scholarly journals Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India

2018 ◽  
Vol 7 (4) ◽  
pp. e000217 ◽  
Author(s):  
Amy Dehn Lunn

Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.

Author(s):  
Zati Sabrina Ahmad Zubaidi

Background: Research on self-medication with antibiotic in Malaysian primary care clinics are limited. This study aimed to assess the practice of self-medication with antibiotic, self-recognized complaints to self-medicate, antibiotic knowledge, attitudes towards antibiotic and potential association to self-medicate in a primary care clinic.Methods: This was a community-based pilot study using a self-administered questionnaire among 281 respondents. Chi square test and independent T test were performed to identify potential associations to self-medication.Results: The prevalence of self-medication with antibiotic was 13.3%. The most common complain to self-medicate was for upper respiratory tract infection (58.8%). Majority of them were able to self-purchased antibiotics (55.9%). 70.6% of respondents who SMA understood that overuse of antibiotic results in antibiotic resistance. Interestingly, antibiotic knowledge among respondents who self-medicate was higher (6.50±1.93) compared to those who did not (5.85±2.46) albeit not statistically significant. However, respondents who self-medicate had poorer attitude towards antibiotic compared to those who did not and this was statistically significant, t (254)=0-4.25, p=0.0001. 95% CI (-4.653, 1.709). This includes keeping antibiotics at home and using leftover antibiotics for respiratory illness.Conclusions: Self-medication with antibiotic in this population is low. Inappropriate attitude towards antibiotic is associated with self-medication with antibiotic. Antibiotic campaigns should focus on improving the community’s attitude towards antibiotic especially pertaining to educating the public against keeping antibiotic at home and using leftover antibiotics for upper respiratory tract infection. The findings demonstrated the need and feasibility of the study protocol for future research. 


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