Program Schedule

High Rate of Antibiotic Prescriptions for Outpatients with Influenza-Like Illness in Southern Sri Lanka

Session: Poster Abstract Session: Global Infectious Diseases
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDSA poster Gayani Tillekeratne.pdf (2.2 MB)
  • Background:

    Acute respiratory illnesses, including influenza, account for a large proportion of ambulatory care visits worldwide. In the developed world, these encounters commonly result in unwarranted antibiotic prescriptions; data from more resource-limited settings are lacking. 


    Consecutive patients presenting to the Outpatient Department in the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI). Patients meeting World Health Organization criteria for ILI-- acute onset of fever ≥38.0°C and cough in prior 7 days—were enrolled. Consenting patients were administered a structured questionnaire, physical examination, and nasal/nasopharyngeal sampling for rapid influenza A/B testing (Veritor, Becton Dickinson). Results were released to clinicians only in aggregate, as the test had not been formally approved for clinical use in Sri Lanka.


    We enrolled 311 patients with ILI from March- November 2013, with 54.7% (170) children ≤18 years and 55% (172) males. Approximately half (147, 47.2%) tested positive for influenza: 94 (30.2%) for influenza A and 53 (17.0%) for influenza B. On bivariable analysis, clinical features associated with influenza included pleuritic chest pain (26.5% vs 8.8%, p<0.001), decreased appetite (83.0% vs 72.3%, p=0.026), fatigue (87.8% vs 76.7%, p=0.012), headache (85.0% vs 73.6%, p=0.014), arthralgias (81.6% vs 62.9%, p<0.001), and myalgias (81.6% vs 66.0%, p=0.002). Most patients (253, 81.4%) were prescribed antibiotics, with no difference with regards to influenza status (p=0.320). Commonly prescribed antibiotics included penicillins (164, 52.7%), first generation cephalosporins (64, 20.6%), and erythromycin (12, 3.9%). Patients prescribed antibiotics were more likely to be clinically diagnosed with a respiratory tract infection versus unspecified viral fever (p<0.001), and to receive additional diagnostic tests (22.9% vs 10.3%, p=0.033).


    Approximately 50% of outpatients with ILI had confirmed influenza, but most were prescribed antibiotics. Improving access to low-cost, rapid diagnostic tests may decrease excessive antibiotic use, drug-related adverse effects, and healthcare costs.  Rational prescribing of antibiotics in all settings is imperative given the rising global threat of antimicrobial resistance.

    L. Gayani Tillekeratne, MD, Global Health, Duke University, Durham, NC, Champica K. Bodinayake, MBBS, MD, MRCP, Medicine, University of Ruhuna, Galle, Sri Lanka, Ajith Nagahawatte, MBBS, MD, Microbiology, University of Ruhuna, Galle, Sri Lanka, Dhammika Vidanagama, MBBS, MD, Microbiology, Teaching Hospital Karapitiya, Galle, Sri Lanka, Vasantha Devasiri, MBBS, MD, Pediatrics, Ruhuna University, Galle, Sri Lanka, Wasantha Kodikara Arachchi, MBBS, MD, MRCP, DTM&H, Medicine, Teaching Hospital Karapitiya, Galle, Sri Lanka, Ruvini Kurukulasooriya, BS, MSc, Ruhuna University, Galle, Sri Lanka, Dharshan De Silva, PhD, Genetech Research Institute, Colombo, Sri Lanka, Truls Ostbye, MBBS, MBA, PhD, Global Health, Community and Family Medicine, Duke University, Durham, NC, Megan E. Reller, MD, MPH, PhD, Pathology, Johns Hopkins University School of Medicine, Baltimore, MD and Christopher W. Woods, MD, MPH, Global Health, Medicine, Duke University, Durham, NC


    L. G. Tillekeratne, None

    C. K. Bodinayake, None

    A. Nagahawatte, None

    D. Vidanagama, None

    V. Devasiri, None

    W. Kodikara Arachchi, None

    R. Kurukulasooriya, None

    D. De Silva, None

    T. Ostbye, None

    M. E. Reller, None

    C. W. Woods, Becton Dickinson: Investigator and Scientific Advisor, Consulting fee and Research support

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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