1677. Prevalence and Patterns of Outpatient Antibiotic Prescription at a Public Tertiary Medical Center in Southern Province, Sri Lanka

Abstract

BackgroundThe global emergence of antimicrobial resistance poses a major public health threat. However, there are little data regarding antimicrobial use from many low- or middle-income countries. In this study, we determined the prevalence and patterns of antibiotic prescription among outpatients at a tertiary healthcare facility in Sri Lanka.MethodsThe study was conducted at the Outpatient Department (OPD) of the largest public tertiary care center in Southern Province, Sri Lanka. This is a free walk-in clinic serving upwards of 1,000 patients per day. Adult and pediatric OPD patients were recruited for a cross-sectional survey in February–April 2019. Pre-visit and post-visit questionnaires were verbally administered to obtain information regarding participants’ demographics and presenting illness. The OPD pharmacy’s electronic prescribing system was queried to calculate the prevalence of antibiotic prescriptions among enrolled patients. Logistic regression was performed to identify features associated with antibiotic prescription.ResultsOf 408 patients surveyed, 246 (62.9%) were female and 88 (21.7%) were children <18 years. Median age was 38 (IQR 19–54) years, and median duration of illness at enrollment was 7 (IQR 3–30) days. Medications were prescribed for 291 (72.4%) patients during the OPD visit, with 146 (35.8% of all patients) receiving an antibiotic. The most frequently prescribed antibiotics were amoxicillin (41, 28.1%), first-generation cephalosporins (38, 26.0%), and amoxicillin/clavulanate (30, 20.5%). The most frequent chief complaints among antibiotic recipients were cough (35, 24.0%), rhinorrhea/congestion (26, 17.8%), and fever (18, 12.3%). Diagnostic investigations were ordered for 38 (26.0%) antibiotic recipients. On bivariable analysis, younger age (P = 0.01), shorter duration of illness (P < 0.001), and lack of prior evaluation (P = 0.001) were positively associated with antibiotic prescription.ConclusionWe show a high prevalence of outpatient antibiotic prescription despite limited diagnostic evaluation at a tertiary medical facility in Southern Province, Sri Lanka. Antibiotic stewardship efforts, especially targeting respiratory illness, may help improve antibiotic use in this setting.Disclosures All authors: No reported disclosures.