Al-Taweel Omar, Shubeita Costa, Zayed Fairouz, Al-Hamed Doaa, Al-Tarifi Doaa, Alnadi Mustafa, Adwan Lina
Department of Pharmacy, College of Pharmacy Nursing and Health Professions, Birzeit University, Birzeit, Palestine.
Ramallah and Al-Bireh Health Directorate, Ramallah, Palestine.
J Infect Dev Ctries. 2024 Dec 30;18(12):1909-1915. doi: 10.3855/jidc.19794.
Appropriate antibiotic use requires using the right antibiotic, at the right dose, for the right duration, and at the right time. Drug-resistant diseases cause numerous deaths globally a year, and antibiotic stewardship is a cornerstone in fighting antibiotic resistance. This study focuses on tracking the antibiotic prescribing practices in Palestine and improving future antibiotic prescribing.
Data from prescriptions of the most commonly prescribed antibiotics was collected from the Health Department of Ramallah and Al-Bireh clinics between January 1 to March 31, 2020. The prescriptions were divided into three categories according to the diagnosis status: unwritten, unspecific, and precise diagnosis. The precise prescriptions were further divided into two categories: appropriate or inappropriate indication. Only appropriate prescriptions were candidates for the assessment of dose and duration appropriateness.
The percentages of the three categories of diagnosis precise, unspecific, and unwritten were 23.4%, 20.4%, and 56.2%, respectively. The percentage of appropriate prescriptions was 16.2%. Azithromycin was the most over-utilized antibiotic, followed by co-amoxiclav (amoxicillin/clavulanic acid). Amoxicillin and co-trimoxazole (trimethoprim/sulfamethoxazole) were under-prescribed. All the prescriptions indicated for urinary tract infections (UTIs) were inappropriate.
Most prescriptions were not candidates for analysis due to missing diagnosis. Amoxicillin, co-amoxiclav, cefuroxime, azithromycin, and ciprofloxacin were the most commonly prescribed antibiotics and were mostly indicated for pharyngitis. The duration of all sinusitis regimens was inappropriate. More rational antibiotic use in the Department of Health could be achieved by improving documentation, following updated guidelines, choosing cost-effective agents, and keeping track of local resistance patterns and antibiograms.
合理使用抗生素需要在正确的时间，以正确的剂量、疗程使用正确的抗生素。耐药性疾病每年在全球导致无数人死亡，而抗生素管理是对抗抗生素耐药性的基石。本研究重点关注追踪巴勒斯坦的抗生素处方行为，并改善未来的抗生素处方。
收集了2020年1月1日至3月31日期间拉马拉和比尔宰特诊所卫生部门最常用抗生素的处方数据。根据诊断情况，处方分为三类：未书写诊断、非特异性诊断和明确诊断。明确诊断的处方进一步分为两类：适应证恰当或不恰当。只有适应证恰当的处方才作为评估剂量和疗程是否恰当的对象。
明确诊断、非特异性诊断和未书写诊断这三类的百分比分别为23.4%、20.4%和56.2%。适应证恰当的处方百分比为16.2%。阿奇霉素是使用最过度的抗生素，其次是阿莫西林克拉维酸。阿莫西林和复方新诺明（甲氧苄啶/磺胺甲恶唑）的处方量不足。所有针对尿路感染（UTI）的处方均不恰当。
由于缺少诊断，大多数处方不适合进行分析。阿莫西林、阿莫西林克拉维酸、头孢呋辛、阿奇霉素和环丙沙星是最常用的抗生素，主要用于治疗咽炎。所有鼻窦炎治疗方案的疗程均不恰当。通过改善病历记录、遵循最新指南、选择性价比高的药物以及跟踪当地的耐药模式和抗菌谱，可以在卫生部实现更合理的抗生素使用。
