Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

doi:10.21315/mjms2022.29.1.9

. 2022 Feb;29(1):91-100.

doi: 10.21315/mjms2022.29.1.9. Epub 2022 Feb 23.

Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

AbdulRahman Muthanna^{1

2}, Siti Zulaikha Zakariah¹, Aneesa Abdul Rashid³, Sazlina Shariff Ghazali³, Rukman Awang Hamat¹, Maliza Mawardi³, Hani Syahida Salim³, Nurainul Hana Shamsuddin³

Affiliations

¹ Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
² Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
³ Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.

PMID: 35283676
PMCID: PMC8887978
DOI: 10.21315/mjms2022.29.1.9

Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

AbdulRahman Muthanna et al. Malays J Med Sci. 2022 Feb.

. 2022 Feb;29(1):91-100.

doi: 10.21315/mjms2022.29.1.9. Epub 2022 Feb 23.

Authors

AbdulRahman Muthanna^{1

2}, Siti Zulaikha Zakariah¹, Aneesa Abdul Rashid³, Sazlina Shariff Ghazali³, Rukman Awang Hamat¹, Maliza Mawardi³, Hani Syahida Salim³, Nurainul Hana Shamsuddin³

Affiliations

¹ Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
² Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.
³ Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.

PMID: 35283676
PMCID: PMC8887978
DOI: 10.21315/mjms2022.29.1.9

Abstract

Background: Over-prescription of antibiotics for upper respiratory tract infection (URTI) is a continuing problem in Malaysia, leading to increased antimicrobial resistance and unnecessary cost incurred for treatment. In a patient presenting with a sore throat, it is recommended to only prescribe antibiotics to group A streptococcus (GAS) pharyngitis confirmed by a throat culture, rapid antigen test or in patients with a Centor score of 4.

Methods: This cross-sectional study assessed the proportion of antibiotics prescribed and antimicrobial susceptibility patterns of GAS pharyngitis in the Malaysian primary care setting. Two-hundred and fifteen adult patients presenting with sore throat were recruited in three primary care clinics. Demographic data and clinical information were collected and analysed. Centor scores were calculated according to the clinical information and throat swabs were collected from all participants for GAS identification.

Results: Only six throat swabs isolated GAS and indicated for antimicrobial treatment (2.8%). However, 48 participants (22.3%) were prescribed antibiotics out of which only four (8.3%) patients with isolated GAS, including three (6.2%) patients who clinically had a Centor score of 4 and one patient with a score of 3. Amoxicillin and erythromycin were the most commonly prescribed antibiotics (58.3% and 25% of all antibiotics, respectively).

Conclusion: There is a high proportion of antibiotic prescriptions which were not indicated in patients with sore throat in this study. This may reflect a common practice of antibiotic overuse for sore throat in primary care settings in Malaysia. Concerted interventions to reduce the inappropriate prescribing of antibiotics are urgently needed.

Keywords: antibiotics; inappropriate prescribing; pharyngitis; prescription; primary care.

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Conflict of interest statement

Conflicts of Interest None.

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References

1. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1545–1602. doi: 10.1016/S0140-6736(16)31678-6. - DOI - PMC - PubMed
1. Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ. Clinical screening tools to diagnose group A streptococcal pharyngotonsillitis in primary care clinics to improve prescribing habits. Malays J Med Sci. 2018;25(6):6–21. doi: 10.21315/mjms2018.25.6.2. - DOI - PMC - PubMed
1. Hersh K, Fleming-Dutra KE, Shapiro DJ, Hyun DY, Hicks LA. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Intern Med. 2016;176(12):1870–1872. doi: 10.1001/jamainternmed.2016.6622. - DOI - PMC - PubMed
1. Andersson DI, Hughes D, Kubicek-Sutherland JZ. Mechanisms and consequences of bacterial resistance to antimicrobial peptides. Drug Resist Updat. 2016;26(2016):43–57. doi: 10.1016/j.drup.2016.04.002. - DOI - PubMed
1. Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012;12(1):70. doi: 10.1186/1471-2466-12-70. - DOI - PMC - PubMed

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[1] Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1545–1602. doi: 10.1016/S0140-6736(16)31678-6. - DOI - PMC - PubMed

[2] Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1545–1602. doi: 10.1016/S0140-6736(16)31678-6. - DOI - PMC - PubMed

[3] Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ. Clinical screening tools to diagnose group A streptococcal pharyngotonsillitis in primary care clinics to improve prescribing habits. Malays J Med Sci. 2018;25(6):6–21. doi: 10.21315/mjms2018.25.6.2. - DOI - PMC - PubMed

[4] Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ. Clinical screening tools to diagnose group A streptococcal pharyngotonsillitis in primary care clinics to improve prescribing habits. Malays J Med Sci. 2018;25(6):6–21. doi: 10.21315/mjms2018.25.6.2. - DOI - PMC - PubMed

[5] Hersh K, Fleming-Dutra KE, Shapiro DJ, Hyun DY, Hicks LA. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Intern Med. 2016;176(12):1870–1872. doi: 10.1001/jamainternmed.2016.6622. - DOI - PMC - PubMed

[6] Hersh K, Fleming-Dutra KE, Shapiro DJ, Hyun DY, Hicks LA. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, and pharyngitis. JAMA Intern Med. 2016;176(12):1870–1872. doi: 10.1001/jamainternmed.2016.6622. - DOI - PMC - PubMed

[7] Andersson DI, Hughes D, Kubicek-Sutherland JZ. Mechanisms and consequences of bacterial resistance to antimicrobial peptides. Drug Resist Updat. 2016;26(2016):43–57. doi: 10.1016/j.drup.2016.04.002. - DOI - PubMed

[8] Andersson DI, Hughes D, Kubicek-Sutherland JZ. Mechanisms and consequences of bacterial resistance to antimicrobial peptides. Drug Resist Updat. 2016;26(2016):43–57. doi: 10.1016/j.drup.2016.04.002. - DOI - PubMed

[9] Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012;12(1):70. doi: 10.1186/1471-2466-12-70. - DOI - PMC - PubMed

[10] Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012;12(1):70. doi: 10.1186/1471-2466-12-70. - DOI - PMC - PubMed

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Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

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Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

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