Evaluation of C-reactive protein and Myxovirus resistance protein A to guide rational use of antibiotics among acute febrile adult patients in Northwest Ethiopia.

OBJECTIVES: In low-resource settings, treatment is often given empirically without knowledge on the etiology due to lack of diagnostics. In the search for reliable rapid tests to guide treatment work-up, we evaluated whether two biomarkers could differentiate bacterial from non-bacterial infections in acute febrile patients.

METHODS: Adults with acute fever were recruited at a referral hospital, Ethiopia. The QuikReadGo test was used to quantify C-reactive protein (qCRP) and the FebriDx test for combined qualitative detection of the bacterial CRP marker with Myxovirus resistance Protein A (MxA), a viral biomarker.

RESULTS: Of the 200 patients, most presented with 2-3 days of fever, headache and joint pain. Antibiotics were prescribed for 83.5% and anti-malarials for 36.5% while bacterial infection was only confirmed in 5% and malaria in 11%. Median qCRP levels were 128 mg/L for confirmed bacterial infections. FebriDx and QuikReadGo test had an overall agreement of 72.0%.

CONCLUSIONS: We observed an over-prescription of antibiotics for febrile patients even for those with low CRP levels and without confirmed bacterial infection. The added value of the FebriDx was limited while the combined use of rapid tests for qCRP and malaria should be considered for the management of acute febrile illness and antibiotic stewardship.