Knowledge attitude and practices of doctors on drug resistant Typhoid and extreme drug resistance Typhoid in Karachi Pakistan

Abstract

Background: Since November 2016, Pakistan has been facing an outbreak of XDR typhoid fever. 7529 Multiple Drug Resistant (MDR) typhoid fever cases were reported from Hyderabad and Karachi and the fever is showing resistance to third generation cephalosporin. Study aims to assess knowledge, attitude and practices of medical doctors on diagnosis and management of typhoid, XDR and MDR typhoid in the tertiary care hospitals of Karachi, Pakistan. Methods and materials: Mix method approach was use to conduct the knowledge attitude and practice survey. For quantitative part 321 doctors interviewed in four tertiary care hospitals between April to June 2019. All medical doctors provided consent and involved in prescribing the medication to doctors were included. In the qualitative part 12 IDIs and 4 focus group were conducted using a semi structured guide- to know doctor's perspective on patients compliance related to antibiotic prescription, DR salmonella and XDR salmonella, routine practices, influencing the decision about prescribing, acceptability and appropriateness of potential interventions. Quantitative data analysis was done on SPSS version 25 and results were presented on ratios and percentages. Qualitative data was analyzed manually based on thematic analysis. Results: Knowledge specific to XDR 85% respondent that infection is common in the country, 65% agreed that they have lack of knowledge on AMR to suspect cases. Antibiotics are overly prescribed by doctors (62%), its available over the counter (58%) and (57%) patient compliance to the treatment option were the most reported reasons to AMR in the survey. Azithromycin is the only drug of choice in both DR and XDR 58% and 48% respectively, very few (3.8%) recommending Carbapenes in XDR and no drug combination is using to treat XDR in all four hospital. In the in-depth discussion majority doctors stated that use of third-generation cephalosporin (in basic fever/flue condition), greatly limiting treatment options and Similar environments and approaches to treatment of typhoid fever, may be the reason of widespread typhoid fever. Conclusion: Considering XDR typhoid is increasing and warranted sense of urgency in the country, there is need to endorse National/Provincial Hospital based AMR prevention guidelines for doctors to reduce the burden of treatable diseases.