In DepthPUBLIC HEALTH

Revolutionary malaria tests have unexpected downsides

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Science  11 Aug 2017:
Vol. 357, Issue 6351, pp. 536-537
DOI: 10.1126/science.357.6351.536

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Summary

A cheap, simple test has transformed the treatment of malaria, a major childhood killer in poor countries. With a single drop of blood taken from a finger prick, rapid diagnostic tests (RDTs) can diagnose malaria accurately and almost instantly, and the test is so easy to use that volunteers from local communities in remote villages across Africa and Asia now commonly deploy it. Until RDTs became widespread, almost all fevers were treated as if they were malaria, leading to the overuse of the new generation of "wonder drugs," artemisinin-based combination therapies (ACTs), which were in danger of being lost to drug resistance. Now, with accurate diagnosis, ACTs can be targeted to those who need them, and the hope has been that patients who don’t have malaria would be treated for the true cause of their fever. But now a huge new study suggests that, along its enormous benefits, the rollout of RDTs has had some unintended—and undesirable—consequences: overprescription of antibiotics, which can exacerbate the rapid rise in antibiotic-resistant infections. What’s more, some patients who did not have malaria were given ACTs anyway, and more troubling, some with malaria were not, leaving them at risk of severe disease or death.