Antibiotic Prescribing Practices of Primary Care Prescribers for Acute Respiratory Tract Infections

and Diarrhoea in New Delhi, India

Anita Kotwani1, Ranjit Roy Chaudhury2, Kathleen Holloway3

1Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, India

2Apollo Hospitals, New Delhi, India 3WHO, SEARO, New Delhi, India

ICIUM 2011, Antalya, Turkey

Current Scenario in Post-Antibiotic Era

• Rapid emergence of antimicrobial resistance (AMR) in the community is a major global health problem

• Overuse of antibiotics for the indications that do not require antibiotic therapy is a major concern

• Methodology* using exit interview of patients receiving any antibiotic (AB) was used

*Kotwani A, Holloway K, Roy Chaudhury R. Methodology for surveillance of antimicrobials use among out-patients in Delhi. Indian Journal of Medical Research 2009; 129: 555-560

Objectives

• To find out the antibiotic prescribing practices of primary care doctors’ for acute upper respiratory infections (ARI) and acute diarrhoea

• Percentage & trends of AB use for patients receiving AB for treatment of ARI and diarrhoea in public and private clinics

Methodology

• Antibiotic use data was collected from public (n=10) and private sector facilities (n=20) from four municipal wards in West Delhi

• After consultation with a prescriber, patients with cough/common cold/sore throat (symptoms of ARI) or acute diarrhoea without any blood were enrolled

Prescription Data Summary: ARI (December 2007-Nov.ember2008)

Public Sector- 45.3% of ARI patients received ABPenicillins J01C - AmoxicillinFluoroquinolones (J01MA) - OfloxacinMacrolides J01FA - RoxithromycinCephalosporins (J01DA) –Cefuroxime

Private Sector - 56.7% of ARI patients received AB; Pediatricians prescribed AB to 60.9%

Penicillins J01C – Amoxicillin+Clavulinic acidFluoroquinolones (J01MA) - LevofloxacinCephalosporins (J01DA) –Cefuroxime, cefpodoxime proxetil, cefixime

Macrolides J01FA - Roxithromycin

•

Prescription Data Summary: Diarrhoea (December 2007-Nov.ember2008)

Public Sector • 43% of patients with acute diarrhoea received AB• 23% children below 13 years of age were prescribed

antibiotic for diarrhoea

Private Sector • 69% of patients with acute diarrhoea received AB• 51.5% children were prescribed antibiotics by

pediatricians for acute diarrhoea

Percentage of prescriptions with various antibiotics in Dirrhoea in public sector and private clinics

(December 2007-November 2008)

0102030405060708090

100110

M P Ce F Co T NA

Antibiotics

Pe

rce

nta

ge

PS (H+D)

PS

PrC

PrC (p)

PS (H+D)- Public Sector (Hospital and Dispensary);PS- Public Sector (Hospital); PrC- Private Clinics; PrC (p)- Private Clinic (pediatrics)

M - Macrolides, P - Penicillins, Ce - Cephalosporins, F - Fluoroquinolones, Co - Cotrimoxazole, T - Tetracyclines, NA - Nalidixic Acid

Key Points Emerged from the Study

1. Irrarational use of antibiotics for treatment of ARI and acute diarrhoea by primary care doctors in both public and private sector in the area surveyed

2. Doctors of public sector were prescribing antibiotic to less number of children (23%) than private clinic doctors ( 51%) for acute diarrhoea

3. Newer members, second-line antibiotics from all classes of antibiotic groups were prescribed for ARI

4. Fluoroquinolones were the main antibiotic prescribed for acute diarrhoea

Policy Implications

• Urgent suitable and sustainable interventions are needed for rational use of antibiotics in the community to decrease misuse of antibiotics in ARI and acute diarrhoea and for the containment of AMR

• Extensive surveillance of antimicrobial in the community to guide and control antimicrobial use

Moving Ahead….

• A multidisciplinary team with political commitment to decrease AMR and appropriate use of antibiotics

• Monitor antimicrobial use in the community

• Qualitative studies with stakeholders to develop suitable and sustainable interventions

• Awareness and educating programs for doctors, pharmacists and community for AMR, appropriate use of ABs, and misuse of ABs for viral infections