PhD upgrade | Should empirical oral antibiotics remain part of TB diagnostic algorithms in the era of antimicrobial stewardship?


Antimicrobial resistance(AMR) is a growing public health threat which is in part fueled by empirical antibiotic usage. However, to complement suboptimal diagnostics for Tuberculosis(TB), the leading cause of infectious disease mortality, standard diagnostic algorithms include empirical antibiotic use. The antibiotic course, referred to as “trial-of-antibiotics” and given to mycobacteriology negative but symptomatic adults, is often broad-spectrum with coverage for pneumonia. Its goal is to treat all causes of TB symptoms except TB, effectively taking the role of a “rule-out” diagnostic test for TB.

Approximately 26.5 million trial-of-antibiotics courses are prescribed in the course of diagnosis of the 5.3 million smear negative TB registrations per annum despite limited evidence supporting diagnostic accuracy, clinical benefit, and impact on AMR. These evidence gaps are the focus of my work. I will use a systematic review to summarize available observational evidence and establish estimates for designing an RCT. The RCT will definitively establish if trial-of-antibiotics has more benefit than harm. We will then perform a network meta meta-analysis of RCTs including ours to establish the relationship between duration of respiratory-use antimicrobial exposure and AMR. This will help establish AMR-appropriate dosing for respiratory illnesses including trial-of-antibiotics.


Speaker: Titus Divala

Date: 26 March 2018

Time: 12:45 – 14:00

Venue: LG80, Keppel Street