Impact of Point-of-Care Rapid Diagnostic Tests on Antibiotic Prescription Among Patients Aged <18 Years in Primary Healthcare Settings in 2 Peri-Urban Districts in Ghana: Randomized Controlled Trial Results

Background. Inappropriate antibiotic prescriptions are a known driver of antimicrobial resistance in settings with limited diagnostic capacity. This study aimed to assess the impact of diagnostic algorithms incorporating rapid diagnostic tests on clinical outcomes and antibiotic prescriptions compared with standard-of-care practices, of acute febrile illness cases at outpatient clinics in Shai-Osudoku and Prampram districts in Ghana. Methods. This was an open-label, centrally randomized controlled trial in 4 health facilities. Participants aged 6 months to <18 years with acute febrile illness were randomized to receive a package of interventions to guide antibiotic prescriptions or standard care. Clinical outcomes were assessed on day 7. Results. A total of 1512 patients were randomized (intervention n = 761; control n = 751). Most were children <5 years (76.3%) and male (53.5%). There was an 11% relative risk reduction of antibiotic prescription in the intervention group overall (RR 0.89; 95% CI .79 to 1.01); 14% in children <5 years (RR 0.86; 95% CI .75 to .98), 15% in nonmalaria patients (RR 0.85; 95% CI .75 to .96), and 16% in patients with respiratory symptoms (RR 0.84; 95% CI .73 to .96). Almost all participants had favorable outcomes (99.7% vs 99.4%). Conclusions. In low- and middle-income countries, the combination of point-of-care diagnostics, diagnostic algorithms, and communication training can reduce antibiotic prescriptions among children with acute febrile illness, patients with nonmalarial fevers, and those with respiratory symptoms. Clinical Trials Registration. NCT04081051.

Alexander Adjei, Vida Kukula, Clement Tetteh Narh, Selase Odopey, Emmanuel Arthur, Gabriel Odonkor, Michael Matey Mensah, Piero Olliaro, Philip Horgan, Sabine Dittrich, Catrin E Moore, Olawale Salami, Elizabeth Awini, Juvenal Nkeramahame, John Williams, Rita Baiden