Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial
Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomised trial
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DOI：
10.1136/bmj.39073.496829.ae
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发表时间：
2007-02-24
影响因子：
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通讯作者：
Whitty, Christopher J. M.
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文献类型：
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作者：
Reyburn, Hugh;Mbakilwa, Hilda;Whitty, Christopher J. M.
目的比较疟疾快速诊断试验(RDT)和常规镜检在指导发热患者治疗决策中的作用。设计随机试验。在坦桑尼亚东北部设置不同疟疾传播水平的门诊部。参与者2416名要求疟疾测试的患者。干预人员接受快速诊断测试培训；被送去进行疟疾测试的患者被随机分配到快速诊断测试或常规显微镜检查。结果在7589例门诊会诊中，2425例(32%)要求进行疟疾测试。在1204名随机接受显微镜检查的患者中，1030名(86%)疟疾检测呈阴性；其中523名(51%)接受了抗疟疾药物治疗。在随机接受快速诊断试验的1193名患者中，1005名(84%)检测为阴性；其中540名(54%)接受过疟疾治疗(优势比1.13，95%可信区间0.95至1.34；P=0.18)。快速诊断试验阴性的5岁以下儿童比那些患有疟疾的儿童更有可能被开出抗疟疾药物。负数(P=0.003)。任何方法检测结果为阴性的患者更有可能被开抗生素处方(优势比分别为6.42、4.72和8.75；P
Objective To compare rapid diagnostic tests (RDTs) for malaria with routine microscopy in guiding treatment decisions for febrile patients.Design Randomised trial.Setting Outpatient departments in northeast Tanzania at varying levels of malaria transmission.Participants 2416 patients for whom a malaria test was requested.Intervention Staff received training on rapid diagnostic tests; patients sent for malaria tests were randomised to rapid diagnostic test or routine microscopy.Main outcome measure Proportion of patients with a negative test prescribed an antimalarial drug.Results Of 7589 outpatient consultations, 2425 (32%) had a malaria test requested. Of 1204 patients randomised to microscopy, 1030 (86%) tested negative for malaria; 523 (51%) of these were treated with an antimalarial drug. Of 1193 patients randomised to rapid diagnostic test, 1005 (84%) tested negative; 540 (54%) of these were treated for malaria (odds ratio 1.13, 95% confidence interval 0.95 to 1.34; P=0.18). Children aged under 5 with negative rapid diagnostic tests were more likely to be prescribed an antimalarial drug than were those with. negative slides (P=0.003). Patients with a negative test by any method were more likely to be prescribed an antibiotic (odds ratio 6.42, 4.72 to 8.75; P