Community-based outpatient practice of antibiotics use in Tehran

Abstract

To study patterns of outpatient antibiotic use in the Great Tehran, in order to develop interventional strategies in rationalizing drug and especially antibiotic use. Ten-percent random sample of all prescription belonging to practitioners in south of Tehran and kept in a data bank was sampled. Drug use indicators were determined in order to develop intervention program to promote rational drug use among practitioners in Tehran. Based on the values of drug use indicators, an interventional program, a program of continuing medical education (CME) targeting rational use of drugs, was designed. Eighty general practitioners (GPs) who contributed to the data bank were selected and allocated to two groups, intervention group and control group. Each group contained 40 GPs. Drug use indicators were measured in each group three times; before and in two intervals after the intervention. The indicators were compared before and after as well as between groups. The drug use indicators determined through the data bank showed that 19% of all prescribed drugs in data bank were antibiotics, which ranked second only after 'analgesics and CNS drugs' with 24%. The drug use indicators were improved in the intervention group (the average number of drugs per encounter lowered from 4.3 +/- 0.5 pre-intervention to 3.6 +/- 0.1 six months thereafter, p value = 0.001). The percentage of encounters with an antibiotic prescribed were lowered in intervention group compared with control group but the difference was not statistically significant. The intervention made a change to all other measured indicators but not all of them were statistically significant. Irrational use of antibiotics can improve by appropriate educational intervention, using CME programs.