Comment citer
Résumé
Introduction
Malaria remains one of the leading causes of morbidity and mortality in sub-Saharan Africa. In the Democratic Republic of the Congo (DRC), it accounts for approximately 12% of morbidity, primarily affecting children under five. Following the 2015 World Health Organization (WHO) guidelines, artemisinin-based combination therapy (ACT) is recommended.
Purpose
To assess the use of antibiotics co-administered with antimalarial drugs in the treatment of uncomplicated malaria in Boma.
Methods
This descriptive, cross-sectional study retrospectively reviewed records of patients with uncomplicated malaria registered between January and June 2022 to evaluate antibiotic co-prescription with antimalarials. Data collection occurred in July 2022. The study was conducted in Boma, at the Boma Red Cross Clinic and the Boma/MABAKU inter-diocesan hospital. A non-probability convenience sample of 100 patient files was examined. All patients included had uncomplicated malaria and received antibiotic therapy. Descriptive statistics and 95% confidence intervals (CIs) were calculated using Stata 12.0.
Results
Children aged 0–5 years comprised 36% of patients. Males accounted for 60% (95% CI: 50–69%), and females for 40% (95% CI: 31–50%); no significant sex difference was observed (p = 0.12). Before treatment, 80% of patients had a positive thick blood smear, 15% were treated without a definitive diagnosis, and only 5% had blood cultures performed. LA was the most prescribed ACT (90%). Among antibiotics, ceftriaxone was the most frequently prescribed (27%). Overall, 83% received antibiotics not aligned with guidelines, and 12% received quinine combined with doxycycline or clindamycin.
Conclusion
The findings indicate excessive and occasionally inappropriate antibiotic use in managing uncomplicated malaria in Boma health facilities. These results underscore the need for stronger adherence to National Malaria Control Program (PNLP) guidelines and enhanced antibiotic stewardship training for prescribers.
Références
Baraka, V., Nhama, A., Aide, P., Bassat, Q., David, A., Gesase, S., ... & Manyando, C. (2021). Prescription patterns and compliance with World Health Organization recommendations for the management of uncomplicated and severe malaria: A prospective, real-world study in sub-Saharan Africa. Malaria Journal, 20(1), 215. https://doi.org/10.1186/s12936-021-03812-w
Baraka, V., Nhama, A., Aide, P., Bassat, Q., David, A., Gesase, S., ... & Manyando, C. (2023). Prescription patterns and compliance with World Health Organization recommendations for the management of uncomplicated and severe malaria: A prospective, real-world study in sub-Saharan Africa. Malaria Journal, 22(1), 215. https://doi.org/10.1186/s12936-023-04650-y
Fomba, S., Koné, D., Doumbia, B., Diallo, D., Druetz, T., Florey, L., ... & Ashton, R. A. (2020). Management of uncomplicated malaria among children under five years at public and private sector facilities in Mali. BMC Public Health, 20(1), 1888. https://doi.org/10.1186/s12889-020-09873-1
Mavoko, H. M., Nabasumba, C., Da Luz, R. I., Van Geertruyden, J.-P., Lutumba, P., & D'Alessandro, U. (2017). Efficacy and safety of re-treatment with the same artemisinin-based combination treatment (ACT) compared with an alternative ACT and quinine plus clindamycin after failure of first-line recommended ACT (QUINACT): A bicentre, open-label, phase 3, randomized controlled trial. The Lancet Global Health, 5(1), e60–e68. https://doi.org/10.1016/S2214-109X(16)30378-2
Means, A. R., Weaver, M. R., Burnett, S. M., Mbonye, M. K., Naikoba, S., & McClelland, R. S. (2014). Correlates of inappropriate prescribing of antibiotics to patients with malaria in Uganda. PLoS ONE, 9(2), e90179. https://doi.org/10.1371/journal.pone.0090179
Mvumbi, D. M. (2017). Place de la biologie moléculaire dans l'épidémiologie, le diagnostic et l'évaluation de la chimiorésistance du paludisme en République Démocratique du Congo (Doctoral thesis). Université de Kinshasa.
Ntamabyaliro, N. Y., Burri, C., Nzolo, D. B., Minja, D. T., & Van Bambeke, F. (2018). Drug use in the management of uncomplicated malaria in public health facilities in the Democratic Republic of the Congo. Malaria Journal, 17, 1–8. https://doi.org/10.1186/s12936-018-2335-0
Pessanha de Carvalho, L., Kreidenweiss, A., & Held, J. (2021). Drug repurposing: A review of old and new antibiotics for the treatment of malaria: Identifying antibiotics with a fast onset of antiplasmodial action. Molecules, 26(8), 2304. https://doi.org/10.3390/molecules26082304
Sandlund, J., Naucler, P., Dashti, S., Shokri, A., Eriksson, S., Hjertqvist, M., ... & Färnert, A. (2013). Bacterial coinfections in travelers with malaria: Rationale for antibiotic therapy. Journal of Clinical Microbiology, 51(1), 15–21. https://doi.org/10.1128/JCM.02149-12
World Health Organization. (2005). Integrated management of childhood illness (IMCI) manual. World Health Organization.
World Health Organization. (2010). Rational use of medicines. World Health Organization.
World Health Organization. (2011). World Health Day 2011: Combating drug resistance: No action today, no cure tomorrow. World Health Organization.
World Health Organization. (2015). Malaria treatment guidelines (3rd ed.). World Health Organization. https://apps.who.int/iris/handle/10665/162441
World Health Organization. (2019). World malaria report 2019. World Health Organization.
World Health Organization. (2022). World malaria report 2022. World Health Organization. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022
Ce travail est disponible sous licence Creative Commons Attribution - Pas d’Utilisation Commerciale 4.0 International.