Progress in malaria leads to overuse of antibiotics

12 March 2014

Improving malaria diagnosis decreased the waste of malaria drugs in patients who didn’t need them. Now, clinicians who don’t know what else is causing fever tend to overprescribe antibiotics,
increasing the risk of drug resistance.

Thanks to the decrease of malaria transmission in the past decade, most patients with fever who arrive at clinics across Africa do not have malaria. The introduction of malaria rapid diagnostic tests (RDT) has improved the targeting of antimalarials to those who truly need them.

But what happens to those who don’t have malaria? “They also deserve good quality of care,” says Dr Valérie D’Acremont from the Swiss Tropical and Public Health Institute, who organised a meeting in London with Prof David Schellenberg from the ACT Consortium, where experts discussed the need to investigate other causes of fever.

Lack of diagnostic tools: If it isn’t malaria, what is it?

Because there isn’t a simple diagnostic test for all diseases as there is for malaria, clinicians tend to prescribe an antibiotic to be on the safe side. Antibiotics do not kill viruses, and overuse of these important drugs is decreasing their effectiveness.

One of the number one killers in children is pneumonia, and studies have shown that most patients with fever who do not have malaria have an acute respiratory infection.

D’Acremont explains: “Most of these acute respiratory infections are just viral and don’t need a specific treatment. But among them there are a few children that have pneumonia and can die of it. We have to find a way to pick that up and treat it appropriately. It’s really a challenge that needs new tools and new thinking, to be managed correctly.”

Investigating other causes of fever

Experts are concerned that we are shifting back to the time when health workers overprescribed antimalarials, because Africa was educated to give malaria treatment within 24 hours to any child with fever.

Dr Hugh Reyburn from the London School of Hygiene & Tropical Medicine says that the London meeting focused on determining research priorities following the successful introduction of malaria rapid diagnostic tests globally.

“We need to identify the causes of infection and the diversity of infection between countries, to reduce the overuse of antibiotics and to minimise the spread of resistance to these valuable drugs,” he explains. “We hope to produce a concept proposal that may be discussed with interested funders.”

The two-day meeting included experts from the Liverpool School of Tropical Medicine, the Worldwide Antimalarial Resistance Network (WWARN), the Foundation for Innovative New Diagnostics (FIND) and the Bill & Melinda Gates Foundation.

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