Kotwani Anita, Joshi P C, Jhamb Urmila, Holloway Kathleen
Department of Pharmacology, V. P. Chest Institute, University of Delhi, New Delhi, India.
Department of Anthropology, University of Delhi, New Delhi, India.
Indian J Pharmacol. 2017 Nov-Dec;49(6):419-431. doi: 10.4103/ijp.IJP_508_17.
The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior.
Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8-12 participants and lasted 2 h. Furthermore, 22 individual face-to-face semi-structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done.
All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow-up and in addition for GDs, workload, no diagnostic facility, and pressure to use near-expiry medicines. Knowledge was gained through self-experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations.
A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use.
本研究的目的是探讨初级保健医生和社区药剂师在儿童急性上呼吸道感染（URTI）和腹泻中使用抗生素的处方习惯、知识和态度，以更好地理解滥用的原因，并确定医疗服务提供者关于改变这种行为的建议。
在德里分别与政府初级保健医生（GDs）、私人全科医生（GPs）、儿科医生和社区药剂师进行了两组焦点小组讨论（FGDs）。每个焦点小组讨论有8 - 12名参与者，持续2小时。此外，还在不同类型和经验的医疗服务提供者工作场所进行了22次个人面对面半结构式访谈。进行了主题和总结性定性内容分析。
所有组都承认存在抗生素过度使用的情况，在儿童URTI和腹泻方面，全科医生似乎比政府初级保健医生和儿科医生使用更多抗生素。药剂师照搬附近医生的处方。除儿科医生外，所有利益相关者对抗菌素耐药性（AMR）的知识都很匮乏。开具抗生素的原因包括患者压力、利润动机、缺乏随访，此外，对于政府初级保健医生来说，还有工作量、没有诊断设施以及使用临近过期药品的压力。知识通过自我经验、模仿他人、制药公司提供的信息获得，对一些人来说，还通过培训、继续医学教育/会议获得。所有组都指责其他专业团体/庸医过度使用抗生素。建议的干预措施包括通过对医疗服务提供者和公众进行适当抗生素使用和AMR的培训，提高开具处方者的意识并赋予其权力，以及实施更严格的规定。
迫切需要针对医疗服务提供者和消费者的一系列干预措施，以提高认识并改变行为，减少社区抗生素的不适当使用。
