BMJ  2005;330:995 (30 April), doi:10.1136/bmj.38408.471991.8F (published 29 March 2005)

Paper

Use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study

¹ Centre for Geographic Medicine Research (coast), PO Box 230, Kilifi, Kenya

Objectives To determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics.

Design Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospectively collected dataset.

Setting Kilifi District Hospital, Kenya.

Participants 11 847 acute paediatric admissions.

Main outcome measures Presence of invasive bacterial infection (bacteraemia or meningitis) or Plasmodium falciparum parasitaemia; antimicrobial sensitivities of isolated bacteria.

Results 6254 (53%) admissions met criteria for syndromes requiring antibiotics (sick young infants; meningitis/encephalopathy; severe malnutrition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80% of all invasive bacterial infections identified), and 753 (12%) died (93% of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibiotics, an invasive bacterial infection was detected in 4.0-8.8%. For the syndrome of meningitis/encephalopathy, 96/123 (76%) isolates were fully sensitive in vitro to penicillin or chloramphenicol.

Conclusions Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death. Malaria parasitaemia does not justify withholding empirical parenteral antibiotics. Lumbar puncture is critical to the rational use of antibiotics.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial

Hugh Reyburn, Hilda Mbakilwa, Rose Mwangi, Ombeni Mwerinde, Raimos Olomi, Chris Drakeley, and Christopher J M Whitty
BMJ 2007 334: 403. [Abstract] [Full Text] [PDF]

Clinical syndromes seem adequate for targeting drug prescribing
BMJ 2005 330: 0. [Full Text]

Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study

Hugh Reyburn, Redepmta Mbatia, Chris Drakeley, Ilona Carneiro, Emmanuel Mwakasungula, Ombeni Mwerinde, Kapalala Saganda, John Shao, Andrew Kitua, Raimos Olomi, Brian M Greenwood, and Christopher J M Whitty
BMJ 2004 329: 1212. [Abstract] [Full Text] [PDF]

Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study

J A Berkley, A Ross, I Mwangi, F H A Osier, M Mohammed, M Shebbe, B S Lowe, K Marsh, and C R J C Newton
BMJ 2003 326: 361. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Sayang, C., Soula, G., Tahar, R., Basco, L. K., Gazin, P., Moyou-Somo, R., Delmont, J. (2009). Use of a Histidine-Rich Protein 2-Based Rapid Diagnostic Test for Malaria by Health Personnel during Routine Consultation of Febrile Outpatients in a Peripheral Health Facility in Yaounde, Cameroon. Am J Trop Med Hyg 81: 343-347 [Abstract] [Full text]  
• Murray, C. K., Gasser, R. A. Jr., Magill, A. J., Miller, R. S. (2008). Update on Rapid Diagnostic Testing for Malaria. Clin. Microbiol. Rev. 21: 97-110 [Abstract] [Full text]  
• Gwer, S., Newton, C. R.J.C., Berkley, J. A. (2007). Over-Diagnosis and Co-Morbidity of Severe Malaria in African Children: A Guide for Clinicians. Am J Trop Med Hyg 77: 6-13 [Abstract] [Full text]  
• Lamikanra, A. A., Brown, D., Potocnik, A., Casals-Pascual, C., Langhorne, J., Roberts, D. J. (2007). Malarial anemia: of mice and men. Blood 110: 18-28 [Abstract] [Full text]  
• Seaton, C., Ignas, J., Muchohi, S., Kokwaro, G., Maitland, K., Thomson, A. H. (2007). Population pharmacokinetics of a single daily intramuscular dose of gentamicin in children with severe malnutrition. J Antimicrob Chemother 59: 681-689 [Abstract] [Full text]  
• Reyburn, H., Mbakilwa, H., Mwangi, R., Mwerinde, O., Olomi, R., Drakeley, C., Whitty, C. J M (2007). Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial. BMJ 334: 403-403 [Abstract] [Full text]  
• POLAGE, C. R., BEDU-ADDO, G., OWUSU-OFORI, A., FRIMPONG, E., LLOYD, W., ZURCHER, E., HALE, D., PETTI, C. A. (2006). LABORATORY USE IN GHANA: PHYSICIAN PERCEPTION AND PRACTICE.. Am J Trop Med Hyg 75: 526-531 [Abstract] [Full text]  
• Scott, J. A. G., Mwarumba, S., Ngetsa, C., Njenga, S., Lowe, B. S., Slack, M. P. E., Berkley, J. A., Mwangi, I., Maitland, K., English, M., Marsh, K. (2005). Progressive Increase in Antimicrobial Resistance among Invasive Isolates of Haemophilus influenzae Obtained from Children Admitted to a Hospital in Kilifi, Kenya, from 1994 to 2002. Antimicrob. Agents Chemother. 49: 3021-3024 [Abstract] [Full text]  

Online poll

Find out more >>