Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka.
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.
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina gayani.tillekeratne@dm.duke.edu.
L Gayani
LG
Tillekeratne
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Champica K
CK
Bodinayake
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Ajith
A
Nagahawatte
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Dhammika
D
Vidanagama
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Vasantha
V
Devasiri
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Wasantha Kodikara
WK
Arachchi
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Ruvini
R
Kurukulasooriya
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Aruna Dharshan
AD
De Silva
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Truls
T
Østbye
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Megan E
ME
Reller
Duke Global Health Institute, Durham, North Carolina; Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Community and Family Medicine, Duke University, Durham, North Carolina; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Christopher W
CW
Woods
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough; D005260:Female; D005334:Fever; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000191:economics; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D013188:Sri Lanka; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents