Use of antibiotics for patients presenting with symptoms suggestive of upper respiratory tract infections of less than 3 days to an outpatient department of a tertiary hospital in Sri Lanka

Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019–Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).

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Drug utilisation pattern of antihistamines in upper respiratory tract infections in paediatric patients

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v10i1.38968 ◽

2021 ◽

Vol 10 (1) ◽

pp. 28-32

Author(s):

Jyoti Prabha Bharati ◽

Sanjay Ulak ◽

Aniket Keshari ◽

Anna Acharya

Keyword(s):

Drug Use ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Outpatient Department ◽

Upper Respiratory Tract Infections ◽

Upper Respiratory Tract ◽

Medical College ◽

Paediatric Patients ◽

Upper Respiratory ◽

Tract Infections

Background: Upper respiratory tract infections (URTIs) are the most common infections in the paediatric population leading to health care consultations. Antihistamines are commonly prescribed medicines in children. Objectives: This study attempted to assess the current prescription patterns of antihistamines used in the treatment of URTIs. Methods: A descriptive cross-sectional study was conducted in the outpatient paediatric department of Kathmandu Medical College from January 2020 to April 2021. Ethical approval was taken from Institutional Review Committee of Kathmandu Medical College. A convenient sampling technique was used. The data were collected from the outpatient department prescription card into a suitably designed proforma. Drug use indicator developed by the World Health Organisation for Rational Use of Drugs was utilised. Data were analysed using SPSS v.20. Results: Data from prescriptions of 345 patients aged less than 14 years were collected from the paediatric outpatient department of KMCTH. The most common condition was common cold (132, 38.26%). Most commonly prescribed antihistamines were Fexofenadine (156, 45.21%). Average number of drugs per prescription was 2.31. The total number of drugs prescribed by generic name was 128 (16%). Antibiotics made its place in prescriptions 279 (34.96%) times. No parenteral medication was used and 140 (17.5 %) of all drugs prescribed were from the National List of Essential Medicines. Conclusion: Antihistamines, mostly second generation, were commonly prescribed in URTIs in paediatric patients. Majority of WHO indicators were within normal limits while some needed marked improvement. Different programmes can be implemented for improvement in prescribing patterns and promotion of rational drug use.

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Implementation of a Delayed Prescribing Model to Reduce Antibiotic Prescribing for Suspected Upper Respiratory Tract Infections in a Hospital Outpatient Department, Ghana

10.20944/preprints202009.0008.v1 ◽

2020 ◽

Author(s):

Sam Ghebrehewet ◽

Wendi Shepherd ◽

Edwin Panford-Quainoo ◽

Saran Shantikumar ◽

Valerie Decraene ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Outpatient Department ◽

Upper Respiratory Tract Infections ◽

Service Improvement ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Improvement Project ◽

Upper Respiratory ◽

Tract Infections

This service improvement project was carried out at LEKMA Hospital, Ghana. Ghana has high levels of antimicrobial resistance (AMR). There is an urgent need to introduce models of care that optimize antibiotic prescribing. Methods Delayed / back-up prescribing is a strategy that could reduce antibiotic use in suspected upper respiratory tract infections. Four different models of delayed / back-up prescribing [no prescription; post-dated prescription (given to patient); post-dated prescription (forwarded to pharmacy); and follow-up appointment for reassessment after 3 days] were implemented in discussion between clinician and patient. Patients were contacted 10 days after their appointment to record compliance, check on their wellbeing, and rate their experience. Results Over a 3-month period (12/2019-02/2020), 142 patients were eligible for delayed / back-up prescribing. The most common clinical diagnoses were sore throat (102/140, 73%), common cold (22/140, 16%) and sinusitis (10/140, 7%). In total, 12 (9%) patients remained symptomatic at day 10, and only one individual in the entire cohort took antibiotics. Most patients (95%) rated their experience as good or very good. Conclusions Delayed / back-up prescribing models can lead to substantial reduction in antibiotic consumption amongst outpatient department patients with suspected upper respiratory tract infections. Delayed / back-up prescribing can be implemented safely in low and middle-income countries.

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Antibiotic Prescribing for Patients with Upper Respiratory Tract Infections by Emergency Physicians in a Singapore Tertiary Hospital

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790501200207 ◽

2005 ◽

Vol 12 (2) ◽

pp. 70-76 ◽

Cited By ~ 2

Author(s):

WY Lee

Keyword(s):

Emergency Department ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Tertiary Hospital ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Emergency Physicians ◽

Upper Respiratory ◽

Tract Infections

Objective Despite the paucity of supporting evidence, the use of antibiotics in the management of upper respiratory tract infections (URTI) remains a persistent and worrying trend worldwide. This survey study set out to examine the antibiotic prescribing profile of emergency physicians for patients diagnosed with URTI at a local tertiary hospital. Methods Patients seeking treatment for URTI at the emergency department in the year 2001 were identified by their ICD-9 code. The electronic medical records of a random sample of these patients were reviewed. Patients with the following documented findings were excluded: (a) a duration of more than 7 days between disease onset and date of consultation, (b) prior antibiotic usage or medical consultation, (c) presentation of purulent sputum and/or purulent nasal discharge, and (d) existing medical conditions requiring antibiotic treatment/prophylaxis. Chi-square and multivariate analyses were performed to assess the association of patient-related factors with antibiotic prescribing. Results Of a random sample of 488 cases of URTI, inappropriate antibiotic prescribing was observed in 24% of cases (95% CI 20%, 28%). Significant associations were observed between antibiotic prescribing and month of consultation, patients' temperature and symptom of rhinorrhoea. Conclusion A substantial proportion of emergency department patients with URTI received antibiotics despite the lack of evidence supporting the drugs' effectiveness. Appropriate interventions to promote evidence-based prescribing amongst emergency physicians are required to reduce the extent of inappropriate antibiotic prescribing as well as to ensure the longevity of antibiotic effectiveness.

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