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Published on: July 4, 2007
Antimicrobial Stewardship in Tropical Infectious Diseases: Focusing on Dengue and Malaria
Ashley Siribhadra1, Thundon Ngamprasertchai1, Pinyo Rattanaumpawan2
1Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Abstract:
Acute undifferentiated febrile illness (AUFI) is the presenting symptom of various tropical and infectious diseases. Viral infection is generally the most common cause of AUFI, accounting for 8-11.8% of cases; thus, antibiotics might be unnecessary. Dengue and malaria are common tropical infectious diseases requiring effective supportive treatment and antimalarial agents, respectively. The uncertainty of early diagnosis results in widespread empirical antimicrobial treatment in high -income as well as in low-and middle-income countries. Although rapid diagnostic tests (RDTs) have been shown to limit antibiotic prescriptions in dengue and malaria, we observed a wide range of antibiotic prescriptions for 13-92.7% of cases in previous literature, particularly in RDT-negative malaria cases. Given several RDT limitations, antimicrobial stewardship (AMS) appears to be an effective strategy for controlling unnecessary antibiotic use and antimicrobial resistance (AMR) prevention. This program should be endorsed by a multidisciplinary team in tropical diseases to control collateral damage of inappropriate antimicrobial use. Empirical antibiotic treatment should be administered based on clinical judgement, microbiological evidence, and local epidemiological data. Rapid termination of antibiotic therapy, including disease control or elimination, is the mainstay of AMS in tropical diseases. Local and international sectors should implement an AMS programme to reduce AMR in the Tropics.
Insights
Acute undifferentiated febrile illness (AUFI) is often viral, not bacterial, making antibiotics unnecessary. Implementing antimicrobial stewardship programs is crucial for preventing antibiotic resistance in tropical diseases.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Acute undifferentiated febrile illness (AUFI) is a common presentation of various tropical and infectious diseases, frequently caused by viruses.
- Empirical antibiotic use is widespread due to diagnostic uncertainty, despite viral infections being the most common cause.
- Dengue and malaria are significant tropical diseases requiring specific management, highlighting the need for accurate diagnosis.
Purpose of the Study:
- To evaluate the role of antimicrobial stewardship (AMS) in managing AUFI in tropical regions.
- To address the overuse of antibiotics in cases of AUFI, particularly when rapid diagnostic tests (RDTs) are inconclusive.
- To propose strategies for reducing antimicrobial resistance (AMR) in the context of tropical infectious diseases.
Main Methods:
- Review of existing literature on AUFI, antibiotic prescription patterns, and RDT efficacy.
- Analysis of factors contributing to empirical antibiotic use in tropical disease management.
- Assessment of the potential impact of AMS programs on antibiotic consumption and AMR.
Main Results:
- Viral infections account for a significant proportion of AUFI cases, suggesting antibiotics are often not indicated.
- Antibiotic prescription rates for AUFI vary widely (13-92.7%), with high rates in RDT-negative malaria cases.
- Limitations of RDTs contribute to the challenge of optimizing antibiotic use.
Conclusions:
- Antimicrobial stewardship (AMS) is essential for controlling unnecessary antibiotic use and preventing antimicrobial resistance (AMR) in tropical diseases.
- Empirical antibiotic therapy should be guided by clinical judgment, microbiological data, and local epidemiology.
- Implementing AMS programs with multidisciplinary teams is vital for reducing AMR in tropical regions.
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