Evidence-based practice in the use of antibiotics for respiratory tract infections in primary health centers in Kuwait.

OBJECTIVES

The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections (URTIs) in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines.

SUBJECTS AND METHODS

A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of these, 270 patients had URTI and were included in the analysis. Data collection was done by observing the whole process starting from patient presentation and history taking to final diagnosis and treatment by the physicians.

RESULTS

Our study showed that about 135 (50%) of the patients with URTIs were given antibiotics, of which only 8 (6%) could be justified according to the NICE guidelines. However, prescriptions for 132 (98%) patients who were not given antibiotics could also be considered as evidence-based. Patients presenting with symptoms such as fever (OR = 2.7; p < 0.001) and sore throat (OR = 1.9; p < 0.01) were more likely be given antibiotics than those presenting without such symptoms. Furthermore, patients diagnosed with tonsillitis (OR = 25; p < 0.002), otitis media (OR = 9; p < 0.004), common cold (OR = 3; p < 0.049) or pharyngitis (OR = 2.7; p < 0.003) were more likely be given an antibiotic treatment as well. We also found that non-Kuwaitis were prescribed antibiotics more often than Kuwaitis (OR = 2.0; p < 0.005).

CONCLUSION

This study showed a very high percentage of non-evidence-based prescriptions of antibiotics in Kuwait, and should be of great public health concern. Although overuse of antibiotics in primary care settings has been well reported from around the world, our finding of non-evidence-based use at 94% is of great public health concern since this may be linked primarily to the lack of evidence-based practice in Kuwait.