Febrile adults and children admitted to a public tertiary care hospital in Pune, India were enrolled. Antibiotic usage and clinical history were recorded. Immunoassays for mosquito-borne disease and bacterial cultures were performed by protocol and clinician directed testing. Clinical factors were assessed for association with empiric antibiotic initiation and discontinuation by day 5 using multivariable logistic regression and propensity score matched Cox proportional hazard models.
Among 1486 participants, 683 (82%) adults and 614 (94%) children received empiric antibiotics. Participants suspected of having mosquito-borne disease were less likely to receive empiric antibiotics, adjusted odds ratio (AOR) 0.5, 95% confidence interval (CI) 0.4-0.8. Empiric antibiotics were discontinued in 450 (35%) participants by day 5. Dengue or malaria testing performed before day 4 was positive in 162 (12%) participants, and was associated with antibiotic discontinuation (AOR 1.7, 95% CI [1.2 – 2.4]). In a propensity score matched model accounting for admission suspicion of mosquito borne disease, positive dengue or malaria tests increased hazard of antibiotic discontinuation (hazard ratio 1.6, 95% CI 1.2-2.0).
Most patients with acute febrile illness in an Indian public hospital setting receive empiric antibiotics. Mosquito-borne disease identification is associated with reduced empiric antibiotic use and faster antibiotic discontinuation.