title: Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test.
abstract: BACKGROUND
  The availability of a rapid diagnostic test for malaria (RDTm) allows accurate diagnosis at all levels of health facilities. The objective of the present study was to evaluate the safety of withholding antimalarials in febrile children who have a negative test result.
  
  
  METHODS
  We conducted a prospective 2-arm longitudinal study in areas of Tanzania that are moderately and highly endemic for malaria. Children with a history of fever were managed routinely by resident clinicians of 2 health facilities, except that no antimalarials were prescribed if the RDTm result was negative. Children were followed up at home on day 7. The main outcome was the occurrence of complications in children with negative RDTm results; children with positive RDTm results were followed up for the same outcomes for indirect comparison.
  
  
  RESULTS
  One thousand children (median age, 24 months) were recruited. Six hundred three children (60%) had a negative RDTm result. Five hundred seventy-three (97%) of these children were cured on day 7. Forty-nine (8%) of the children with negative RDTm results spontaneously visited the dispensary before day 7, compared with 10 (3%) of the children with positive RDTm results. All children who had negative initial results had negative results again when they were tested either at spontaneous attendance or on day 7 because they were not cured clinically, except for 3 who gave positive results on days 2, 4, and 7 respectively but who did not experience any complication. Four children who had negative initial results were admitted to the hospital subsequently, all with negative results for malaria tests upon admission. Two of them died, of causes other than malaria.
  
  
  CONCLUSIONS
  Not giving antimalarial drugs in febrile children who had a negative RDTm result was safe, even in an area highly endemic for malaria. Our study provides evidence for treatment recommendations based on parasitological diagnosis in children <5 years old.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. valerie.dacremont@unibas.ch
authors.forename: Valérie
authors.initials: V
authors.lastname: d'Acremont
authors.forename: Aggrey
authors.initials: A
authors.lastname: Malila
authors.forename: Ndeniria
authors.initials: N
authors.lastname: Swai
authors.forename: Robert
authors.initials: R
authors.lastname: Tillya
authors.forename: Judith
authors.initials: J
authors.lastname: Kahama-Maro
authors.forename: Christian
authors.initials: C
authors.lastname: Lengeler
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials