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Antibiotic utilization and the role of suspected and diagnosed mosquito borne illness among adults and children with acute febrile illness in Pune, India.

Abstract

Background

Antibiotic resistance mechanisms originating in low- and middle- income countries are among the most common worldwide. Reducing unnecessary antibiotic use in India, the world's largest antibiotic consumer is crucial to control antimicrobial resistance globally. Limited data describing factors influencing Indian clinicians to start or stop antibiotics is available.

Methods

Febrile adults and children admitted to a public tertiary care hospital in Pune, India were enrolled. Antibiotic usage and clinical history were recorded. Immunoassays for mosquito-borne disease and bacterial cultures were performed by protocol and clinician directed testing. Clinical factors were assessed for association with empiric antibiotic initiation and discontinuation by day 5 using multivariable logistic regression and propensity score matched Cox proportional hazard models.

Results

Among 1486 participants, 683 (82%) adults and 614 (94%) children received empiric antibiotics. Participants suspected of having mosquito-borne disease were less likely to receive empiric antibiotics, adjusted odds ratio (AOR) 0.5, 95% confidence interval (CI) 0.4-0.8. Empiric antibiotics were discontinued in 450 (35%) participants by day 5. Dengue or malaria testing performed before day 4 was positive in 162 (12%) participants, and was associated with antibiotic discontinuation (AOR 1.7, 95% CI [1.2 - 2.4]). In a propensity score matched model accounting for admission suspicion of mosquito borne disease, positive dengue or malaria tests increased hazard of antibiotic discontinuation (hazard ratio 1.6, 95% CI 1.2-2.0).

Conclusions

Most patients with acute febrile illness in an Indian public hospital setting receive empiric antibiotics. Mosquito-borne disease identification is associated with reduced empiric antibiotic use and faster antibiotic discontinuation.

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  • Authors+Show Affiliations

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    Johns Hopkins University School of Medicine, Center for Clinical Global Health Education, Division of Infectious Diseases, Baltimore, MD.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College, Pune, India. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

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    Tulane University School of Medicine, New Orleans, USA, now at Phoenix Children's Hospital/Maricopa Medical Center, Phoenix, AZ.

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    Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD. Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD. Johns Hopkins School of Medicine, Department of Emergency Medicine, Baltimore, MD. Center for Disease Dynamics, Economics & Policy, Washington, DC.

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    Johns Hopkins University School of Medicine, Center for Clinical Global Health Education, Division of Infectious Diseases, Baltimore, MD.

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    Johns Hopkins University School of Medicine, Center for Clinical Global Health Education, Division of Infectious Diseases, Baltimore, MD. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD.

    Johns Hopkins University School of Medicine, Center for Clinical Global Health Education, Division of Infectious Diseases, Baltimore, MD. Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29211830