Integrating hospital-acquired lessons into community health practice: optimizing antimicrobial use in Bangalore.

Introduction: Even as antimicrobial resistance is a serious public health concern worldwide, the uncertainties of diagnosis and treatment of fever strongly influence community practitioners toward prescribing antibiotics. To help community practitioners resolve their diagnostic questions and reduce the unnecessary use of antibiotics for viral fevers, thus helping to contain antibiotic resistance, we suggest fever-charting and monitoring fever patterns for two days. Methods: This was a qualitative study, with relevant quantitative descriptions. Patients presenting with recent onset fever to the Vydehi Institute of Medical Sciences (VIMS) and Research Centre, Bangalore, India, were monitored with simple fever charting and managed based on their fever patterns for two days. Initially only antipyretics were given in optimal doses; if the fever showed a continuous pattern suggestive of septicemia, antibiotics were instituted for typhoid, the commonest organism to cause sepsis in a community setting short of pointers to other causes. The different clinical profiles of these patients of viral and enteric fevers were circulated among the community practitioners, and an assessment of their approach was made. Finally, it was revealed to the practitioners how successful management of the patient was possible without antibiotics. Results: During the study period, 4289 patients presented to VIMS. The antibiotic prescribing rate when given the clinical profiles of true patients with viral fevers was high among community practitioners. Community practitioners agreed that in a controlled hospital setting, the results could be spectacular, but the challenges were different in community practice. There was an initial reluctance to use fever chatting due to fear of patient noncompliance. Discussion: Fever charting can be an invaluable means to help differentiate viral and enteric fevers and thus help reduce unnecessary antibiotic prescriptions for viral fevers.