Antimicrobial Use and Diagnosis among Hospitalized Febrile Patients in Pune, India

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Antimicrobial resistance, a leading threat to human health, is enabled by unnecessary antibiotic use. Strategies to reduce unnecessary antibiotic use in India, the world’s largest antibiotic consumer, are urgently needed. Although most patients hospitalized in India with acute febrile illness receive antibiotics, many cases of acute febrile illness are caused by mosquito-borne diseases, which do not require them. Lack of confirmed diagnosis for acute febrile illness limits judicious antibiotic use. However, the relationship between diagnostic uncertainty and antimicrobial prescription for acute febrile illness has not been well characterized.

Aims and Objectives

  • Primary Objectives: To determine the impact of (Aim 1) missed diagnosis and (Aim 2) delayed diagnosis on antibiotic use in hospitalized patients in India with mosquito-borne disease.
  • Secondary Objective: To establish a repository of specimens to validate novel diagnostic techniques for acute febrile illness.


Adults and adolescents ≥ 12 years of age who present to Sassoon General Hospital with acute febrile illness will be enrolled. Upon admission, we will perform a standardized clinical history, document vital signs, and obtain a blood sample. Testing will include bacterial culture and batch testing for dengue, chikungunya, malaria, and possibly Zika by commercial immunoassays and real time–polymerase chain reaction. Inpatient antibiotic use and timing of receipt of test results for mosquito-borne disease will be prospectively recorded. Association of the presence of and time to mosquito-borne disease diagnosis and days of antibiotic use will be evaluated. Willing participants will be asked to return for follow-up sample collection. Specimens will be banked for use in future studies aiming to evaluate novel diagnostic methods to identify acute febrile illness etiology.