In Practice

The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care

Adrian John Brink, Johan van Wyk, V M Moodley, Craig Corcoran, Pieter Ekermans, Louise Nutt, Tom Boyles, Olga Perovic, Charles Feldman, Guy Richards, Marc Mendelson

Abstract


Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.

Authors' affiliations

Adrian John Brink, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa

Johan van Wyk, Ampath National Laboratory Services, Cape Town, South Africa

V M Moodley, Ampath National Laboratory Services, Cape Town, South Africa

Craig Corcoran, Department of Molecular Biology, Ampath National Reference Laboratory, Centurion, South Africa

Pieter Ekermans, Department of Clinical Microbiology, Ampath National Reference Laboratory, Centurion, South Africa

Louise Nutt, Ampath National Laboratory Services, Port Elizabeth, South Africa

Tom Boyles, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa

Olga Perovic, Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Charles Feldman, Division of Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Guy Richards, Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Marc Mendelson, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa

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Keywords

Diagnostic; Stewardship; Antibiotics; Respiratory

Cite this article

South African Medical Journal 2016;106(6):554-561. DOI:10.7196/SAMJ.2016.v106i6.10857

Article History

Date submitted: 2016-04-02
Date published: 2016-05-10

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