title: Antibiotic use among patients with febrile illness in a low malaria endemicity setting in Uganda.
abstract: BACKGROUND
  Uganda embraced the World Health Organization guidelines that recommend a universal 'test and treat' strategy for malaria, mainly by use of rapid diagnostic test (RDT) and microscopy. However, little is known how increased parasitological diagnosis for malaria influences antibiotic treatment among patients with febrile illness.
  
  
  METHODS
  Data collection was carried out within a feasibility trial of presumptive diagnosis of malaria (control) and two diagnostic interventions (microscopy or RDT) in a district of low transmission intensity. Five primary level health centres (HCs) were randomized to each diagnostic arm (diagnostic method in a defined group of patients). All 52,116 outpatients (presumptive 16,971; microscopy 17,508; and RDT 17,638) aged 5 months to ninety five years presenting with fever (by statement or measured) were included. Information from outpatients and laboratory registers was extracted weekly from March 2010 to July 2011. The proportion of patients who were prescribed antibiotics was calculated among those not tested for malaria, those who tested positive and in those who tested negative.
  
  
  RESULTS
  Seven thousand and forty (41.5%) patients in the presumptive arm were prescribed antibiotics. Of the patients not tested for malaria, 1,537 (23.9%) in microscopy arm and 810 (56.2%) in RDT arm were prescribed antibiotics. Among patients who tested positive for malaria, 845 (25.8%) were prescribed antibiotics in the RDT and 273(17.6%) in the microscopy arm. Among patients who tested negative for malaria, 7809 (61.4%) were prescribed antibiotics in the RDT and 3749 (39.3%) in the microscopy arm. Overall the prescription of antibiotics was more common for children less than five years of age 5,388 (63%) compared to those five years and above 16798 (38.6%).
  
  
  CONCLUSIONS
  Prescription of antibiotics in patients with febrile illness is high. Testing positive for malaria reduces antibiotic treatment but testing negative for malaria increases use of antibiotics.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00565071.
authors.affiliation: Department of Community Health, Mbarara University of Science & Technology P, O, Box 1410, Mbarara, Uganda. vkbatwala@gmail.com
authors.forename: Vincent
authors.initials: V
authors.lastname: Batwala
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D019353:Endemic Diseases; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D010274:Parasitology / Q000379:methods; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents