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Meta-Analysis
. 2023 Jul 25;77(Suppl 2):S199-S205.
doi: 10.1093/cid/ciad324.

Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients <18 Years of Age With Acute Febrile Illness

Piero Olliaro  1   2 , Juvenal Nkeramahame  2 , Philip Horgan  2   3   4 , Halidou Tinto  5 , François Kiemde  5 , Rita Baiden  6   7 , Alexander Adjei  7 , James Kapisi  8 , Heidi Hopkins  9 , Olawale Salami  2 , Catrin E Moore  3   10 , Sabine Dittrich  2   11   12 , Stephan Weber  2 , Stefano Ongarello  2 ; ADIP study group
Collaborators, Affiliations
Meta-Analysis

Synthesis and Meta-analysis of 3 Randomized Trials Conducted in Burkina Faso, Ghana, and Uganda Comparing the Effects of Point-of-Care Tests and Diagnostic Algorithms Versus Routine Care on Antibiotic Prescriptions and Clinical Outcomes in Ambulatory Patients <18 Years of Age With Acute Febrile Illness

Piero Olliaro et al. Clin Infect Dis. .

Abstract

This meta-analysis included 3 randomized trials conducted in sub-Saharan Africa comparing the effects of point-of-care tests and diagnostic algorithms versus routine care on antibiotic prescriptions and clinical outcomes in ambulatory patients presenting at outpatient facilities with acute uncomplicated febrile illness.

Keywords: antibiotic prescriptions; diagnostic algorithms; febrile illnesses; point-of-care diagnostic tests.

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Conflict of interest statement

Potential conflicts of interest. All authors are employees of FIND, employees of the University of Oxford, or members of the ADIP study group. P. H. reports research funding from FIND and an honoraria payment from Oxford International Biomedical Centre (OIBC). H. H. reports the following: being employed by the London School of Hygiene & Tropical Medicine; receiving separate financial support from the study sponsors for work on the project reported in this supplement and salary support from the UK Foreign Commonwealth and Development Office; receiving royalties from UpToDate, a clinical decision support tool from Wolters Kluwer, for authorizing and maintaining the chapter on laboratory tools for diagnosing malaria; receiving honoraria for lecturing for the University of Virginia and for a doctoral thesis review for the University of Otago in New Zealand; and holding index-linked mutual fund and retirement account investments. S. W. reports that ACOMED provided statistical analysis and services. 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.
Clinical outcome (A) and antibiotic prescription rates (B). Note that no follow-up information was available for 37 patients in Burkina Faso (12 in the intervention and 25 in the control group 25) and 7 in Ghana (1 in the intervention and 6 in the control group). Abbreviations: CI, confidence interval; MH fixed, Mantel-Haenszel fixed-effect method; RR, risk ratio.
See this image and copyright information in PMC

References

    1. Kiemde F, Valia D, Kabore B, et al. 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. Clin Infect Dis 2023. - PMC - PubMed
    1. Adjei A, Kukula V, Narh CT, et al. Impact of point-of-care rapid diagnostic tests on antibiotic prescription among patients under 18 years in primary health care settings in two peri-urban districts in Ghana; randomized controlled trial results. Clin Infect Dis 2023. - PMC - PubMed
    1. Kapisi J, Kitutu FE, Rutebemberwa E, et al. Impact of the introduction of a package of diagnostic tools, diagnostic algorithm, and training and communication on outpatient acute fever case management at three diverse sites in Uganda: results of a randomized controlled trial. Clin Infect Dis 2023. - PMC - PubMed
    1. Olliaro P, Nkeramahame J, Salami O, et al. Advancing access to diagnostic tools essential for universal health coverage and antimicrobial resistance prevention—an overview of trials in sub-Saharan Africa. Clin Infect Dis 2023. - PMC - PubMed
    1. Salami O, Horgan P, Moore CE, et al. Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial. Trials 2020; 21:974. - PMC - PubMed

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