Irrational antibiotic prescribing: a local issue or global concern?

Abstract

Resistance to antibiotics is a major public-health concern and antibiotic use is being ever more recognized as the main discriminatory pressure driving this resistance. The aim was to assess the outpatient usage of antibiotics in teaching hospitals in various parts of capital city of Iran, Tehran and its association with resistance. 600 outpatient antibiotic prescriptions between December 2011 and May 2012 were reviewed in our teaching hospitals. All prescriptions were scrutinized in order to evaluate the antibiotic prescribing. The medical doctors from all grades were asked to note the chief complaints and the most possible diagnosis on each prescription. Clinical data, patient demographic and ultimately the total quantities of antibiotics were recorded. Our data was then compared against the major antibiotic guidelines and similar studies in other countries. The most common prescribed antibiotics are Penicillins (Penicillin, Co-Amoxiclav and Amoxicillin) (40 %), Cephalosporins (Cefixime, Cephalexin and Ceftriaxone) (24.5 %) and Macrolides (particularly Azithromycin) (15.3 %). In total, 18.2 % of cases were combinational antibacterial therapies (≥ 2). The most common diagnosis was upper respiratory tract infections as common cold (29.2 %) and sore throat (11.8 %). Directions (instructions for use) of 58 % of selected antibiotics were acceptable. Parenteral administration remains the common route of administration with 22 % of all reviewed prescriptions. Based on Cochrane reviews the antibiotic prescribing was unjustified in 42.7 % of the cases. The prescribing habit, correct diagnosis and the use of antibiotics need instant consideration. These data can provide useful information for assessing public-health policy that aims to reduce the antibiotic use and resistance levels.

Keywords: antibiotic prescribing; outpatients; resistance; review.

Table 1. List of most common essential antibiotics as recommended by the World Health Organization

Table 2. Demographic and prescriptions evaluation data for all patient

Table 3. Comparison between antibacterial therapies in teaching hospitals against Cochrane suggestion

Figure 1. Location of Iran as define by the WHO (extracted from the WHO website)

Figure 2. Major influencing factors for antibiotic prescribing. OTC: Over The Counter

Figure 3. Process of primary evaluation for outpatient prescriptions

Figure 4. Ratio of antibiotics used as single or in combination with other antibiotics

Figure 5. Detailed fraction of the most common antibacterial agents prescribed in outpatient centers

Figure 6. Most common noted diagnosis by physicians in outpatient centers