สัดส่วน ลักษณะและปัจจัยที่เกี่ยวข้องของการใช้ยาปฏิชีวนะอย่างไม่สมเหตุผลในโรคติดเชื้อระบบทางหายใจส่วนบนเฉียบพลัน

Pattamas Ruanpech; Pitchayanont Ngamchaliew

Authors

Pattamas Ruanpech Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University
Pitchayanont Ngamchaliew Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University

Keywords:

inappropriate antibiotic prescriptions, acute upper respiratory tract infection, rational drug use hospital policy, student health center

Abstract

Objectives: To study the proportion, patterns, and factors associated with inappropriate antibiotic prescription (IAP) in acute upper respiratory tract infection (ARTI) at the Student Health Center (SHC), Prince of Songkla University (PSU). Methodology: A descriptive retrospective study was conducted by reviewing medical records from the hospital information system (HIS) of Songklanagarind Hospital. Seven hundred and thirty ARTI patients, who met inclusion criteria at the SHC, PSU from 1 January to 30 September 2018 and diagnosed with common cold, acute pharyngitis, and acute tonsillitis under the ICD10 code. Four hundred and thirty-four patients were excluded after medical record review. Descriptive and inferential statistics were employed in the data analysis using the R^® 4.0.0. software program. Associations were evaluated via odds ratios with 95% confidence intervals. The level of statistical significance was set at p<0.05 using multivariate analysis. Results: Two hundred and ninety-six participants were enrolled in the study. The proportion of antibiotic use in ARTI was 17.2% (51 of 296). Among antibiotic prescriptions, the proportion of IAP was 80.4 % (41 of 51). The patterns of IAP were as follows: no antibiotics indication 90.2% (37 of 41), wrong duration 26.2% (11 of 41,—a 5 day amoxicillin therapy was the most common 27.2%), and wrong dose 12.2% (5 of 41,—all received amoxicillin in the dose of 2,000 mg/day). The multivariate analysis demonstrated that factors significantly associated with IAP were being a patient with an underlying disease (adjusted OR=4.22, p=<0.001) and a nurse practitioner as prescriber (adjusted OR=10.93, p=<0.001). Conclusion: Antibiotic prescriptions in ARTI at the SHC, PSU did not exceed the 20% rate set in the rational drug use hospital policy for antibiotic prescription criteria. Nevertheless, the proportion of IAP among ARTI patients was high, and the most common pattern was prescribing antibiotics without an indication. Therefore, future research should focus on how to enhance the adherence to antibiotic prescription guidelines to promote appropriate antibiotic prescription, especially among nurse practitioners.

References

Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotic for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulmonary Medicine 2012;12:70.

Yuniar CT, Anggadiredja K, Islamiyah AN. Evaluation of rational drug use for acute pharyngitis associated with the incidence and prevalence of the disease at two community health centers in Indonesia. Scientia Pharmaceutica 2017;85(2):22.

Vincent MT, Celestin N, Hussain AN. Pharyngitis. Am Fam Physician 2004;69(6):1465-70.

Treebupachatsakul P, Tiengrim S, Thamlikitkul V. Upper respiratory tract infection in Thai adults: prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines. J Med Assoc Thai 2006;89(8):1178-86.

Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1(3):239-46. doi: 10.1177/0272989X 8100100304.

McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158(1):75-83.

Aalbers J, O’Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD, et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9:67.

World Health Organization. Antimicrobial resistance: global report on surveillance: 2014 summary. Available from: https://www.who.int/drugresistance/documents/surveillancereport/en/.

Barnett ML, Linder JA. Antibiotic prescribing to adults with sore throat in the United States, 1997-2010. JAMA Intern Med 2014;174(1):138-40.

Thamlikitkul V, Apisitwittaya W. Implementation of clinical practice guidelines for upper respiratory infection in Thailand. Int J Infect Dis 2004 Jan;8(1):47-51. doi: 10.1016/j.ijid. 2003.09.001.

Rattanaponglekla C, Kunarangsri B, Wichaikosol T, Seubsang A, Kultanmanusorn A. Study for antibiotic use system development in acute pharyngitis and tonsillitis follow antibiotic smart use policy at Kornburi Hospital [Internet]. 2012 [cited 2017 Nov 18]. Available from: https://med.mahidol.ac.th/commed/sites/default/files/public/pdf/pdf1/pdf2/Korn_12_55.pdf. (unpublished work) (in Thai)

Puyati P, Kanjanarach T. Prevalence and pattern of antibacterial use in upper respiratory tract infection: a study in sub-district health promoting hospitals of Buayai contracted unit of primary care in Nakhon Ratchasima province. Khonkaen: Khonkaen University; 2015. (unpublished work) (in Thai)

Imanpour S, Nwaiwu O, McMaughan DK, DeSalvo B, Bashir A. Factors associated with antibiotic prescriptions for the viral origin diseases in office-based practices, 2006-2012. JRSM Open 2017;8(8):2054270417717668.

Malo S, Poblador-Plou B, Prados-Torres A, Lallana MJ, Laguna-Berna C, Rabanaque MJ. Poor congruence with guidelines in the use of antibiotics for acute bronchitis: a descriptive study based on electronic health records. Fam Pract 2016;33:471–5. https://doi.org/10.1093/fampra/cmw037. PMID: 27221732.

Aunruean W, Saensom D. Behavior of KKU students on antibiotic use in sore throat, clean wound and acute diarrhea. KKU Institutional Research 2015;3(3):221-32. (in Thai)

Mincey BA, Parkulo MA. Antibiotic prescribing practices in a teaching clinic: comparison of resident and staff physicians. South Med J 2001;94(4):365-9.

Tell D, Engstrom S, Molstad S. Adherence to guidelines on antibiotic treatment for respiratory tract infection in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. BMJ Open 2015;5(7):e008096.

Gomez J, Garcia-Vazquez E, Bonillo C, Hernandez A, Bermejo M, Canteras M. Self-assessment of patterns of antibiotic use in a university hospital. Enferm Infecc Microbiol Clin 2014;32(8):507-10.

Ladd E. The use of antibiotics for viral upper respiratory tract infections: an analysis of nurse practitioner and physician prescribing practices in ambulatory care, 1997–2001. J Am Acad Nurse Pract 2005;17:416-24.

Ness V, Price L, Currie K, Reilly J. Influences on independent nurse prescribers’ antimicrobial prescribing behaviour: a systematic review. J Clin Nurs 2016;25(9-10):1206-17.

Rational Use of Drug Subcommittee. 2017.Teacher’s guide for promoting rational drug use [Internet]. Nonthaburi: Food and Drug Administration, Ministry of Public Health, Thailand. 2017. [cited 2017 Nov 18]. Available from: http://www.fda.moph.go.th/sites/drug/Shared%20Documents/New/RDU%20curriculum%202017.pdf. (in Thai)

Rational Drug Use Committee. In: Chayakul C, Chongtrakul P, Wananukul W, Punnapurata P, Kanjanarat P, Yodsombat K, et al., editors. Rational drug use hospital manual. Bangkok: The Agricultural Cooperative Federation of Thailand Printing; 2015. p. 84-8 (in Thai)