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Antimicrobials in children admitted to hospital in malaria endemic areas

BMJ 2010; 340 doi: (Published 08 April 2010) Cite this as: BMJ 2010;340:c1818
  1. Kathryn Maitland, professor in tropical paediatric infectious diseases
  1. 1Department of Paediatrics, Division of Medicine, Imperial College, London W2 1PG
  1. kathryn.maitland{at}

    Identifying children with sepsis is the first major challenge

    The cornerstones of the Surviving Sepsis Campaign are the prompt identification of sepsis and the subsequent implementation of evidence based treatments.1 A key component of this strategy is the timely use of antibiotics. Even in countries embracing these guidelines, “sepsis” is largely diagnosed clinically, so prompt recognition and treatment should be possible even for hospitals with basic clinical and diagnostic capabilities. What are the barriers to the implementation of this goal and, more specifically, to the targeted antimicrobial treatment of children admitted to hospital in malaria endemic Africa? In the linked prospective study (doi:10.1136/bmj.c1350), Nadjm and colleagues assess the performance of the World Health Organization’s referral care manual (which guides the use of antibiotics in children admitted to hospital in Africa) in identifying children with invasive bacterial disease in an area of intense malaria transmission.2

    Four major challenges exist. Firstly, presentation to hospital with febrile disease is extremely common, so making informed choices about who to treat with parenteral antibiotics needs to be balanced against overtreatment. Secondly, in malaria endemic areas, children often carry falciparum malaria asymptomatically, so malaria is overdiagnosed at the expense of …

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