria Status, for Intervention-Arm Patients by Malaria Rapid Diagnostic Test Result, Among Patients Who Actually Received an Antibiotic Prescription and Those Who Did NotAmong those who actually received an antibiotic prescription, the top row (“Don’t prescribe antibiotic”; bold values), shows over-prescription (ie, patients for whom strict adherence to the algorithm would have resulted in no antibiotic, but who in fact were prescribed an antibiotic). Among those who did not receive an antibiotic prescription, the third row (“Prescribe antibiotic”, bold values) shows under-prescription (ie, patients for whom strict adherence to the algorithm would have resulted in an antibiotic, but who in fact were not prescribed one).Abbreviations: CBC, complete blood count; CRP, C-reactive protein; mRDT, malaria rapid diagnostic test; Neg, negative; Pos, positive.If clinically indicated in the clinician's judgment and/or if the patient was aged <5 years and met World Health Organization (WHO) pneumonia criteria.The most prescribed antibiotics at each site are shown in Pie charts showing the most commonly prescribed antibiotics in a randomized controlled trial that introduced point-of-care tests to guide the management of outpatients with febrile illness at 3 clinical sites in Uganda.