ACT

Your Editorial on the urgent need for more antibiotics comes at an opportune time. Except in the case of South Africa, very little data exist on the burden of antibiotic resistance in sub-Saharan Africa, where presumptive treatment of febrile illness with an antimalarial drug is common. This practice has contributed to resistance to all common antimalarials.

WHO is about to publish revised guidelines recommending prescription of antimalarial drugs only to patients of any age with confirmed malaria (in situations where confirmation is possible). The availability of rapid diagnostic tests (RDTs) for malaria is the driving force for the new guidelines. However, the lack of a rapid point-of-care test to diagnose other infections could become a barrier to the effective implementation of the guidelines. Many health-care providers ignore the malaria RDT results and continue to prescribe antimalarial drugs for patients who test negative or substitute antibiotics for antimalarials.

Sub-Saharan Africa may soon be faced with a substantial increase in the blind use of antibiotics. In Zanzibar, the introduction of RDTs led to a substantial increase in the prescription of antibiotics. And in a randomised controlled trial setting, the use of RDTs led to a striking increase in the unconfirmed diagnosis of urinary-tract infection and overprescription of antibiotics.

Efforts to address the problem of antibiotic resistance must be global and should incorporate strategies for monitoring antibiotic use in the era of confirmation-based management of malaria in sub-Saharan Africa.