Improvement of antibiotic use in sore throat, tonsillitis and acute otitis media in Palestine: a prospective full cycle audit

Abstract

Introduction: Antibiotics are commonly prescribed for upper respiratory tract infections (URTIs) which are generally caused by viral pathogens and do not require antibiotics under most circumstances. Adherence to the international guidelines regarding the necessity of prescribing antibiotics and the selection of antibiotics used for these illnesses have never been reviewed in West Bank.

Methodology: This study was a prospective full cycle audit and re-audit done in West Bank, Palestine. Audit and re-audit phases involved short interviews. The intervention phase included surveys, oral presentations, and development of mobile/web applications. p values of < 0.05 were considered significant.

Results: A total of 297 cases were reviewed during the audit and reaudit phases. These cases included tonsillitis (56.9%), sore throat (29.6%) and acute otitis media (13.5%). Improvements in the percentages of correct antibiotics prescriptions in the reaudit phase were noticed, including + 6.5% for correct direct antibiotics prescriptions, + 44.4% for correct backup antibiotics prescriptions, and + 63.4% for correct no antibiotics prescriptions. Improvements in the percentages of prescribing the correct choice of antibiotic (+ 41.4%) and frequency, dosage and duration (+ 13.3%) were also recorded.

Conclusions: There was inadequate adherence to the international guidelines of antibiotic prescription for URTIs indicating a possible national problem. There is an evident trend toward using the second-line antibiotics for URTI. Improvements were observed in antibiotic prescribing patterns over a four months period. Therefore, our study's improvement strategies and approaches can be extended to other disease management systems and locations.

Keywords: Acute Otitis Media; Pharyngitis; Sore throat; Tonsillitis; URTIs; audit.