Pattern and appropriateness of antimicrobial prescription for acute respiratory tract infection in primary healthcare settings in Ethiopia.

IF 4.4 2区 医学 Q1 INFECTIOUS DISEASES
Gashaw Enbiyale Kasse, Suzanne M Cosh, Judy Humphries, Md Shahidul Islam
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引用次数: 0

Abstract

Background: Acute respiratory tract infections (ARTIs) are the leading cause of antimicrobial misuse, contributing to the increasing problem of antimicrobial resistance. Little information exists about the pattern and appropriateness of antimicrobial prescribing in patients with ARTIs in the study area. Therefore, this study aims to investigate antimicrobial prescriptions and their appropriateness for ARTIs in primary healthcare settings in Ethiopia, as well as to identify potential risk factors for inappropriate antimicrobial prescriptions.

Methods: A cross-sectional study was conducted in seven selected primary health centres. Data were collected through face-to-face structured questionnaire interviews with outpatients diagnosed with ARTIs and a review of their medical charts. To be eligible for this study, patients had to be diagnosed with one of the ARTIs as diagnosed by physicians. The appropriateness of antimicrobial prescription was evaluated by two experienced physicians based on national and international guidelines. Multivariable logistic regression was used to identify the significant factors, including sociodemographic and clinical characteristics, associated with inappropriate antimicrobial prescriptions. A p-value < 0.05 was considered a level of statistical significance. We used Variance Inflation Factors (VIF) to check the multicollinearity of independent variables.

Results: Among 420 patients included in the study, 55% were female. The mean age of the participants was 45.1 years (SD ± 16.8 years) with a range of 18-90 years. The most frequent diagnoses of ARTIs were acute bronchitis (24%), common cold (22.4%), and tonsillitis (15.2%). 352 (83.8%) of patients received antimicrobial prescriptions. The most frequently prescribed antimicrobial classes were penicillin (69.1%), macrolides (20.4%), and fluoroquinolones (6.2%). Moreover, amoxicillin (36.9%) and amoxicillin-clavulanic acid (32.4%) were the most inappropriately prescribed antimicrobials. The rate of inappropriate antimicrobial prescription was 64.2%. Among these, 71.7% of patients received antimicrobials that were not indicated, while the remaining 28.3% received an inappropriate dose and frequency. Patients diagnosed with common colds, acute bronchitis and tonsillitis had a higher rate of inappropriate antimicrobial prescriptions. The presence of fever (OR = 5.42; 95% CI = 3.36-8.75; P < 0.001), patients with comorbidities (OR = 1.31; 95% CI = 1.23-3.93; p = 0.001) and patient age ≥ 60 years (OR = 1.18; 95% CI = 1.08-2.48; p < 0.001) were associated with a higher likelihood of inappropriate antimicrobial prescribing.

Conclusion: Overall, the study findings highlight a high rate of antimicrobial prescriptions for ARTIs, with the majority being prescribed inappropriately. These results underscore the need for targeted interventions, including antimicrobial stewardship programs and adherence to international guidelines, to reduce inappropriate prescriptions and combat antimicrobial resistance.

埃塞俄比亚初级卫生保健机构急性呼吸道感染抗菌药物处方的模式和适当性。
背景:急性呼吸道感染(ARTIs)是抗生素滥用的主要原因,导致抗生素耐药性问题日益严重。关于研究地区ARTIs患者抗菌药物处方的模式和适当性的信息很少。因此,本研究旨在调查埃塞俄比亚初级卫生保健机构的抗微生物处方及其对抗逆转录病毒感染的适宜性,并确定不适当的抗微生物处方的潜在风险因素。方法:在选定的7个初级保健中心进行横断面研究。数据是通过面对面的结构化问卷调查和对诊断为ARTIs的门诊患者的医疗图表的回顾来收集的。为了有资格参加这项研究,患者必须被医生诊断出患有其中一种ARTIs。两名经验丰富的医生根据国家和国际指南对抗菌药物处方的适宜性进行了评估。使用多变量logistic回归来确定与不适当的抗菌药物处方相关的重要因素,包括社会人口统计学和临床特征。p值结果:纳入研究的420例患者中,55%为女性。参与者的平均年龄为45.1岁(SD±16.8岁),年龄范围为18-90岁。最常见的急性支气管炎(24%)、普通感冒(22.4%)和扁桃体炎(15.2%)。352例(83.8%)患者获得抗菌药物处方。最常用的抗菌药物是青霉素(69.1%)、大环内酯类(20.4%)和氟喹诺酮类(6.2%)。阿莫西林(36.9%)和阿莫西林-克拉维酸(32.4%)是处方最不适当的抗菌药物。抗菌药物处方不当率为64.2%。其中,71.7%的患者接受了未指征的抗菌素治疗,而其余28.3%的患者接受了不适当的剂量和频率。诊断为普通感冒、急性支气管炎和扁桃体炎的患者服用不适当抗菌药物的比例更高。结论:总体而言,研究结果突出了ARTIs抗菌药物处方的高发率,但大多数处方不当。这些结果强调需要有针对性的干预措施,包括抗菌素管理规划和遵守国际准则,以减少不适当的处方和对抗抗菌素耐药性。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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