Antibiotic Prescribing by Informal Healthcare Providers for Common Illnesses: A Repeated Cross-Sectional Study in Rural India (original) (raw)
Related papers
Journal of Clinical Pharmacy and Therapeutics, 2008
Background: Emerging antibiotic resistance in common pathogens is a worldwide problem known to be related to inappropriate overuse of antibiotics. Wide variability in antibiotic use throughout the world is because of various factors, including socio-cultural differences. Objective: To study the rate of antibiotic prescribing for common outpatient illnesses and the various disease, patient, physician and health facility characteristics, which influence this in primary and secondary healthcare settings in Uttar Pradesh. Methods: After sampling of health facilitiesboth private and government, rural and urban, a cross-sectional survey of prescriptions for patients presenting with runny or blocked nose, cough, sore throat, diarrhoea or fever without localizing symptoms was conducted. Information on disease, patient, physician and facility characteristics was collected. Outcome factors: antibiotic prescription and group of antibiotic prescribed. No intervention was made. Results: Overall antibiotic prescription rate was 81AE8%. It was significantly higher in urban private than in government settings, and higher in rural than in urban settings. Presence of fever prompted antibiotic use across all strata. Lower age of patients and higher socioeconomic status were associated with higher antibiotic use. Patient requests for antibiotics were very rare. Specialist practices with staff with higher qualifications and better opportunities for updating knowledge were associated with lower antibiotic prescribing. Government health-facilities with larger staff complement and better infrastructure was associated with lower prescribing rates. The most common antimicrobial agents used were the penicillin, sulfonamides and fluoroquinolones. Injection use paralleled antibiotic use. Conclusions: These data on overprescribing of antibiotics can be used to design educational programs for physicians working in these settings.
Antibiotics, 2022
Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers that influence IHCPs’ prescribing behaviour for common illnesses in children under five, with an emphasis on antibiotic use in rural areas of India. A total of 48 IHCPs participated in focus group discussions. Thematic framework analysis with an inductive approach was used, and findings were collated in the theoretical framework based on knowledge, attitude, and practice model which depicted that the decisions made by IHCPs while prescribing antibiotics are complex and influenced by a variety of external and internal drivers. IHCPs’ internal drivers included the misconception that it is impossible to treat a patient without antibiotics and ...
The Indian journal of medical research, 2008
Irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. This study was undertaken to determine the rate and pattern of antimicrobial prescribing in patients with uncomplicated acute respiratory infections, fever and diarrhoea attending a few rural and urban health settings. The study was done in primary and secondary health care facilities of public/government and private settings at four sites in India. Patients with fever, cough, diarrhoea or ear, nose or throat infections of < 7 days were included. Pregnant women, lactating mothers, infants, seriously ill patients and patients with bloody diarrhoea or purulent nasal or ear discharge were excluded. Overall antimicrobial prescription rate was 69.4 per cent (95% CI 67.1, 71.7). Wide variation was observed (Thiruvananthapuram 47.6%, Lucknow 81.8%, Chennai 73.1% and Vellore 76.5%). Physicians practicing in rural and public/government settings prescribed antimicrobials mo...
An Epidemiological Observation of Judicious use of Antibiotics in Dhar District, M.P. (India)
Indian Journal of Pharmacy Practice, 2021
Background: Antibiotic resistance is presently the gigantic challenge to the effective treatment of infections globally. It is a rapidly growing clinical problem and public health threat. Promiscuous use of antibiotics is epidemic in India and this is an affair of consequential concern. Irrational use of antibiotics can cause increase adverse drug reaction, lead to antibiotic resistance and increase the treatment cost. Antibiotic resistance unfavourably influence both clinical and financial therapeutic results, with repercussion ranging from the failure of an individual patient to respond to therapy and the need for costly and/or toxic alternative medicine to the social cost of higher morbidity and mortality rates, longer duration of hospitalization and the need for changes in empirical therapy. Analysing the antibiotics utilization pattern is significant in the context of its escalating use and its overall impact on the health care system. Materials and Methods: An observational and prospective study was conducted by interviewing (using a data collection form) the patients to evaluate the utilization of antibiotics in multispecialty hospital, Dhar district, Madhya Pradesh, India. Results: Out of 102 patients interviewed, 85 (83.33%) were prescribed antibiotics either alone or in combination with other drugs. The maximum number of patients received antibiotics belongs to the age group of 31-40 (22, 18.7%). Ciprofloxacin (25, 21.25%) was the widely prescribed antibiotics followed by metronidazole (20, 17%) penicillin (15, 12.75%), azithromycin (12, 10.2%) cephalosporin (11, 9.35%) and amoxicillin (10, 8.5%). Maximum prescriptions of antibiotics were for high grade fever (29, 24.65%) followed by gastrointestinal infection (18, 15.3%). Conclusion: Proper strategy like antibiotic policy and educational intercession are necessary to control the excessive use of antibiotics in health care settings.
Cureus
Introduction Antimicrobial resistance is a serious problem to solve for the public health authorities at the global level, particularly in developing countries like India. One of the possible reasons for antimicrobial resistance could be the inappropriate or overuse of antibiotics. The Indian government started the National Action Plan on Antimicrobial Resistance to promote rational use of antibiotics in our country. This study was conducted with the objective to monitor antibiotic use in public health facilities of Puducherry which is a union territory of south India. Methods Total 900 prescriptions were prospectively collected from the 10 public health facilities (nine primary health centres and one outpatient department of tertiary care hospital) over the period of one year to analyse antibiotic use. Results We found that 36.66 % of prescriptions contained at least one antibiotic. Our result shows that antibiotics were more commonly prescribed from the access category. Upper respiratory tract infections was the most common indication for which antibiotic was prescribed in primary health centres. In the tertiary care teaching hospital, half of the antibiotics were prescribed for cough, followed by pharyngitis (20 %). Conclusions A high proportion of antibiotics were prescribed for viral infections. Using antibiotics unnecessary can increase the cost of treatment as well as risk of antibiotic resistance. The Department of Medical Services, Puducherry should take initiative to ensure the successful implantation of the National Action Plan on Antimicrobial Resistance. Data of this study can be used to provide educational intervention for all drug stake holders such as physicians, pharmacists and policy makers to promote rational use of antibiotics.
The aim of the study is to determine the prescribing pattern of antimicrobials at various rural and urban hospitals and to propose possible interventions on improving antibiotic usage by implementing pharmacist role to prevent antibiotic resistance in future for that a prospective – observational study was conducted in urban and rural hospitals, in Tamilnadu, India between June 2012 to January, 2013 which includes 360 antibiotic containing prescriptions are analyzed and Each prescription was compared with standard treatment guidelines and the observations are noted. A specially designed data entry form was used to collect data. From our study it was observed that Antibiotics are being extensively prescribed where alternate therapy is available. Irrational Use of much high power antibiotic to patients will cause resistance to antibiotics. To prevent this pharmacist role was implemented which undergone the issue of standard treatment guidelines, right drug for right microorganisms wer...
Many studies have investigated the prevalence and nature of self medication. It is a common type of self care behavior among the population of various Countries. The Government of India was proposed to develop a policy to control the misuse of antibiotics. The policy calls for making of a new schedule under the Drugs and Cosmetics Act 1940 called as Schedule HX.The reason to take up the present study was to carry out head to head comparison of demographic variables with self antibiotic medication. It is a cross section study with a pretested questionnaire and conducted at Sahaswan, Utter Pradesh, India, with 600 study subjects during the period between November and December 2011. It was observed that the antibiotics were extensive supplied medicines without prescription including those used for serious illness conditions. The percentage of patients who were seeking self antibiotic medication was approximately 54%. Most patients were seeking self antibiotic medication for respiratory tract infection (16.83%); wound infection, cough and cold (14.5%); fever and GIT infection (13.66%); eye/ear infection (7%) were commonly noted aligminets. The antibiotics highly dispensed or purchased on a self medication were cephalosporins groups (24.15%) and minimum was tetracyclines groups (12.83%). Patient health awareness programs and pharmacist continuing education are necessary.These findings highlight the need for planning interventions to promote the judicious use of antibiotics, create awareness regarding the problems of antimicrobial resistance.
Clinical Infection and Immunity, 2017
Background: Bangladesh is not exempted from the grave dangers of antibiotic resistance and the other problems arising from its misuse. The prevalent aberrations in the practice of using antibiotics in Bangladesh include self-medication, prescription by quacks and nonphysicians, non-registered "village doctors", irrational prescription, etc. The resultant rises in resistant strains of several bacteria are also seen, and probably much is yet unseen and unnoticed. Methods: This observational descriptive study attempted to describe the actual scenario. A total of 155 patients (60% male and 40% female) were included in this study with consecutive purposive sampling who took antibiotics prior to coming to the primary health care facility. Results: Most common problems were common cold symptoms, only fever with or without body ache but without any other specific features and gastrointestinal upset (constipation/diarrhea/abdominal pain) with/without fever. Most (67.9%) of the patients also had taken some antibiotics in the past year for similar reasons, most common of which is "mixed reasons", followed by common cold. Most of the time, the antibiotic was prescribed by drug seller at medicine store (89, 57.4%), followed by quack/village doctor (29, 18.7%). In mere 14.2% of cases, the antibiotic was prescribed by registered Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors (22, 14.2%). Most have no clear idea about the definition of a doctor, and most (137, 89%) consider non-medical as doctors and think them to be qualified enough to prescribe antibiotic. About 80% of the respondents had no idea or flawed idea about importance of regularity in taking antibiotics, or completion of the course or the concept and threat of antibiotic resistance. Most commonly taken antibiotic was ciprofloxacin (38, 24.7%), followed by cefixime (30, 19.5%), and azithromycin (26, 16.9%). Patients had already spent from a minimum of 12 Bangladeshi Taka (BDT) to a maximum of 675 BDT, average being 166.61 BDT and a median of 117 BDT, before they came for consultation. So the economic impact is also not negligible. Conclusion: This study shows that gross misuse of antibiotics is being done in Bangladesh. Most of the responsibilities of gross misuse belong to two parties, non-physicians, illegal medical practitioners, quacks, and lack of awareness among the patients.
ANTIBIOTICS PRESCRIPTION PATTERN IN RURAL AREA OF BANGLADESH: A CROSS-SECTIONAL STUDY IN DEBIDWAR
International Journal of Pharmacy and Pharmaceutical Sciences, 2018
Objective: The study was aimed to evaluate the antibiotic prescription pattern by physicians in the area of study. Methods: This cross-sectional observational study was carried out with a self-designed standard questionnaire by manual data collection over a three months period at the Debidwar Upazila of Comilla District. The data were collected by directly interviewing the participants. Microsoft Excel 2010 was used for the analysis of the collected data. Results: Out of 242 patients, 60.74% of patients were male, 39.26% of patients were female. Majority of the patients (50%) belonged to age group 9 to 20 and in terms of profession, 53.30% were students. Among the previous disease history, hypertension (20.25%) was found at the dominant position. Common cold (28.95%) was the frequent reason for visiting doctor and ciprofloxacin was prescribed to 30.17% patients (Male: 21.90%, Female: 8.26%). Before prescribing anti-bacterial agents or any other agents, only 23.55% patients were recommended diagnostic tests and in 81.81% cases, physicians simply prescribed medicine by his/her own assumption and culture and sensitivity test was recommended and done for 18.18% patients. Conclusion: Prescription of broad-spectrum antibiotics for common cold and diarrhea, prescribing antibiotics or medicine based on presumption was the clear indications of irrational antibiotics use and inappropriate prescription pattern.
Journal of preventive epidemiology, 2022
Introduction: India is a leading consumer of antibiotics; rational use of antibiotics is of prime importance. Objectives: The majority of the population in India resides in rural areas; hence this study was conducted to capture their knowledge, attitude and practice regarding antibiotic use and antimicrobial resistance. Patients and Methods: A cross-sectional questionnaire-based survey was conducted among 130 randomly selected general public of rural Mangaluru. Descriptive analysis and Pearson's chi-square were employed in data analysis. Results: Adequate knowledge was observed only in 18.5% of the participants. Around 30.8% of participants thought antibiotics killed all germs while 23.8% were of no opinion. Furthermore, 60.8% thought that antibiotics speed up recovery from flu. Only about 23% thought frequent use of antibiotics would make the bacteria stronger and ineffective in the future. A minimal of 16.2% knew that antibiotic resistance is a global problem. About 52.3% preferred to take an antibiotic whenever they had the flu. However, 47% wanted to take it after doctors' consultation. The study showed that compliance to complete the course was better when a doctor explained the proper use of the prescribed antibiotic. Additionally 31.5% opted for self-medication using the previous prescription and 21.5% took the antibiotics suggested by anyone other than the doctor. Conclusion: The study findings help re-evaluate the current public awareness activity and provide insight into some of the areas required to be focused on and aid the adequate legislative changes for a better outcome.