Abstract
BackgroundOver-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.MethodsThis 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.ResultsOnly 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).ConclusionThere 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.
Highlights
Upper respiratory tract infection (URTI) is the most common acute illness seen in primary care clinics globally
In terms of prescribing habit, a diagnosis of pharyngitis/tonsilitis correlates with the decision to prescribe, most of these cases do not fulfil the clinical criteria of group A streptococcus (GAS) pharyngitis as we found 42 patients who were prescribed antibiotics (87.5%) had a Centor score of 0–2
For most patients with respiratory tract infection, antibiotic use is unnecessary and these results suggest that antibiotics were not clinically indicated, overused in the three primary care clinics in Malaysia
Summary
Upper respiratory tract infection (URTI) is the most common acute illness seen in primary care clinics globally. Antibiotics should be prescribed only for patients with GAS pharyngitis [2]. Previous studies have reported that there is an overprescription of antibiotics for URTI in general practice, where 73% of patients with pharyngitis were prescribed antibiotics [5, 6]. In Malaysia, antibiotics are commonly prescribed by primary care providers and most frequently for respiratory tract infections [7]. 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
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