A Review on Assessment on The Dispensing Pattern of Drugs in The Management of Respiratory Tract Infections

To combat possible overuse, the current prescribing of antibiotics for respiratory tract infections (RTIs) must be determined. Every prescription for an RTI was examined retrospectively (1). 123,524 prescriptions in total were examined and evaluated. RTI was the reason for 7129 of these prescriptions. Some prescribers' prescription practices didn't align with the most recent recommendations that support the development of resistance. To enhance the use of antibiotics, national antimicrobial stewardship programs and further educational initiatives are continuously being implemented (2). Acute infections affecting the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi that are brought on by a number of viruses, primarily rhinovirus, are referred to as upper respiratory tract infections (URTIs). Antibiotics have relatively little therapeutic value, thus routinely prescription them to treat URTIs is not justified. Nonetheless, they are often recommended for conditions for which they are not appropriate, such as illnesses with an unclear bacterial or viral cause. Therefore, URTIs pose a significant challenge to healthcare systems, particularly when improper antibiotic use results in clinical failure or a rise in antibiotic resistance. Clinical failure occurs when patients do not get better or worse and the recommended treatment is unable to address the underlying infections (3). In general, respiratory conditions account for the majority of antibiotic prescriptions in ambulatory care. However, there has always been a problem with ambulatory care providers administering antibiotics inappropriately (4). For instance, about 12 million prescriptions for acute bronchitis and RTIs were written by ambulatory care doctors in the US in 1992. Of these, antibiotics were prescribed for 66% of adults with acute bronchitis, 51% of adults with colds, and 52% of adults with non-specific upper respiratory infections. Because antibiotics are inexpensive and widely available despite concerns, their unchecked and careless use in ambulatory care raises the potential of resistance development. Including doctors, pharmacists, infection control teams, and managerial staff has been accomplished with success in a number of nations. Antibiotic use and spending in those nations have significantly decreased as a result of these multipronged campaigns and initiatives (5). In order to record the prevalence of RTI-specific antibiotic prescriptions in public primary healthcare settings before these current attempts, we conducted a prescription study. Additionally, we sought to examine how various public sector healthcare providers choose, distribute, and follow the recommendations for prescription oral antibiotics to patients with RTIs. The national antibiotic recommendations and the new antimicrobial stewardship program can be used to plan future actions, if necessary.

METHODS

Study design and prescription selection criteria

Prescriptions with diagnosis of ‘RTI’, ‘tonsillitis’, ‘pharyngitis’, ‘rhinitis’, ‘common cold’, ‘sore throat’, ‘cough’, or ‘otitis media’ were included in the study. Incomplete prescriptions, missing diagnosis, or prescriptions with more than one infection were excluded from the study. This was done to avoid or minimize uncertainty of the diagnosis and the purpose of antibiotics in the prescription.

Identification of RTI diagnosis

All prescriptions were in hard copies, retrieved manually from the pharmacy units from each clinic. The selection of prescriptions to be included in the study was based solely on the written diagnosis on the prescription, i.e. the written diagnosis and prescribed treatment. We did not verify the validity and accuracy of the diagnosis as we did not have access to specific clinical data for each patient diagnosed with a URTI including their symptomatology or laboratory results. RTIs were defined, similar to several studies in literature, as any encounter with the diagnosis of upper respiratory tract infection including pharyngitis, acute tonsillitis, acute sinusitis, rhinitis and otitis media.

Classification and appropriate prescribing of antibiotics

we evaluated prescribers’ conformity to the guidelines before the implementation of the more comprehensive surveillance programme in conjunction with the launch of the ASP protocol among the healthcare centres.

Study settings and sampling

 Multiple services are provided at these clinics, including general outpatient services, maternal and child health services for the urban and sub-urban population. Other services include family health, dental, dietetics and nutrition, health education and promotion, home nursing, radiology, pharmacy, adolescent health and community mental services.

 Statistical analysis

 The data was entered into Microsoft Excel spread sheet, and then exported to the Statistical Package for the Social Sciences (SPSS), version 20 for further analysis. Both descriptive and inferential statistics were used for data elaboration.

 Ethical approval

 The Medical Research and Ethics Committee Ministry of Health, approved the study. 

RESULTS

Over the three months, 123,524 prescriptions were screened and analysed according to the established inclusion and exclusion criteria. 49,251 prescriptions were excluded as they were appointment-based prescriptions mainly for chronic conditions.

Table 1: Prescribing activities at the 10 clinics