Prescribing Patterns for Upper Respiratory Tract Infections: A Prescription-Review of Primary Care Practice in Quetta, Pakistan and the Implications

Hania Hashmi,Abdul Raziq,Abdul Malik Tareen,Abdul Sadiq,Fahad Saleem,Sajjad Haider,Adnan Khalid,Shanaz Raza,Nazeer Ahmad Sasoli,Fakhra Batool,Qaiser Iqbal,Muhammad Alam Mengal,Syed Umer Jan

doi:10.3389/fpubh.2021.787933

Abstract

Background: To identify and address the potential overuse of antibiotics, it is important to ascertain the prescribing practices of physicians. We, therefore, conducted this prescription analysis to document URTI-specific antibiotic prescription frequency in a public primary healthcare setting of Quetta city, Pakistan.Methods: A retrospective record review was conducted of all prescriptions for URTIs in Combined Military Hospital, Quetta from 1 March to 31st May 2021. The Mann-Whitney U and Jonckheere–Terpstra test was used to evaluate the association between the tendencies of a different group of prescribers. p-value of <0.05 was of statistical significance.Results: Over the 3 months, 50,705 prescriptions were screened and analyzed according to the established inclusion and exclusion criteria. A total of 4,126 (8.13%) URTI prescriptions met the inclusion criteria, of which 2,880 (69.80%) prescriptions contained antibiotics. Among all antibiotics, penicillins (Amoxicillin + Clavulanate) were the most prescribed antibiotic, constituting 1,323 (45.9%) of total antibiotics prescribed for all cases, followed by the Macrolide group 527 (18.2%). The Jonckheere–Terpstra test revealed a statistically significant association between the status of the prescriber and the diagnosis (p = 0.002). Furthermore, a moderate positive trend was reported with specialists being more competent in antibiotic prescribing based on their diagnosis, followed by postgraduates and house officers (τ = 0.322).Conclusion: The prescribing patterns for the management of URTIs in the hospital were inconsistent with current guidelines. Strict adherence to guidelines must be ensured and antibiotic prescribing for URTIs should be discouraged.

Highlights

Upper respiratory tract infections (URTIs) are acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi [1]
40% of the prescriptions were diagnosed as non-specific URTI followed by cough (694, 16.8%) and rhinitis (491, 11.9%)
Thirty percent of prescriptions were from the pediatrics unit and the majority (1,664, 78.3%) of the prescription with URTIs were prescribed by postgraduates (Table 1)

Summary

Introduction

Upper respiratory tract infections (URTIs) are acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi [1]. Defining and differentiating such patients is difficult because the clinical presentations connected with bacterial or viral-related URTIs commonly overlap [6], antibiotics are frequently prescribed to manage URTIs in primary care settings [7,8,9,10,11]. Other than certain exceptions, antibiotics are unnecessarily prescribed for URTIs [12] This frequent use of antibiotics adds a burden to healthcare systems that result in clinical failure and/or an increase in the development of antibiotic resistance [13]. To identify and address the potential overuse of antibiotics, it is important to ascertain the prescribing practices of physicians. We, conducted this prescription analysis to document URTI-specific antibiotic prescription frequency in a public primary healthcare setting of Quetta city, Pakistan

Objectives

Methods

Results

Discussion

Conclusion