Abstract
BackgroundTo investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan.MethodsA cross-sectional study was designed according to the World Health Organization (WHO) methodology for AM usage from January, 2017 to June, 2017. Standard data collection forms designed by the WHO were used to collect the data from 32 PHCCs (16 rural healthcare centers (RHCs) and 16 basic health units (BHUs)) in Punjab province of Pakistan. PHCCs were randomly selected from 8 main cities. The study sample consisted of prescription records of 6400 outpatients (200 prescriptions records from each PHCC) and 800 inpatients (25 inpatient records from each PHCC). Data of the year 2016 were collected retrospectively by using systematic random sampling technique and analyzed through SPSS.ResultsAmong the hospital indicators, standard treatment guidelines (STGs) regarding the infectious diseases were not available in PHCCs. Number of days during which key AMs were out of stock was 12.1 days per month (range = 3.1–19.2). Out of total PHCC medicines costs, expenditures on AMs were 26.2% (range = 17.1–39.0). In case of prescribing indicators, the average number of AMs per prescription was 1.4 (range = 1.1–1.7), percentage of prescriptions prescribed with AMs was 81.5% (range = 68.9–89.1) and duration of AM treatment on average was 5.1 days per patient (range = 3.3–6.4). Average cost of prescribed AMs per patient was 1.3 USD (range = 0.6–4.3). The PHCCs prescribed a median of 5 (range = 3–9) types of AMs, including 10 (range = 5–15) individual agents. Out of 79.3% prescriptions of outpatients prescribed with AMs, only 16.4% were properly prescribed. Out of 100% prescriptions of inpatients prescribed with AMs, 12.1% were properly prescribed. Out of all the AM prescriptions 23.6% contained penicillins, 20.1% contained cephalosporins and 19.4% contained fluoroquinolones Metronidazole (18.0%), ciprofloxacin (16.5%) and co-amoxiclav (14.3%) were most commonly prescribed AMs.ConclusionsIn PHCCs, AMs were prescribed more frequently. However large proportions of these prescriptions were inappropriate. Continuous education and training of medical staff and cost effective policies could play an important role in promotion of rational use of AMs.
Highlights
To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan
The total PHCCs existing in 8 main cities of Punjab (Lahore, Faisalabad, Bahawalpur, Multan, Dera Ghazi Khan, Sargodha, Rawalpindi, and Gujranwala) are 128 (43 Rural health centers (RHC) and 85 Basic health units (BHU)). 4 PHCCs (2 RHCs and 2BHUs) were randomly selected from the peripheries of each selected city so total 32 PHCCs (16 RHCs and 16 BHUs) were selected for this study
Hospital indicators In all PHCCs, the Drug and Therapeutic Committee (DTC) was working on regular basis and a formulary list/essential medicines list (FL/EML) was available that contains 15 generics of AMs. 15 AMs listed in FL/EML were available in 22 different dosage forms
Summary
To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan. AMR result in decreased potency of antimicrobials (AMs) against causative microbes, unnecessary health costs and leads to failure of therapy. Out of total use of AMs, 20–50% is not proper [2, 7, 8] leading to decreased quality of patient care, increased cost of therapy and prevalence of adverse drug effects [9]. AMR has emerged widely but developing countries are more affected by this issue due to lack of proper health care facilities and high rate of infections [10, 11]. In Pakistan, most of the physicians in government hospitals tend to prescribe those AMs that are not effective against majority of the causative microbes [12]
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