Impact of Dengue Rapid Diagnostic Tests on the Prescription of Antibiotics and Anti-Inflammatory Drugs by Physicians in an Endemic Area in Colombia

Abstract

There is insufficient evidence on whether dengue rapid diagnostic tests (dRDTs) influence clinical decisions in endemic areas. Therefore, our objective was to evaluate the impact of dRDTs on the prescription of antibiotics and antiinflammatory drugs by physicians in a dengue-endemic area in Colombia. A retrospective cohort study was conducted with 330 patients in Cali, Colombia, between January 2012 and December 2017. The exposure was defined by the result of the dRDT. The outcomes were prescription of antibiotics and anti-inflammatory drugs after results of dRDT. Incidence and RR with 95% CIs were estimated. Multivariate logistic regression models were fitted separately for each outcome. Antibiotics were prescribed in 3% exposed and 14% unexposed. Anti-inflammatory drugs were prescribed in 1.2% exposed and 7.9% unexposed. A positive dRDT reduced the prescription of anti-inflammatories (AdjOR: 0.06, 95% CI: 0.008-0.5) but, by itself, had no effect on antibiotics (AdjOR: 1.1, 95% CI: 0.2-6); however, in hospitalized patients, a positive result reduced the probability of antibiotic prescription (AdjOR: 0.02, 95% CI: 0.00-0.8). Despite limitations of current dRDTs, they influence treatment decisions. Further studies are needed to assess the effect of dRDTs in patient outcomes and health-care costs.

Population-based assessment of factors influencing antibiotic prescribing for adults with dengue infection in Taiwan

“…While antibiotics may be prescribed inappropriately for conditions that are likely to have a viral etiology, they also may be used in early intervention of febrile illnesses when the pre-test probability of a bacterial infection argues for empirical therapy. The non-specific clinical manifestations of dengue (DENV) overlap with signs and symptoms of other febrile illnesses common to tropical and subtropical zones, such as leptospirosis, for which antimicrobial therapy is therapeutic [ 2 – 7 ]. At the point of clinical presentation, differentiating dengue from bacterial infections that should be treated with antibiotics may be difficult but also is contextual, depending on the local epidemiology of the respective pathogens [ 8 ].…”

“…At the point of clinical presentation, differentiating dengue from bacterial infections that should be treated with antibiotics may be difficult but also is contextual, depending on the local epidemiology of the respective pathogens [ 8 ]. For example, within Thailand, the likelihood of encountering dengue versus leptospirosis differs geographically and pre-test strategies for empirical use of antibiotics in respective locations have been modeled [ 7 , 9 ].…”

Improving dengue case confirmation by combining rapid diagnostic test, clinical, and laboratory variables

“…Together, these different factors may not only help in understanding the rising incidence and prevalence rates in our country but also explain the increasingly frequent severe and fatal cases [30] Unfortunately, most of the reported dengue cases in Colombia are diagnosed by clinical criteria, and only a small percentage of the cases are confirmed by Immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) test or reverse transcriptionpolymerase chain reaction (RT-PCR) (34.7%); only severe or fatal cases are investigated by non-structural protein-1 (NS1) ELISA or RT-PCR [44,45]. For these reasons, some secondary and tertiary care hospitals independently perform rapid diagnostic tests (RDT) for IgM/IgG or NS1 to improve the clinical diagnosis and treatment of cases suspected of dengue [46][47][48]. Despite the widespread use of RDT in Colombia, the few reports evaluating the performance of RDT suggest that a negative result in these tests does not rule out dengue; therefore, clinicians should be aware of dengue diagnosis and confirm cases by laboratory tests [47][48][49][50].…”

“…For these reasons, some secondary and tertiary care hospitals independently perform rapid diagnostic tests (RDT) for IgM/IgG or NS1 to improve the clinical diagnosis and treatment of cases suspected of dengue [46][47][48]. Despite the widespread use of RDT in Colombia, the few reports evaluating the performance of RDT suggest that a negative result in these tests does not rule out dengue; therefore, clinicians should be aware of dengue diagnosis and confirm cases by laboratory tests [47][48][49][50].…”