ArticleBMJ open2018
Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03855215 (Implementation of CRP Point of Care Testing in Primary Care to Improve Antibiotic Targeting in Respiratory Illness), which is not on this map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementation of CRP Point of Care Testing in Primary Care to Improve Antibiotic Targeting in Respiratory Illness (ICAT)
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prevalence of antibiotics prescription amongst patients with and without COVID-19 in low- and middle-income countries: a systematic review and meta-analysis.Pathogens and global health · 2023Pooled it
- Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis.PLoS medicine · 2020Pooled it
- Prevalence of Group AThe American journal of tropical medicine and hygiene · 2020Trial
- Effect of point-of-care C-reactive protein testing on antibiotic prescription in febrile patients attending primary care in Thailand and Myanmar: an open-label, randomised, controlled trial.The Lancet. Global health · 2019Trial
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Increase in Antibiotic Utilisation in Primary Care Post COVID-19 Pandemic.Antibiotics (Basel, Switzerland) · 2025Article
- Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study.BMC infectious diseases · 2023Article
- Outpatient antibiotic prescribing for acute respiratory infections in Vietnamese primary care settings by the WHO AWaRe (Access, Watch and Reserve) classification: An analysis using routinely collected electronic prescription data.The Lancet regional health. Western Pacific · 2023Article
- Article
- Modelling the cost-effectiveness of pulse oximetry in primary care management of acute respiratory infection in rural northern Thailand.Tropical medicine & international health : TM & IH · 2022Review
- Review
- The good and the bad: using C reactive protein to distinguish bacterial from non-bacterial infection among febrile patients in low-resource settings.BMJ global health · 2020Review
- Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities.PloS one · 2020Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
introductionAntibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the use of antibiotics in primary care in low-resource settings.
objectiveTo describe the presentation of acute infections and the indications for antibiotic prescription.
designA 2-year retrospective review of routinely collected data.
settingAll 32 primary care units in one district in northern Thailand.
participantsPatients attending primary care with a history of fever, documented temperature, International Statistical Classification of Diseases 10 code for infection or prescribed a systemic antibiotic. Patients attending after the initiation of a study on C-reactive protein testing in four centres were excluded. OUTCOME MEASURES: The proportion of patients prescribed an antibiotic and the frequency of clinical presentations.
results762 868 patients attended the health centres, of whom 103 196 met the inclusion criteria, 5966 were excluded resulting in 97 230 attendances consisting of 83 661 illness episodes.46.9% (39 242) of the patients were prescribed an antibiotic during their illness. Indications for antibiotic prescription in the multivariable logistic regression analysis included male sex (adjusted OR (aOR) 1.21 (95% CI 1.16 to 1.28), p<0.001), adults (aOR 1.77 (95% CI 1.57 to 2), p<0.001) and a temperature >37.5°C (aOR 1.24 (95% CI 1.03 to 1.48), p=0.020). 77.9% of the presentations were for respiratory-related problems, of which 98.6% were upper respiratory tract infections. The leading infection diagnoses were common cold (50%), acute pharyngitis (18.9%) and acute tonsillitis (5%) which were prescribed antibiotics in 10.5%, 88.7% and 87.1% of cases, respectively. Amoxicillin was the most commonly prescribed antibiotic.
conclusionsNearly half of the patients received an antibiotic, the majority of whom had a respiratory infection. The results can be used to plan interventions to improve the rational use of antibiotics. Further studies in private facilities, pharmacies and dental clinics are required.
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