Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

Helen L Zhang,L Gayani Tillekeratne,Tianchen Sheng,Gaya B Wijayaratne,Christopher Woods,Ajith Nagahawatte,D L Bhagya Piyasiri,Ruvini Kurukulasooriya,Champica Bodinayake,Pasangi Jayatissa

doi:10.1186/s12879-021-05804-6

Abstract

BackgroundInappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka.MethodsThis cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy’s electronic prescribing system.ResultsOf 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies.ConclusionsA high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.

Highlights

Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries
While reliable estimates are lacking in low- and middle- income countries (LMICs), morbidity and mortality attributable to antimicrobial resistance (AMR) are expected to be even greater in these settings due to a higher prevalence of infectious diseases and lesser access to newer-generation antibiotics [3]
Antibiotics were prescribed to approximately one-third of patients in this study, similar to the proportions of 33–54% reported in a 2015 World Health Organization audit of Sri Lankan Outpatient Department (OPD) as well as antibiotic prescribing figures reported in other South East Asian countries [8, 9]

Summary

Introduction

Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. While reliable estimates are lacking in low- and middle- income countries (LMICs), morbidity and mortality attributable to AMR are expected to be even greater in these settings due to a higher prevalence of infectious diseases and lesser access to newer-generation antibiotics [3]. Epidemiologic surveillance of AMR in Sri Lanka has only recently been implemented, available data reveal a high prevalence of infections caused by drug-resistant organisms. National surveillance data of urine culture isolates demonstrated resistance to ciprofloxacin and third-generation cephalosporins at proportions exceeding 50% among enteric gram-negative bacteria [5]

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