Mishra Sudhir, Srivastava Preeti, Sunder Sarala, Mishra Asit Kumar, Tanti Sanjay Kumar
Department of Pediatrics, Tata Main Hospital, Jamshedpur, Jharkhand, India.
Indian J Pharmacol. 2022 Jan-Feb;54(1):13-18. doi: 10.4103/ijp.ijp_373_21.
Inappropriate antibiotic (ab)use contributes to antimicrobial resistance. Upper respiratory tract infection (URTI) is the most common reason for antibiotic prescription in an outpatient department (OPD). Several factors influence the high and unjustified antibiotic use in a common ailment.
A clinical audit was performed to assess antibiotic prescription rate (APR) for URTI in the pediatric OPD against the available benchmark. The prescription pattern was assessed, and interventions were formulated to improve prescription behavior. Data of all children attending OPD and fulfilling the criteria for URTI group were collected from the online hospital management system and analyzed. Interventions, in the form of discussions, presentations, posters, and guidelines (Indian Ministry of Health Guidelines for URTI) regarding etiology of URTI, and indications for antibiotic prescription were implemented. Data were monitored and feedback to consultants was given.
The baseline APR was 14.7%. There was wide variation in APR (4.1%-53.1%) among consultants. Three consultants had a rate of 53.1%, 29.7%, and 28.6%, which was very high. Postintervention, the average APR decreased to 8.7%, a reduction of 40.8%. There was a reduction in APR among consultants with high APR as well. There was reduction in the use of azithromycin, a drug recommended for patients with penicillin allergy, from 21.2% to 14.4% (32.1% reduction). Amoxycillin plus clavulanic acid combination and amoxicillin alone continued to be the most prescribed antibiotics.
Interventions through clinical audit were useful in reducing APR. The APR of 8.7% achieved in this study postintervention can be used as a benchmark by other institutions to assess APR in children with URTI.
不恰当的抗生素使用会导致抗菌药物耐药性。上呼吸道感染（URTI）是门诊抗生素处方最常见的原因。多种因素导致了这种常见疾病中抗生素的高使用率和不合理使用。
进行了一项临床审计，以根据现有基准评估儿科门诊中URTI的抗生素处方率（APR）。评估了处方模式，并制定了干预措施以改善处方行为。从在线医院管理系统收集并分析了所有到门诊就诊且符合URTI组标准的儿童的数据。通过讨论、讲座、海报和指南（印度卫生部URTI指南）等形式，就URTI的病因和抗生素处方指征进行了干预。对数据进行监测并向顾问提供反馈。
基线APR为14.7%。顾问之间的APR存在很大差异（4.1%-53.1%）。三位顾问的比率分别为53.1%、29.7%和28.6%，非常高。干预后，平均APR降至8.7%，降低了40.8%。高APR顾问的APR也有所下降。推荐给青霉素过敏患者的阿奇霉素的使用从21.2%降至14.4%（降低了32.1%）。阿莫西林加克拉维酸组合和单独的阿莫西林仍然是最常处方的抗生素。
通过临床审计进行的干预有助于降低APR。本研究干预后达到的8.7%的APR可被其他机构用作评估URTI儿童APR的基准。
