Incidence and etiology of clinically-attended, antibiotic-treated diarrhea among children under five years of age in low- and middle-income countries: Evidence from the Global Enteric Multicenter Study

Abstract

Diarrhea is a leading cause of antibiotic consumption among children in low-and middleincome countries. While vaccines may prevent diarrhea infections for which children often receive antibiotics, the contribution of individual enteropathogens to antibiotic use is minimally understood. We used data from the Global Enteric Multicenter Study (GEMS) to estimate pathogen-specific incidence of antibiotic-treated diarrhea among children under five years old residing in six countries of sub-Saharan Africa and South Asia before rotavirus vaccine implementation. GEMS was an age-stratified, individually-matched case-control study. Stool specimens were obtained from children presenting to sentinel health clinics with newly-onset, acute diarrhea (including moderate-to-severe and less-severe diarrhea) as well as matched community controls without diarrhea. We used data from conventional and quantitative molecular diagnostic assays applied to stool specimens to estimate the proportion of antibiotic-treated diarrhea cases attributable to each pathogen. Antibiotics were administered or prescribed to 9,606 of 12,109 moderate-to-severe cases and 1,844 of 3,174 less-severe cases. Across all sites, incidence rates of clinically-attended, antibiotic-treated diarrhea were 12.2 (95% confidence interval

Indication for Antibiotic Prescription Among Children Attending Primary Healthcare Services in Rural Burkina Faso

“…Etiologic studies of diarrhea in this setting may be useful for determining the most common causes of diarrhea in these children and guiding treatment decisions. Although the WHO does not recommend antibiotic treatment for nonbloody diarrhea, studies have shown that it is common in multiple settings [ 15 , 16 ]. In the present study, approximately 1 in 5 cases of nonbloody diarrhea were treated with antibiotics, which may represent an opportunity to reduce antibiotic prescription.…”

Ethnobotany, Ethnopharmacology, and Phytochemistry of Medicinal Plants Used for Treating Human Diarrheal Cases in Rwanda: A Review

“…[12]. The major implicated viruses are rotavirus, adenovirus, and hepatitis A virus [12,13], while parasites include Entamoeba histolytica and Giardia spp. [13,14].…”

External Validation of a Mobile Clinical Decision Support System for Diarrhea Etiology Prediction in Children: A Multicenter Study in Bangladesh and Mali

“…7,[23][24][25][26] A 2020 re-analysis of results from the GEMS study also estimated that there were approximately 12.6 inappropriate-treated diarrhea cases for each appropriatelytreated case, with viruses (rotavirus, adenovirus, sapovirus) among the leading antibiotic-treated etiologies. 27 Tools such as the App created for this study may provide clinicians with muchneeded evidence to better identify patients with viral-only diarrhea and increase their confidence in following guidelines when antibiotic use is not indicated. Used for a broad variety of applications in HICs, CDSSs have been beneficial for patient and health systems outcomes alike; CDSSs have been shown to improve antibiotic stewardship and reduce inappropriate prescription of antibiotics, reduce the use of high-cost computed tomography (CT) studies in emergency department patients, and improve glucose control in patients with diabetes, among many other examples.…”