Department of Community Health, Mbarara University of Science and Technology, Mbarara, P.O Box 1410, Uganda.
Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda.
BMC Pulm Med. 2024 Sep 12;24(1):446. doi: 10.1186/s12890-024-03246-9.
Most respiratory tract infections (RTIs) are viral and do not require antibiotics, yet their inappropriate prescription is common in low-income settings due to factors like inadequate diagnostic facilities. This misuse contributes to antibiotic resistance. We determined antibiotic prescription patterns and associated factors among outpatients with RTIs in Jinja City, Uganda.
We conducted a retrospective observational study that involved data abstraction of all patient records with a diagnosis of RTIs from the outpatient registers for the period of June 1, 2022, to May 31, 2023. An interviewer-administered questionnaire capturing data on prescribing practices and factors influencing antibiotic prescription was administered to drug prescribers in the health facilities where data were abstracted and who had prescribed from June 1, 2022, to May 31, 2023. We used modified Poisson regression analysis to identify factors associated with antibiotic prescription.
Out of 1,669 patient records reviewed, the overall antibiotic prescription rate for respiratory tract infections (RTIs) was 79.8%. For specific RTIs, rates were 71.4% for acute bronchitis, 93.3% for acute otitis media, and 74.4% for acute upper respiratory tract infections (URTIs). Factors significantly associated with antibiotic prescription included access to Uganda Clinical Guidelines (Adjusted prevalence ratio [aPR] = 0.61, 95% CI = 0.01-0.91) and Integrated Management of Childhood Illness guidelines (aPR = 0.14, 95% CI = 0.12-0.87, P = 0.002), which reduced the likelihood of prescription. Prescribers without training on antibiotic use were more likely to prescribe antibiotics (aPR = 3.55, 95% CI = 1.92-3.98). Patients with common cold (aPR = 0.06, 95% CI = 0.04-0.20) and cough (aPR = 0.11, 95% CI = 0.09-0.91) were less likely to receive antibiotics compared to those with pneumonia.
The study reveals a high rate of inappropriate antibiotic prescription for RTIs, highlighting challenges in adherence to treatment guidelines. This practice not only wastes national resources but also could contribute to the growing threat of antibiotic resistance. Targeted interventions, such as enforcing adherence to prescription guidelines, could improve prescription practices and reduce antibiotic misuse in this low-income setting.
大多数呼吸道感染（RTIs）是由病毒引起的，不需要使用抗生素，但由于诊断设施不足等因素，在低收入环境中抗生素的不适当处方仍然很常见。这种滥用导致了抗生素耐药性的产生。我们确定了在乌干达金贾市门诊 RTIs 患者中的抗生素处方模式和相关因素。
我们进行了一项回顾性观察研究，从 2022 年 6 月 1 日至 2023 年 5 月 31 日期间，从门诊登记处提取所有 RTIs 患者的病历记录。我们对在数据提取的卫生设施中从 2022 年 6 月 1 日至 2023 年 5 月 31 日开具处方的药物提供者进行了访谈式问卷调查，以获取有关处方实践和影响抗生素处方的因素的数据。我们使用修正泊松回归分析来确定与抗生素处方相关的因素。
在审查的 1669 份患者记录中，呼吸道感染（RTIs）的总体抗生素处方率为 79.8%。对于特定的 RTIs，急性支气管炎的比率为 71.4%，急性中耳炎为 93.3%，急性上呼吸道感染（URTIs）为 74.4%。与抗生素处方显著相关的因素包括获得乌干达临床指南（调整后患病率比[aPR] = 0.61，95%置信区间[CI] = 0.01-0.91）和儿童疾病综合管理指南（aPR = 0.14，95%CI = 0.12-0.87，P = 0.002），这降低了处方的可能性。没有接受过抗生素使用培训的医生更有可能开具抗生素处方（aPR = 3.55，95%CI = 1.92-3.98）。与肺炎患者相比，患有普通感冒（aPR = 0.06，95%CI = 0.04-0.20）和咳嗽（aPR = 0.11，95%CI = 0.09-0.91）的患者接受抗生素治疗的可能性较低。
研究显示，RTIs 的抗生素处方不合理率很高，这表明在遵守治疗指南方面存在挑战。这种做法不仅浪费了国家资源，而且还可能导致抗生素耐药性的日益威胁。针对这种情况，采取如执行处方指南等有针对性的干预措施，可能会改善低收入环境中的处方实践，并减少抗生素的滥用。
