Zaas AK, Garner BH, Tsalik EL, Burke T, Woods CW, Ginsburg GS, 2014. The current epidemiology and clinical decisions surrounding acute respiratory infections. Trends Mol Med 20: 579–588.
Grijalva CG, Nuorti JP, Griffin MR, 2009. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302: 758–766.
Peltola V, Ruuskanen O, 2008. Editorial commentary: respiratory viral infections in developing countries: common, severe, and unrecognized. Clin Infect Dis 46: 58–60.
McCaig LF, Hughes JM, 1995. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 273: 214–219.
Donnelly JP, Baddley JW, Wang HE, 2014. Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother 58: 1451–1457.
Gonzales R, Malone DC, Maselli JH, Sande MA, 2001. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 33: 757–762.
Gonzales R, Steiner JF, Sande MA, 1997. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 278: 901–904.
Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J Jr, 2008. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 46: 155–164.
Bhavnani D, Phatinawin L, Chantra S, Olsen SJ, Simmerman JM, 2007. The influence of rapid influenza diagnostic testing on antibiotic prescribing patterns in rural Thailand. Int J Infect Dis 11: 355–359.
Tillekeratne L, Bodinayake C, Nagahawatte A, Vidanagama D, Devasiri V, Kodikara Arachchi W, Kurukulasooriya R, De Silva A, Ostbye T, Reller M, Woods C, 2015. An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Am J Trop Med Hyg 92: 1023–1029.
Hassan F, Nguyen A, Formanek A, Bell JJ, Selvarangan R, 2014. Comparison of the BD Veritor System for Flu A + B with the Alere BinaxNOW influenza A&B card for detection of influenza A and B viruses in respiratory specimens from pediatric patients. J Clin Microbiol 52: 906–910.
Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW, 2003. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 112: 363–367.
Esposito S, Marchisio P, Morelli P, Crovari P, Principi N, 2003. Effect of a rapid influenza diagnosis. Arch Dis Child 88: 525–526.
Noyola DE, Demmler GJ, 2000. Effect of rapid diagnosis on management of influenza A infections. Pediatr Infect Dis J 19: 303–307.
Falsey AR, Murata Y, Walsh EE, 2007. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 167: 354–360.
Sharma V, Dowd MD, Slaughter AJ, Simon SD, 2002. Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med 156: 41–43.
World Health Organization, 2012. WHO Interim Global Epidemiological Surveillance Standards for Influenza. Geneva, Switzerland: World Health Organization, 1–61.
Ozkaya E, Cambaz N, Coskun Y, Mete F, Geyik M, Samanci N, 2009. The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency department. Acta Paediatr 98: 1589–1592.
Wang J, Wang P, Wang X, Zheng Y, Xiao Y, 2014. Use and prescription of antibiotics in primary health care settings in China. JAMA Intern Med 174: 1914–1920.
Lucas M, Liyanage U, Lokukankanamage L, 2001. A study of antibiotic usage in acute respiratory infections in children. Sri Lankan Journal of Child Health 30: 5–7.
Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, Mullee M, Stuart B, 2014. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ 348: g1606.
Lam TP, Lam KF, 2003. What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting? J Clin Pharm Ther 28: 197–201.
Holloway K, 2011. Promoting the rational use of antibiotics. Regional adviser, essential drugs and other medicines, World Health Organization, Regional Office for South-East Asia. Regional Health 15: 122–130.
Montalto NJ, 2003. An office-based approach to influenza: clinical diagnosis and laboratory testing. Am Fam Physician 67: 111–118.
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Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access to rapid influenza test results could reduce antibiotic prescriptions for ARTIs in a resource-limited setting. We conducted a prospective, pre-post study from March 2013 to October 2014. Outpatients presenting to a hospital in Sri Lanka were surveyed for influenza-like illness–onset of fever ≥ 38.0°C and cough in prior 7 days. Enrolled patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling for rapid influenza A/B testing. Influenza test results were released only during phase 2 (January–October 2014). We enrolled 571 patients with ILI–316 in phase 1 and 241 in phase 2. The proportion positive for influenza was 46.5% in phase 1 and 28.6% in phase 2, P < 0.001. Between phases, antibiotic prescriptions decreased from 81.3% to 69.3% (P = 0.001) among all patients and from 83.7% to 62.3% (P = 0.001) among influenza-positive patients. On multivariable analysis, a positive influenza result during phase 2 was associated with lower odds of antibiotic prescriptions (OR = 0.50, 95% CI = 0.26–0.95). This prospective study suggests that providing access to rapid influenza testing may reduce unnecessary antibiotic prescriptions in resource-limited settings.
Financial support: This work was supported by the NIH Research Training Grant #R25 TW009337 funded by the Fogarty International Center and the National Institute of Mental Health.
Disclosure: Woods has served in an advisory capacity to Becton, Dickinson, and Company.
Authors' addresses: L. Gayani Tillekeratne, Global Health Institute, Duke University, Durham, NC, E-mail: gayani.tillekeratne@dm.duke.edu. Champica K. Bodinayake, Ajith Nagahawatte, and Vasantha Devasiri, Departments of Medicine, Microbiology, and Pediatrics, Ruhuna University, Galle, Sri Lanka, E-mails: bodinayake@yahoo.co.uk, ajithnagahawatte@yahoo.co.uk, and vdevasiri@gmail.com. Dhammika Vidanagama and Wasantha Kodikara Arachchi, Teaching Hospital Karapitiya, Galle, Sri Lanka, E-mails: dhammikasv@yahoo.com and kody@sltnet.lk. Ruvini Kurukulasooriya, Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka, E-mail: ruhunasearch@gmail.com. Aruna Dharshan De Silva, Genetech, Research Institute, Colombo, Sri Lanka, E-mail: dslv90@yahoo.com. Truls Østbye, Department of Community and Family Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mail: truls.ostbye@dm.duke.edu. Megan E. Reller, Department of Pathology, Johns Hopkins University, Baltimore, MD, E-mail: mreller1@jhmi.edu. Christopher W. Woods, Department of Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mail: chris.woods@duke.edu.
Zaas AK, Garner BH, Tsalik EL, Burke T, Woods CW, Ginsburg GS, 2014. The current epidemiology and clinical decisions surrounding acute respiratory infections. Trends Mol Med 20: 579–588.
Grijalva CG, Nuorti JP, Griffin MR, 2009. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 302: 758–766.
Peltola V, Ruuskanen O, 2008. Editorial commentary: respiratory viral infections in developing countries: common, severe, and unrecognized. Clin Infect Dis 46: 58–60.
McCaig LF, Hughes JM, 1995. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 273: 214–219.
Donnelly JP, Baddley JW, Wang HE, 2014. Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother 58: 1451–1457.
Gonzales R, Malone DC, Maselli JH, Sande MA, 2001. Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 33: 757–762.
Gonzales R, Steiner JF, Sande MA, 1997. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 278: 901–904.
Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J Jr, 2008. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 46: 155–164.
Bhavnani D, Phatinawin L, Chantra S, Olsen SJ, Simmerman JM, 2007. The influence of rapid influenza diagnostic testing on antibiotic prescribing patterns in rural Thailand. Int J Infect Dis 11: 355–359.
Tillekeratne L, Bodinayake C, Nagahawatte A, Vidanagama D, Devasiri V, Kodikara Arachchi W, Kurukulasooriya R, De Silva A, Ostbye T, Reller M, Woods C, 2015. An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Am J Trop Med Hyg 92: 1023–1029.
Hassan F, Nguyen A, Formanek A, Bell JJ, Selvarangan R, 2014. Comparison of the BD Veritor System for Flu A + B with the Alere BinaxNOW influenza A&B card for detection of influenza A and B viruses in respiratory specimens from pediatric patients. J Clin Microbiol 52: 906–910.
Bonner AB, Monroe KW, Talley LI, Klasner AE, Kimberlin DW, 2003. Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: results of a randomized, prospective, controlled trial. Pediatrics 112: 363–367.
Esposito S, Marchisio P, Morelli P, Crovari P, Principi N, 2003. Effect of a rapid influenza diagnosis. Arch Dis Child 88: 525–526.
Noyola DE, Demmler GJ, 2000. Effect of rapid diagnosis on management of influenza A infections. Pediatr Infect Dis J 19: 303–307.
Falsey AR, Murata Y, Walsh EE, 2007. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med 167: 354–360.
Sharma V, Dowd MD, Slaughter AJ, Simon SD, 2002. Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med 156: 41–43.
World Health Organization, 2012. WHO Interim Global Epidemiological Surveillance Standards for Influenza. Geneva, Switzerland: World Health Organization, 1–61.
Ozkaya E, Cambaz N, Coskun Y, Mete F, Geyik M, Samanci N, 2009. The effect of rapid diagnostic testing for influenza on the reduction of antibiotic use in paediatric emergency department. Acta Paediatr 98: 1589–1592.
Wang J, Wang P, Wang X, Zheng Y, Xiao Y, 2014. Use and prescription of antibiotics in primary health care settings in China. JAMA Intern Med 174: 1914–1920.
Lucas M, Liyanage U, Lokukankanamage L, 2001. A study of antibiotic usage in acute respiratory infections in children. Sri Lankan Journal of Child Health 30: 5–7.
Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, Mullee M, Stuart B, 2014. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ 348: g1606.
Lam TP, Lam KF, 2003. What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting? J Clin Pharm Ther 28: 197–201.
Holloway K, 2011. Promoting the rational use of antibiotics. Regional adviser, essential drugs and other medicines, World Health Organization, Regional Office for South-East Asia. Regional Health 15: 122–130.
Montalto NJ, 2003. An office-based approach to influenza: clinical diagnosis and laboratory testing. Am Fam Physician 67: 111–118.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 793 | 679 | 48 |
Full Text Views | 406 | 10 | 0 |
PDF Downloads | 150 | 10 | 0 |