Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Jul 25;77(Suppl 2):S134-S144.
doi: 10.1093/cid/ciad331.

A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso

Francois Kiemde  1 , Daniel Valia  1 , Berenger Kabore  1 , Toussaint Rouamba  1 , Alima Nadine Kone  1 , Seydou Sawadogo  1 , Adelaide Compaore  1 , Olawale Salami  2 , Philip Horgan  2   3   4 , Catrin E Moore  3   5 , Sabine Dittrich  2   6   7 , Juvenal Nkeramahame  2 , Piero Olliaro  2   8 , Halidou Tinto  1
Affiliations
Randomized Controlled Trial

A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso

Francois Kiemde et al. Clin Infect Dis. .

Abstract

Background: Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes.

Methods: Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0.

Results: Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P = .135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P < .001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P < .001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P < .001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P < .001). Except for the period July-September, the reduction was consistent across the other quarters (P < .001).

Conclusions: The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes.

Clinical trials registration: clinicaltrials.gov; NCT04081051.

Keywords: acute febrile illness; antibiotic prescription; antibiotic reduction; antimicrobial resistance.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. J. N., P. O., P. H., and S. D. were all employed by FIND, or member of ADIP, during the design and conduct of the study and writing of the manuscript. P. H. reports research funding from FIND and an honoraria payment from Oxford International Biomedical Centre (OIBC). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Diagnostic algorithm used in prescription decision making. Abbreviations: CBC, complete blood count; CRP, C-reactive protein (mg/L); GAS, group A streptococci; RSV, respiratory syncytial virus; RTI, respiratory tract infection; WBC, white blood cell count (per μL); WHO, World Health Organization.
Figure 2.
Figure 2.
Participant disposition.
See this image and copyright information in PMC

References

    1. Nnedu ON, Rimel B, Terry C, Jalloh-Vos H, Baryon B, Bausch DG. Syndromic diagnosis of malaria in rural Sierra Leone and proposed additions to the national integrated management of childhood illness guidelines for fever. Am J Trop Med Hyg 2010; 82:525–8. - PMC - PubMed
    1. Richardson M, Lakhanpaul M. Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance. BMJ 2007; 334:1163–4. - PMC - PubMed
    1. Kiemde F, Tahita MC, Lompo P, et al. Treatable causes of fever among children under 5 years in a seasonal malaria transmission area, Nanoro in Burkina Faso. Infect Dis Poverty 2018; 7:60. - PMC - PubMed
    1. World Health Organization . Integrated Management of Childhood Illness (IMCI) chart booklet. Distance Learning Course 2014; (March):1–76.
    1. Archibald LK, Reller LB. Clinical microbiology in developing countries. Emerg Infect Dis 2001; 7:302–5. - PMC - PubMed

Publication types

Substances

Associated data