Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children

Abstract Background Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. We compared antibiotic treatment of children before and after the implementation of highly effective malaria control interventions in Tororo, a historically high transmiss...

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Autores principales:	Paul J. Krezanoski, Michelle E. Roh, John Rek, Joaniter I. Nankabirwa, Emmanuel Arinaitwe, Sarah G. Staedke, Susan Nayiga, Michelle S. Hsiang, David Smith, Moses Kamya, Grant Dorsey
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Malaria control Pediatric infectious diseases Antibiotic prescriptions Malaria Antibiotic usage Prevention Medicine R
Acceso en línea:	https://doaj.org/article/2131815dbe4f4c7b994f5578646d1442
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spelling	oai:doaj.org-article:2131815dbe4f4c7b994f5578646d14422021-12-05T12:11:12ZMarked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children10.1186/s12916-021-02167-21741-7015https://doaj.org/article/2131815dbe4f4c7b994f5578646d14422021-11-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02167-2https://doaj.org/toc/1741-7015Abstract Background Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. We compared antibiotic treatment of children before and after the implementation of highly effective malaria control interventions in Tororo, a historically high transmission area of Uganda. Methods Two successive cohorts of children, aged 0.5 to 10 years, were followed from September 2011 to October 2019 in a dedicated study clinic. Universal distribution of long-lasting insecticidal nets was conducted in 2013 and 2017. Sustained indoor residual spraying of insecticide (IRS) was initiated in December 2014. Generalized linear mixed-effects models were used to compare the incidence of antimalarial and antibiotic treatments before and after vector control measures were implemented. Results Comparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4–5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR] = 0.02, 95% CI 0.01–0.03, p < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR = 0.30, 95% CI 0.27–0.34, p < 0.001). The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics. Conclusions In a historically high transmission setting, the implementation of highly effective vector control interventions was followed by a marked reduction in antibiotic treatment of children. This added benefit of malaria control could have important implications for antibiotic prescribing practices, efforts to curtail antimicrobial resistance, and health system costs.Paul J. KrezanoskiMichelle E. RohJohn RekJoaniter I. NankabirwaEmmanuel ArinaitweSarah G. StaedkeSusan NayigaMichelle S. HsiangDavid SmithMoses KamyaGrant DorseyBMCarticleMalaria controlPediatric infectious diseasesAntibiotic prescriptionsMalariaAntibiotic usagePreventionMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Malaria control Pediatric infectious diseases Antibiotic prescriptions Malaria Antibiotic usage Prevention Medicine R
spellingShingle	Malaria control Pediatric infectious diseases Antibiotic prescriptions Malaria Antibiotic usage Prevention Medicine R Paul J. Krezanoski Michelle E. Roh John Rek Joaniter I. Nankabirwa Emmanuel Arinaitwe Sarah G. Staedke Susan Nayiga Michelle S. Hsiang David Smith Moses Kamya Grant Dorsey Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
description	Abstract Background Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. We compared antibiotic treatment of children before and after the implementation of highly effective malaria control interventions in Tororo, a historically high transmission area of Uganda. Methods Two successive cohorts of children, aged 0.5 to 10 years, were followed from September 2011 to October 2019 in a dedicated study clinic. Universal distribution of long-lasting insecticidal nets was conducted in 2013 and 2017. Sustained indoor residual spraying of insecticide (IRS) was initiated in December 2014. Generalized linear mixed-effects models were used to compare the incidence of antimalarial and antibiotic treatments before and after vector control measures were implemented. Results Comparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4–5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR] = 0.02, 95% CI 0.01–0.03, p < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR = 0.30, 95% CI 0.27–0.34, p < 0.001). The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics. Conclusions In a historically high transmission setting, the implementation of highly effective vector control interventions was followed by a marked reduction in antibiotic treatment of children. This added benefit of malaria control could have important implications for antibiotic prescribing practices, efforts to curtail antimicrobial resistance, and health system costs.
format	article
author	Paul J. Krezanoski Michelle E. Roh John Rek Joaniter I. Nankabirwa Emmanuel Arinaitwe Sarah G. Staedke Susan Nayiga Michelle S. Hsiang David Smith Moses Kamya Grant Dorsey
author_facet	Paul J. Krezanoski Michelle E. Roh John Rek Joaniter I. Nankabirwa Emmanuel Arinaitwe Sarah G. Staedke Susan Nayiga Michelle S. Hsiang David Smith Moses Kamya Grant Dorsey
author_sort	Paul J. Krezanoski
title	Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
title_short	Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
title_full	Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
title_fullStr	Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
title_full_unstemmed	Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children
title_sort	marked reduction in antibiotic usage following intensive malaria control in a cohort of ugandan children
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2131815dbe4f4c7b994f5578646d1442
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Marked reduction in antibiotic usage following intensive malaria control in a cohort of Ugandan children

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