Retrospective Analysis of Antibiotic Prescribing Pattern for Upper Respiratory Tract Infection (URTI) in Seremban 2 Health Clinic
Antibiotic Prescribing Pattern for Upper Respiratory Tract Infection
Abstract
Introduction: URTI is a common problem seen in primary care. URTIs are often of viral origin and therefore the use of antibiotics are not necessary. Overprescribing of antibiotics can lead to antibiotic resistance.
Objectives: 1) Determine the antibiotic prescribing pattern for URTI at Seremban 2 Health Clinic. 2) Determine the appropriateness of antibiotics prescribed for URTI based on Malaysian National Antibiotic Guideline (MNAG) 2014 and the defined daily dose (DDD) system introduced by WHO.
Method: Information was collected from Pharmacy Information System (PhIS). All records of patients attending the clinic from 1st January 2018 to 31st December 2018, who fulfilled the necessary criteria were screened and retrieved for further investigation. The data obtained was analysed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA).
Results: URTI was found to be the most common diagnosis, which accounted for about 27.0% from the total diagnosis for which antibiotics were prescribed. The overall antibiotic prescribing rate and URTI antibiotic prescribing rate in the current study were 11.6% and 25.2% respectively. Amoxicillin (49.8%) was the most frequently prescribed antibiotic for the indication of URTI followed by erythromycin (43.4%), cloxacillin (2.8%), amoxicillin/clavulanic acid (1.8%), cephalexin (1.8%), cefuroxime (0.3%) and doxycycline (0.2%). The most utilized antibiotics for URTI was amoxicillin (1.31 DDD/100 patients), and was used almost 3-fold more than erythromycin which was the second most utilized antibiotic for URTI (0.48 DDD/100 patients).
Conclusion: These results show that the current practice is not following the antibiotic guidelines.
Keywords:
antibiotic prescribing pattern, upper respiratory tract infection, Malaysia
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References
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Akter S.F.U., Rani M.F.A., Rahman J.A., et al.(2012). Antimicrobial use and factors influencing prescribing in medical wards of a tertiary care hospital in Malaysia. Int J Sci Environ Technol. 1(4), 274-284.
Almeman A.A., Ibrahim M.I.M., Rasool S. (2014). Cost analysis of medications used in upper respiratory tract infections and prescribing patterns in university sans Malaysia, Penang, Malaysia. Tropical Journal of Pharmaceutical Research. 13(4), 621–626.
Arnold S.R., Straus S.E.(2005). Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;4:CD003539
Bisno A.L. (2001). Acute pharyngitis. N Engl J Med. 344(3), 205–11.
Boonstra E., Lindbaek M., Ngome E. (2005). Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 6 years old in primary health care in Botswana. Int J Qual Health Care;17(3), 221-227.
Centers for Disease Control Prevention. Get smart for healthcare (2017). Retrieved 15 June 2019. Available from: www.cdc.gov/getsmart/healthcare
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Costelloe C., Metcalfe C., Lovering A., et al.(2010). Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ,340,c2096.
Don’t ask for antibiotics if not needed. In: The Star. Malaysia; 31 May 2015. Retrieved 16 June 2019. Available from: https://www.thestar.com.my/news/nation/2015/05/31/dont-ask-for-antibiotics-if-not-needed-doc-tough-to-convince-such-patients/
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Fikru W. and Dagmawit T.. (2018). Retrospective Assessment of Antibiotics Prescribing at Public Primary Healthcare Facilities in Addis Ababa, Ethiopia. Hindawi Interdisciplinary Perspectives on Infectious Diseases,2018, 1-9. https://doi.org/10.1155/2018/4323769
Huttner B., Goossens H., Verheij T., Harbarth S. (2010). Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 10(1),17–31.
Kamarudin Mohd. F. and Noh Kamaliah M. (2013). The effect of profiling report on antibiotic prescription for upper respiratory tract infection. Malays Fam Physician. 8(2), 26–31.
Kung K., Wong C.K., Wong S.Y., Lam A., Chan C.K., Griffiths S., Butler C. (2014). Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong. BMC Fam Pract. 15, 95.
Li Y., Xu J., Wang F. et al. (2012). Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Affairs.31(5), 1075-82.
McIsaac W.J., White D., Tannenbaum D., Low D.E. (1998). A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Canadian Medical Association Journal. 158(1), 75-83.
Ministry of Health Malaysia (2018) Official portal. Retrieved 10 December 2018. Available from: http://www.moh.gov.my/english.php/database_stores/store_view/1
O'Neill J. (2016). Tackling drug-resistant infections globally: Final report and recommendations. The review on antimicrobial resistance. Available from: https://amr-review.org/sites/default/files/160518_Final%20paper_ with%20cover.pdf
Pharmaceutical Services Division. National Antibiotic Guideline (NAG), 2nd Edition. 2014. Retrieved 5 June 2019. Available from: http://www.pharmacy.gov.my/v2/ms/dokumen/national-antibiotic-guideline-nag-2ndedition.html.
Philips H., Huibers L., Holm Hansen E., et al. (2014). Guidelines adherence to lower urinary tract infection treatment in out-of-hours primary care in European countries. Qual Prim Care 22(4), 221-231.
Rabiatul S., Hassali M., Alrasheedy A.A.,et al. (2015). Prescribing Patterns for Upper Respiratory Tract Infections: A Prescription-Review of Primary Care Practice in Kedah, Malaysia and the implications. Expert Rev Anti Infect Ther. 13(12),1547-56.
Rezel R.S., Hassali M.A., Alrasheedy A.A., et al. (2015). Prescribing patterns for upper respiratory tract infections: A prescription review of primary care practice in Kedah, Malaysia, and the implications. Expert Rev Anti Infect Ther, 13(12),1547-1556.
Rico-Ferreira P., Palazon-Bru A., Calvo-Perez M., Gil-Guillen V.F. (2015). Nonadherence to guidelines for prescribing antibiotic therapy to patients with tonsillitis or pharyngotonsillitis: A cross sectional study. Curr Med Res Opin., 31(7),1319-1322.
Ruiz-Aragón J., Rodríguez López R., Molina Linde J.M. (2010). Evaluation of rapid methods for detecting Streptococcus pyogenes. Systematic review and meta-analysis. An Pediatr (Barc). 72(6), 391–402
Shafinaz S., Muhammad E.A., Syed Tabish R.Z. et al. (2016). Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation. International Journal of Infectious Diseases, 52, 16-22.
‘Superbugs’ spur campaign for stricter use of antibiotics. The Star. Malaysia; 29 September 2012. Retrieved 16 June 2019. Available from: http://www.thestar.com.my/news/nation/2012/09/29/superbugs-spur-campaign-for-stricter-use-of-antibiotics/
Teng C.L., Achike F.I., Phua K.L., et al. (2004). General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting. International Journal of Antimicrobial Agents. 24(5), 496–501.
Teng C.L., Achike F.I., Phua K.L., Nurjahan M.I., Mastura I., Asiah H.N., Mariam A.M., Narayanan S., Norsiah A., Sabariah I., et al.(2006). Modifying antibiotic prescribing: the effectiveness of academic detailing plus information leaflet in a Malaysian primary care setting. Med J Malaysia. 61(3),323–31.
Teng C.L., Nurjahan M.I., Hashim N.A., et al.(2003). Upper respiratory tract infections: to what extent is the management evidence-based? Med J Malaysia, 58,159–66.
Teng C.L. (2014). Antibiotic prescribing for upper respiratory tract infection in the Asia-Pacific region: a brief review. Malays Fam Physician,9(2),18-25.
The World Health Organization. Antimicrobial resistance, global report on surveillance (2014) Retrieved 30 November 2018. Available from: http://apps.who.int/iris/bitstream/handle/10665/112642/9789241564748_eng.pdf;jsessionid=4788A03552E40DCBCED39A2F0D820491?sequence=1
Van den Broek d’Obrenan J., Verheij T.J, Numans M.E., van der Velden A.W. (2014). Antibiotic use in Dutch primary care: relation between diagnosis, consultation and treatment. J Antimicrob Chemother. 69(6),1701–7.
WHO (2018) ATC/DDD Index 2019. Retrieved 4 December 2018. Available from: https://www.whocc.no/atc_ddd_index/
WHO (2018) Defined Daily Dose (DDD). Retrieved 4 December 2018. Available from: https://www.who.int/medicines/regulation/medicines-safety/toolkit_ddd/en/
WHO Collaborating Centre for Drug Statistics Methodology (2018). ATC/DDD Index 2019. Retrieved 5 June 2019. Available from: https://www.whocc.no/atc_ddd_index/
World Population Review (2018) Population of Cities in Malaysia (2018). Retrieved 10 November 2018. Available from: http://worldpopulationreview.com/countries/malaysia-population/cities/
Zeyad A., Mohamed A., Abdullah A., et al. (2017). Study of antibiotics prescribing pattern in infants: Retrospective study: The study of drug utilization pattern in paediatric patients. International Journal of Medicine Research, 2(6), 16-22.
Akter S.F.U., Rani M.F.A., Rahman J.A., et al.(2012). Antimicrobial use and factors influencing prescribing in medical wards of a tertiary care hospital in Malaysia. Int J Sci Environ Technol. 1(4), 274-284.
Almeman A.A., Ibrahim M.I.M., Rasool S. (2014). Cost analysis of medications used in upper respiratory tract infections and prescribing patterns in university sans Malaysia, Penang, Malaysia. Tropical Journal of Pharmaceutical Research. 13(4), 621–626.
Arnold S.R., Straus S.E.(2005). Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;4:CD003539
Bisno A.L. (2001). Acute pharyngitis. N Engl J Med. 344(3), 205–11.
Boonstra E., Lindbaek M., Ngome E. (2005). Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 6 years old in primary health care in Botswana. Int J Qual Health Care;17(3), 221-227.
Centers for Disease Control Prevention. Get smart for healthcare (2017). Retrieved 15 June 2019. Available from: www.cdc.gov/getsmart/healthcare
Cheong L.T., Seng F.T., Ee M.K., et al. Antibiotics for URTI and UTI Prescribing in Malaysian primary care settings. Australian Family Physician May 2011; 40:5.
Costelloe C., Metcalfe C., Lovering A., et al.(2010). Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ,340,c2096.
Don’t ask for antibiotics if not needed. In: The Star. Malaysia; 31 May 2015. Retrieved 16 June 2019. Available from: https://www.thestar.com.my/news/nation/2015/05/31/dont-ask-for-antibiotics-if-not-needed-doc-tough-to-convince-such-patients/
Faridah A.M., Sivasampu S., Lian L., et al. (2010) Malaysian Statistics on Medicine 2007. Retrieved 17 June 2019. Available from: https://vdocuments.site/malaysian-statistics-on-medicines-2007291010.html
Fikru W. and Dagmawit T.. (2018). Retrospective Assessment of Antibiotics Prescribing at Public Primary Healthcare Facilities in Addis Ababa, Ethiopia. Hindawi Interdisciplinary Perspectives on Infectious Diseases,2018, 1-9. https://doi.org/10.1155/2018/4323769
Huttner B., Goossens H., Verheij T., Harbarth S. (2010). Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 10(1),17–31.
Kamarudin Mohd. F. and Noh Kamaliah M. (2013). The effect of profiling report on antibiotic prescription for upper respiratory tract infection. Malays Fam Physician. 8(2), 26–31.
Kung K., Wong C.K., Wong S.Y., Lam A., Chan C.K., Griffiths S., Butler C. (2014). Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong. BMC Fam Pract. 15, 95.
Li Y., Xu J., Wang F. et al. (2012). Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Affairs.31(5), 1075-82.
McIsaac W.J., White D., Tannenbaum D., Low D.E. (1998). A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Canadian Medical Association Journal. 158(1), 75-83.
Ministry of Health Malaysia (2018) Official portal. Retrieved 10 December 2018. Available from: http://www.moh.gov.my/english.php/database_stores/store_view/1
O'Neill J. (2016). Tackling drug-resistant infections globally: Final report and recommendations. The review on antimicrobial resistance. Available from: https://amr-review.org/sites/default/files/160518_Final%20paper_ with%20cover.pdf
Pharmaceutical Services Division. National Antibiotic Guideline (NAG), 2nd Edition. 2014. Retrieved 5 June 2019. Available from: http://www.pharmacy.gov.my/v2/ms/dokumen/national-antibiotic-guideline-nag-2ndedition.html.
Philips H., Huibers L., Holm Hansen E., et al. (2014). Guidelines adherence to lower urinary tract infection treatment in out-of-hours primary care in European countries. Qual Prim Care 22(4), 221-231.
Rabiatul S., Hassali M., Alrasheedy A.A.,et al. (2015). Prescribing Patterns for Upper Respiratory Tract Infections: A Prescription-Review of Primary Care Practice in Kedah, Malaysia and the implications. Expert Rev Anti Infect Ther. 13(12),1547-56.
Rezel R.S., Hassali M.A., Alrasheedy A.A., et al. (2015). Prescribing patterns for upper respiratory tract infections: A prescription review of primary care practice in Kedah, Malaysia, and the implications. Expert Rev Anti Infect Ther, 13(12),1547-1556.
Rico-Ferreira P., Palazon-Bru A., Calvo-Perez M., Gil-Guillen V.F. (2015). Nonadherence to guidelines for prescribing antibiotic therapy to patients with tonsillitis or pharyngotonsillitis: A cross sectional study. Curr Med Res Opin., 31(7),1319-1322.
Ruiz-Aragón J., Rodríguez López R., Molina Linde J.M. (2010). Evaluation of rapid methods for detecting Streptococcus pyogenes. Systematic review and meta-analysis. An Pediatr (Barc). 72(6), 391–402
Shafinaz S., Muhammad E.A., Syed Tabish R.Z. et al. (2016). Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation. International Journal of Infectious Diseases, 52, 16-22.
‘Superbugs’ spur campaign for stricter use of antibiotics. The Star. Malaysia; 29 September 2012. Retrieved 16 June 2019. Available from: http://www.thestar.com.my/news/nation/2012/09/29/superbugs-spur-campaign-for-stricter-use-of-antibiotics/
Teng C.L., Achike F.I., Phua K.L., et al. (2004). General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting. International Journal of Antimicrobial Agents. 24(5), 496–501.
Teng C.L., Achike F.I., Phua K.L., Nurjahan M.I., Mastura I., Asiah H.N., Mariam A.M., Narayanan S., Norsiah A., Sabariah I., et al.(2006). Modifying antibiotic prescribing: the effectiveness of academic detailing plus information leaflet in a Malaysian primary care setting. Med J Malaysia. 61(3),323–31.
Teng C.L., Nurjahan M.I., Hashim N.A., et al.(2003). Upper respiratory tract infections: to what extent is the management evidence-based? Med J Malaysia, 58,159–66.
Teng C.L. (2014). Antibiotic prescribing for upper respiratory tract infection in the Asia-Pacific region: a brief review. Malays Fam Physician,9(2),18-25.
The World Health Organization. Antimicrobial resistance, global report on surveillance (2014) Retrieved 30 November 2018. Available from: http://apps.who.int/iris/bitstream/handle/10665/112642/9789241564748_eng.pdf;jsessionid=4788A03552E40DCBCED39A2F0D820491?sequence=1
Van den Broek d’Obrenan J., Verheij T.J, Numans M.E., van der Velden A.W. (2014). Antibiotic use in Dutch primary care: relation between diagnosis, consultation and treatment. J Antimicrob Chemother. 69(6),1701–7.
WHO (2018) ATC/DDD Index 2019. Retrieved 4 December 2018. Available from: https://www.whocc.no/atc_ddd_index/
WHO (2018) Defined Daily Dose (DDD). Retrieved 4 December 2018. Available from: https://www.who.int/medicines/regulation/medicines-safety/toolkit_ddd/en/
WHO Collaborating Centre for Drug Statistics Methodology (2018). ATC/DDD Index 2019. Retrieved 5 June 2019. Available from: https://www.whocc.no/atc_ddd_index/
World Population Review (2018) Population of Cities in Malaysia (2018). Retrieved 10 November 2018. Available from: http://worldpopulationreview.com/countries/malaysia-population/cities/
Zeyad A., Mohamed A., Abdullah A., et al. (2017). Study of antibiotics prescribing pattern in infants: Retrospective study: The study of drug utilization pattern in paediatric patients. International Journal of Medicine Research, 2(6), 16-22.
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How to Cite
Pei Shan, M., & Zhi Juan, C. (2020). Retrospective Analysis of Antibiotic Prescribing Pattern for Upper Respiratory Tract Infection (URTI) in Seremban 2 Health Clinic. International Journal of Advancement in Life Sciences Research, 3(2), 29-39. https://doi.org/https://doi.org/10.31632/ijalsr.20.v03i02.004
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Research Articles
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