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Study Finds Rapid Tests for Malaria Linked to Increased Antibiotic Usage

Researchers from the London School of Hygiene and Tropical Medicine (LSHTM) discovered that introducing malaria rapid diagnostic tests across malaria-endemic regions improved antimalarial targeting, but also has prompted a slew of unintended consequences including the overuse of antibiotics.

Malaria rapid diagnostic tests are intended to improve the management of suspected malaria cases, increasing the use of first-line antimalarials in patients with confirmed malaria and encouraging the diagnosis and appropriate treatment of patients without malaria.

According to the study, published in the American Journal of Tropical Medicine and Hygiene, the analysis showed that while in most situations the rapid tests effectively limited the routine practice of prescribing malaria medications known as artemisinin combination therapies (ACTs), the technology has indirectly caused a spike in antibiotic prescriptions and other problems.  

"We found that in many places a reduction in the use of ACTs was accompanied by an increase in the use of antibiotics, which may drive up the risk of antibiotic-resistant infections," LSHTM assistant professor Katia Bruxvoort said in a statement.

Bruxvoort and her team believe that the shift to antibiotics after ruling out malaria may suggest that many patients and clinicians do not feel comfortable with standard treatment for non-malaria related fevers, which involves taking fever-reducing drugs and drinking plenty of fluids.

"We don't currently have a reliable way to determine which fevers are evidence of a bacterial infection that requires a specific antibiotic treatment and which fevers resolve with supportive care only," Bruxvoort said.

The researchers analyzed drug prescriptions written from 2007 to 2013 in over half a million patient encounters documented in 10 related studies in malaria-endemic locations of Afghanistan and Africa conducted by the ACT Consortium, a global research initiative investigating important issues around anti-malarial drugs. The studies looked at the impact of rapid diagnostic test introduction on fever case management across a range of clinical and epidemiological contexts and among various types of healthcare providers.

Rapid diagnostic tests were introduced in health facilities, community health workers, private drug shops, and pharmacies.

In most areas, 40 to 80 percent of patients who tested negative for malaria via rapid diagnostic tests were prescribed antibiotics, despite the awareness of standard treatment for fevers unrelated to malaria.

Even more worrisome for researchers, a negative test for malaria was only partially effective at limiting ACT prescriptions. For example, in two areas, Cameroon and Ghana, 39 to 43 percent of patients who tested negative for malaria still received ACTs.

Overall, 75 percent of patients studied left clinics with either antibiotics or an ACT, sparking concerns about drug-resistant malaria.

Rapid diagnostic test usage for malaria has skyrocketed globally since 2010 as World Health Organization officials have sought to reduce unnecessary prescriptions for ACTs. In Africa, where ACTs have been a major factor in the 60 percent drop in malaria deaths in the past 15 years, researchers fear the recent strides in public health could disappear if ACT-resistant malaria moves across the continent.

"Technology alone cannot solve complex health problems; community and provider education, as well as health system changes, must occur hand in hand to improve patient outcomes" Patricia Walker, president of the American Society of Tropical Medicine and Hygiene said in a statement.

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