Utilization of antibiotics in primary healthcare setting / Shafinaz Shamsuddin

Background : In the primary settings, oral antimicrobial drugs feature consistently in the top leading therapeutic classes of drugs, in terms of frequency of use and cost. This trend is similar in the managed care environment. It is thus imperative to monitor the trend of usage patterns to determine its impact on the managed health care system. Nowadays awareness of the rational use of medicine is increasing among healthcare professionals. The fundamental step on supporting the rational use of medicine is by collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions Objective : To describe the pattern of use of selected antibiotic prescribing for acute infectious diseases among adult in the primary care settings of PKD Klang. Method : This was a retrospective study of the utilization of selected antibiotics in three (3) government health clinics under in Selangor. The Information identified from electronic Clinic Management System (e-CMS) from January to December 2013. The prescribed medicine, frequency and dose were recorded for each patient to obtain the drugs' Defined Daily Dose (DDD) per 1,000 inhabitants per day. We referred Malaysian CPG on the National Antibiotic Guideline 2008 to evaluate the quality of prescribing. Result : A total of 73 5 patient encounters was analysed, females were significantly higher as compared to males (60.4% versus 39.6% %2= 8.8,p = 0.01). Patients aged between 18 to 30 years old was the highest (n=304, 41.4%). However, age range between patients were similar (%2= 3.5, p = 0.48). The mean age (SD) was 36.11 (12.66).From the expenditure data in 2011-2013, Amoxycillin 250mg cap showed the highest purchased and usage item. Total antibiotics used for the 3 clinics is 2.675 DID. The five most utilized antibiotics was Amoxycillin (1.36 DID) followed by Cloxacillin (0.68 DID), Erythromycin (0.32 DID), Cephalexin (0.11 DID) and Bacampicillin (0.13 DID). The Pandamaran health clinic showed the highest utilized Amoxycillin which is (1.49 DID). There was no significant difference between gender and age range. Indian patient consumed the most Amoxycillin 250mg cap (35.8%) followed by Malay (34.8%) and Chinese (33.1%). Amoxycillin 250mg cap is mainly prescribed for respiratory infections (54.2%)

Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation

Objectives: To examine the appropriateness of antibiotics prescribed for acute infection based on the Malaysian national antibiotic guidelines and the defined daily dose (DDD) system of the World Health Organization (WHO). This study also aimed to describe the factors influencing the drug use pattern and to investigate the procurement patterns of antibiotics in the primary healthcare setting. Methods: A retrospective cohort follow-up study of randomly selected patients from all patients who received any antibiotic between January and December 2013 was conducted at three primary healthcare clinics in Selangor State of Malaysia. For each patient, the following information was recorded: name of the antibiotic, frequency and dose, and Anatomical Therapeutic Chemical (ATC) group. The defined daily dose per 1000 inhabitants per day was calculated for each antibiotic. The national antibiotic guidelines were used to assess the appropriateness of each antibiotic prescription. Results: A total of 735 patients were included in the study. The five most used antibiotics were amoxicillin (1.36 g, 35.2%), cloxacillin (0.68 g, 26.3%), erythromycin (0.32 g, 22.3%), bacampicillin (0.13 g, 7.2%), and cephalexin (0.11 g, 6.9%). Respiratory tract infections were the most commonly treated infections, and the doctors’ preferred antibiotic for the treatment of these infections was amoxicillin. More than 18% of all amoxicillin prescriptions were deemed inappropriate according to the national antibiotic guidelines. In terms of procurement costs, USD 88 885 was spent in 2011, USD 219 402 in 2012, and USD 233 034 in 2013 at the three primary healthcare clinics, an average of USD 180 440 per year for the three clinics. Conclusions: This study reports the antibiotic usage at three primary healthcare clinics in Klang Province. The most prescribed antibiotic was amoxicillin in capsules (250 mg), which was mainly prescribed for respiratory infections. Although the national antibiotic guidelines state that amoxicillin is a preferred drug for acute bacterial rhinosinusitis, this drug is also being prescribed for other disease conditions, such as acute pharyngitis and acute tonsillitis. This result shows that current practice is not following the current antibiotic guidelines, which state that phenoxypenicillin should be the preferred drug