LB-2112-24 Diagnostic accuracy, clinical impact and antimicrobial resistance consequences of using trial-of-antibiotics for tuberculosis diagnosis: a randomised controlled trial in Malawi (ACT-TB study)

T Divala; E Corbett; N French; C Kandulu; Peter MacPherson; B Moyo; M Nliwasa; L Chiume; J Ndaferankhande; K Fielding

LB-2112-24 Diagnostic accuracy, clinical impact and antimicrobial resistance consequences of using trial-of-antibiotics for tuberculosis diagnosis: a randomised controlled trial in Malawi (ACT-TB study)

T Divala, E Corbett, N French, C Kandulu, Peter MacPherson, B Moyo, M Nliwasa, L Chiume, J Ndaferankhande, K Fielding

Clinical Sciences

Research output: Contribution to conference › Paper

Abstract

Background: Tuberculosis (TB) diagnostic algorithms often include ‘trial-of-antibiotics’— empirical antibiotics for mycobacteriology-negative individuals to treat infectious causes other than tuberculosis, as a ‘rule- out’ diagnostic test for tuberculosis. We investigated the effect of trial-of-antibiotics among adults being investigated for TB on diagnostic accuracy, clinical outcomes, and antimicrobial resistance (AMR). Methods: We randomised (1:1:1) Malawian adults (≥18 years) attending primary care for illness ≥2 weeks in- cluding cough not previously treated with antibiotics to receive: azithromycin (500mg once daily, 3 days), amoxi- cillin (1g three times/day, 5 days), or standard-of-care (SOC, no immediate antibiotic). Sputum taken at enrol- ment and day 8 was tested using mycobacteriology (mi- croscopy, Xpert MTB/RIF, and TB culture). Nasopha- ryngeal swabs at enrolment and day 29 were cultured onto blood agar. Primary outcomes were specificity, de- fined as proportion reporting symptom improvement on

Original language	English
Pages	S404
Publication status	Published - 24 Oct 2020

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title = "LB-2112-24 Diagnostic accuracy, clinical impact and antimicrobial resistance consequences of using trial-of-antibiotics for tuberculosis diagnosis: a randomised controlled trial in Malawi (ACT-TB study)",

abstract = "Background: Tuberculosis (TB) diagnostic algorithms often include {\textquoteleft}trial-of-antibiotics{\textquoteright}— empirical antibiotics for mycobacteriology-negative individuals to treat infectious causes other than tuberculosis, as a {\textquoteleft}rule- out{\textquoteright} diagnostic test for tuberculosis. We investigated the effect of trial-of-antibiotics among adults being investigated for TB on diagnostic accuracy, clinical outcomes, and antimicrobial resistance (AMR). Methods: We randomised (1:1:1) Malawian adults (≥18 years) attending primary care for illness ≥2 weeks in- cluding cough not previously treated with antibiotics to receive: azithromycin (500mg once daily, 3 days), amoxi- cillin (1g three times/day, 5 days), or standard-of-care (SOC, no immediate antibiotic). Sputum taken at enrol- ment and day 8 was tested using mycobacteriology (mi- croscopy, Xpert MTB/RIF, and TB culture). Nasopha- ryngeal swabs at enrolment and day 29 were cultured onto blood agar. Primary outcomes were specificity, de- fined as proportion reporting symptom improvement on",

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TY - CONF

T1 - LB-2112-24 Diagnostic accuracy, clinical impact and antimicrobial resistance consequences of using trial-of-antibiotics for tuberculosis diagnosis: a randomised controlled trial in Malawi (ACT-TB study)

AU - Divala, T

AU - Corbett, E

AU - French, N

AU - Kandulu, C

AU - MacPherson, Peter

AU - Moyo, B

AU - Nliwasa, M

AU - Chiume, L

AU - Ndaferankhande, J

AU - Fielding, K

PY - 2020/10/24

Y1 - 2020/10/24

N2 - Background: Tuberculosis (TB) diagnostic algorithms often include ‘trial-of-antibiotics’— empirical antibiotics for mycobacteriology-negative individuals to treat infectious causes other than tuberculosis, as a ‘rule- out’ diagnostic test for tuberculosis. We investigated the effect of trial-of-antibiotics among adults being investigated for TB on diagnostic accuracy, clinical outcomes, and antimicrobial resistance (AMR). Methods: We randomised (1:1:1) Malawian adults (≥18 years) attending primary care for illness ≥2 weeks in- cluding cough not previously treated with antibiotics to receive: azithromycin (500mg once daily, 3 days), amoxi- cillin (1g three times/day, 5 days), or standard-of-care (SOC, no immediate antibiotic). Sputum taken at enrol- ment and day 8 was tested using mycobacteriology (mi- croscopy, Xpert MTB/RIF, and TB culture). Nasopha- ryngeal swabs at enrolment and day 29 were cultured onto blood agar. Primary outcomes were specificity, de- fined as proportion reporting symptom improvement on

AB - Background: Tuberculosis (TB) diagnostic algorithms often include ‘trial-of-antibiotics’— empirical antibiotics for mycobacteriology-negative individuals to treat infectious causes other than tuberculosis, as a ‘rule- out’ diagnostic test for tuberculosis. We investigated the effect of trial-of-antibiotics among adults being investigated for TB on diagnostic accuracy, clinical outcomes, and antimicrobial resistance (AMR). Methods: We randomised (1:1:1) Malawian adults (≥18 years) attending primary care for illness ≥2 weeks in- cluding cough not previously treated with antibiotics to receive: azithromycin (500mg once daily, 3 days), amoxi- cillin (1g three times/day, 5 days), or standard-of-care (SOC, no immediate antibiotic). Sputum taken at enrol- ment and day 8 was tested using mycobacteriology (mi- croscopy, Xpert MTB/RIF, and TB culture). Nasopha- ryngeal swabs at enrolment and day 29 were cultured onto blood agar. Primary outcomes were specificity, de- fined as proportion reporting symptom improvement on

M3 - Paper

SP - S404

ER -

LB-2112-24 Diagnostic accuracy, clinical impact and antimicrobial resistance consequences of using trial-of-antibiotics for tuberculosis diagnosis: a randomised controlled trial in Malawi (ACT-TB study)

Abstract

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