Khare Shweta, Purohit Manju, Sharma Megha, Tamhankar Ashok J, Lundborg Cecilia Stalsby, Diwan Vishal, Pathak Ashish
Department of Public Health Sciences, Global Health-Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, Tomtebodavagen 18A, SE-171 77 Stockholm, Sweden.
Department of Public Health and Environment, RD Gardi Medical College, Ujjain, Madhya Pradesh 456006, India.
Antibiotics (Basel). 2019 Sep 5;8(3):139. doi: 10.3390/antibiotics8030139.
Informal healthcare providers (IHCPs) are predominant healthcare providers in rural India, who prescribe without formal training. Antibiotic prescription by IHCPs could provide crucial information for controlling antibiotic resistance. The aim of this study is to determine the practices and seasonal changes in antibiotic prescribing for common illnesses by IHCPs. A repeated cross-sectional study was conducted over 18 months, covering different seasons in the rural demographic surveillance site, at Ujjain, India. Prescriptions given to outpatients by 12 IHCPs were collected. In total, 15,322 prescriptions for 323 different complaint combinations were analyzed, of which 11,336 (74%) included antibiotics. The results showed that 14,620 (95%) of antibiotics prescribed were broad spectrum and the most commonly prescribed were fluoroquinolones (4771,31%), followed by penicillin with an extended spectrum (4119,27%) and third-generation cephalosporin (3069,20%). Antibiotics were prescribed more frequently in oral and dental problems (1126,88%), fever (3569,87%), and upper respiratory tract infections (3273, 81%); more during the monsoon season (2350,76%); and more frequently to children (3340,81%) than to adults (7996,71%). The study concludes that antibiotics were the more commonly prescribed drugs compared to other medications for common illnesses, most of which are broad-spectrum antibiotics, a situation that warrants further investigations followed by immediate and coordinated efforts to reduce unnecessary antibiotic prescriptions by IHCPs.
非正规医疗服务提供者（IHCPs）是印度农村地区主要的医疗服务提供者，他们在没有接受正规培训的情况下开处方。IHCPs开具抗生素的情况可为控制抗生素耐药性提供关键信息。本研究的目的是确定IHCPs针对常见疾病开具抗生素的做法及季节性变化。在印度乌贾因农村人口监测点进行了一项为期18个月的重复横断面研究，涵盖不同季节。收集了12名IHCPs给门诊患者开具的处方。总共分析了针对323种不同症状组合的15322张处方，其中11336张（74%）包含抗生素。结果显示，所开具的抗生素中有14620张（95%）为广谱抗生素，最常开具的是氟喹诺酮类（4771张，31%），其次是广谱青霉素（4119张，27%）和第三代头孢菌素（3069张，20%）。口腔和牙齿问题（1126张，88%）、发热（3569张，87%）及上呼吸道感染（3273张，81%）时抗生素的开具频率更高；季风季节开具得更多（2350张，76%）；儿童（3340张，81%）比成人（7996张，71%）开具得更频繁。该研究得出结论，与治疗常见疾病的其他药物相比，抗生素是更常开具的药物，其中大多数是广谱抗生素，这种情况值得进一步调查，并立即采取协调一致的努力来减少IHCPs不必要的抗生素处方行为。
