Antibiotic use in acute upper respiratory tract infections and uncomplicated lacerations in the Gaza Strip: clinical audit and re-audit

Abstract

Background: Overuse of antibiotics is increasing worldwide and has led to a marked increase in multidrug-resistant pathogens. Acute upper respiratory tract infections and uncomplicated lacerations do not require antibiotics. We assessed adherence to the best international standards of antibiotic prescribing for these conditions.

Methods: We did an audit and reaudit at Nasser Hospital in the Gaza Strip. The audit included patients presenting from January to March, 2017, with acute upper respiratory tract infections or uncomplicated lacerations. Random selection, stratified by condition, was used to assign patients to the audit or reaudit. After the audit an action plan was implemented focusing on education of health-care providers and patients for one year. The reaudit was done in 2018, from January to March. Ethics approval was obtained from the Palestinian Ministry of Health.

Findings: 240 patients were included overall, 60 with each condition in the audit and 60 with each condition in the reaudit. The 60 patients in the first audit with acute upper respiratory tract infections had a mean age of 32·1 (SD 6·4) years. 25 (42%) had throat examinations, of which 20 (33%) were normal. 52 (87%) of these 60 patients were prescribed antibiotics, which were used by 29 (48%) who cited that they believed it was important to do so. The 60 patients presenting with uncomplicated lacerations had a mean age of 14·5 (SD 10·3) years. Injuries were closed by sutures in 59 (98%) patients, who all received antibiotics. 52 (87%) of 60 patients with lacerations believed that antibiotics accelerate healing. Reaudit after the action plan was implemented showed that antibiotics were prescribed to 43 (71%) patients with acute upper respiratory tract infections (p=0·002) for difference and to 50 (84%) with uncomplicated lacerations.

Interpretation: Despite some improvement in appropriate antibiotic use for acute upper respiratory tract infections after hospital-based quality improvement efforts, physicians did not generally follow international guidelines for appropriate antibiotic use and patients believed that their use was important. Development of evidence-based guidelines and education of patients are needed.

Funding: None.