Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka

• Published in: The American journal of tropical medicine and hygiene 2015-11, Vol.93 (5), p.1031-1037
• Main Authors: Tillekeratne, L Gayani, Bodinayake, Champica K, Nagahawatte, Ajith, Vidanagama, Dhammika, Devasiri, Vasantha, Arachchi, Wasantha Kodikara, Kurukulasooriya, Ruvini, De Silva, Aruna Dharshan, Østbye, Truls, Reller, Megan E, Woods, Christopher W
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Cohort Studies; Cough; Female; Fever; Humans; Inappropriate Prescribing - prevention & control; Influenza, Human - diagnosis; Influenza, Human - drug therapy; Male; Outpatients; Practice Patterns, Physicians' - economics; Prospective Studies; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - drug therapy; Sri Lanka; Time Factors; Young Adult
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.15-0269

Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access to rapid influenza test results could reduce antibiotic prescriptions for ARTIs in a resource-limited setting. We conducted a prospective, pre-post study from March 2013 to October 2014. Outpatients presenting to a hospital in Sri Lanka were surveyed for influenza-like illness-onset of fever ≥ 38.0°C and cough in prior 7 days. Enrolled patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling for rapid influenza A/B testing. Influenza test results were released only during phase 2 (January-October 2014). We enrolled 571 patients with ILI-316 in phase 1 and 241 in phase 2. The proportion positive for influenza was 46.5% in phase 1 and 28.6% in phase 2, P < 0.001. Between phases, antibiotic prescriptions decreased from 81.3% to 69.3% (P = 0.001) among all patients and from 83.7% to 62.3% (P = 0.001) among influenza-positive patients. On multivariable analysis, a positive influenza result during phase 2 was associated with lower odds of antibiotic prescriptions (OR = 0.50, 95% CI = 0.26-0.95). This prospective study suggests that providing access to rapid influenza testing may reduce unnecessary antibiotic prescriptions in resource-limited settings.