ABSTRACT
COVID-19 pandemic changed the face of global health and brought about new issues in global health security and economy. The World Health Organization published guidelines for clinical management of COVID-19 four months after declaration of COVID-19 as a pandemic. Scholarly reviews and studies from member states within WHO AFRO reveals significant deviation from the WHO published protocols on COVID-19. Assessment of national treatment protocols of 30 of 47 WHO AFRO member states showed widespread inappropriate use of antimicrobial agents for patients, which may worsen the global and concerning threat of antimicrobial resistance. There is need for adopting interventions that optimize antimicrobial use in the context of pre- and post-pandemic preparedness to ensure long-term effectiveness and sustainability for antimicrobials. Treatment guidelines are to be adopted or adapted depending on best clinical evidence available. Non-compliance with guidelines might lead to mismanagement of infectious diseases with attendant negative consequences including antimicrobial resistance and misdirection of critical resources and supplies amongst others.
La pandémie de COVID-19 a changé le visage de la santé mondiale et a soulevé de nouveaux problèmes en matière de sécurité sanitaire et d'économie mondiale. L'Organisation mondiale de la santé a publié des lignes directrices pour la gestion clinique du COVID-19 quatre mois après la déclaration du COVID-19 comme pandémie. Les revues scientifiques et les études des États membres de l'OMS AFRO révèlent un écart significatif par rapport aux protocoles publiés par l'OMS sur le COVID-19. L'évaluation des protocoles nationaux de traitement de 30 des 47 États membres de l'OMS AFRO a révélé une utilisation inappropriée et généralisée d'agents antimicrobiens chez les patients, ce qui pourrait aggraver la menace mondiale et préoccupante de résistance aux antimicrobiens. Il est nécessaire d'adopter des interventions qui optimisent l'utilisation des antimicrobiens dans le contexte de la préparation pré et post-pandémique afin de garantir l'efficacité et la durabilité à long terme des antimicrobiens. Les directives thérapeutiques doivent être adoptées ou adaptées en fonction des meilleures preuves cliniques disponibles. Le non-respect des directives pourrait conduire à une mauvaise gestion des maladies infectieuses avec des conséquences négatives qui en découlent, notamment la résistance aux antimicrobiens et une mauvaise orientation des ressources et fournitures essentielles, entre autres.
Subject(s)
Therapeutics , Clinical Protocols , COVID-19 , Bacterial Infections , Guideline Adherence , PandemicsABSTRACT
Background: Pulmonary aspergillosis (PA) is common among patients with tuberculosis (TB). With both infections presenting with similar clinical and radiologic features, diagnosis of PA is often made too late or missed completely due to lack of clinical suspicion and poor diagnostic laboratory capacity for mycotic infections prevalent in our settings. We present a case of preventable mortality caused by delayed diagnosis and treatment of PA in a patient with pulmonary TB (PTB). Case presentation: A 13-year-old female was diagnosed and treated for PTB, having received anti-TB regimen for 8 months in a mission hospital from where she was referred due to worsening cough, chest pain and progressive breathlessness. The patient was re-assessed and investigated, with GeneXpert detecting Mycobacterium tuberculosis, susceptible to rifampicin. Diagnosis of pulmonary tuberculosis complicated by right pneumothorax was made indicating an emergency thoracotomy and chest tube insertion and continuation of the first line anti-TB regimen. At about 2 weeks into admission, patients had features of superimposed acute bacterial sepsis with fever becoming high grade, marked neutrophilia with toxic granulation and elevated sepsis biomarker, and this necessitated empiric antibiotic treatment with parenteral meropenem and vancomycin. However, the patient only had mild clinical improvement following which there was progressively worsening respiratory symptoms and massive haemoptysis. Result of sputum fungal study was available on admission day 20 and revealed a growth of Aspergillus flavus. Treatment with intravenous voriconazole was however commenced rather late when the fungal respiratory disease could no longer be remedied. The patient died on admission day 23. Conclusion: Diagnosis of PA in patients with background TB is often made too late to guarantee timely and effective antifungal treatment with negative consequences on patients' outcomes. Improving clinical and laboratory capacities is essential to reducing mortality from PA in healthcare facilities.