General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications

Abstract

Background: Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Aim: Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. Results: One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions could be appreciably reduced. Conclusion: Further programs are needed to educate GPs and patients about antibiotics building on current initiatives.

Keywords:

• antibiotics
• education programs
• irrational use of medicines
• Malaysia
• patients
• physicians
• respiratory tract infections

Acknowledgements

We would like to thank Madam Noraini Mohamad from the Pharmaceutical Services Division, Ministry of Health, Malaysia, for providing details of the Antibiotic Stewardship Program in Malaysia.

Financial & competing interests disclosure

Faridah Aryani Md Yusof is employed by the Ministry of Health in Malaysia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The majority of private general practitioners (GPs) in the survey, who are the highest prescribers of antibiotics compared with public sector GPs, agreed that antibiotic resistance was problematic in Malaysia, and that antibiotic prescribing can contribute to the development of resistance.

• However, although 84% agreed that most URTIs were caused by viruses, 50% agreed that antibiotics were helpful in treating URTIs, 56% agreed that antibiotics reduce the duration of URTIs and 78% the occurrence of complications from URTIs. The majority of GPs who disagreed with the statement ‘Most URTIs are caused by viruses’ had been practicing for >30 years.

• The majority of GPs felt that patient expectations enhanced their prescribing of antibiotics even if they believed them to be unnecessary, as this was sometimes easier that providing explanations to patients. Overall GPs believed antibiotic prescribing could be reduced by more than 25% without affecting patient outcomes.

• Consequently, there is a need for educational activities among both GPs and patients in Malaysia to improve the rational use of antibiotics, building on current and planned activities by the Ministry of Health.