Antibiotic prescribing in outpatients: Hospital and seasonal variations in Ujjain, India

Abstract

Background: We prospectively explored prescribing patterns, with an emphasis on seasonal and hospital differences, for adults and children under 5 y of age reporting to the outpatient clinics of 2 hospitals (1 teaching hospital and 1 non-teaching hospital) in Ujjain, India. Methods: The study was done over 15 months from November 2007 to February 2009, covering 4 seasons (2 winters, 1 summer and 1 rainy season). The treating consultant completed diagnosis prescribing forms for first consultations with outpatients for selected infectious disease complaints (n = 5623). Antibiotics were coded according to the World Health Organization, Anatomic Therapeutic Chemical classification with defined daily dose (ATC/ DDD). All DDD were calculated per 1000 patients per diagnosis (DDD/TPD). Results: The study covered 80% of all first consultations. Antibiotics were prescribed to 66.3% (3732/5623) of patients. Indications of antibiotic prescribing were respiratory tract infections (42.9%), vaginal discharge (24.2%), urinary tract infections (11.5%), skin and soft tissue infections (10.5%), diarrhoea (9.4%), dysentery (1.2%) and prophylaxis (0.6%). The most commonly prescribed antibiotic group was the quinolones. The antibiotic prescribing rate differed by diagnosis, age group, education, hospital and season, and was 11.3 percentage units less in the teaching hospital compared to the non-teaching hospital (p < 0.001). The study showed higher prescribing of broad-spectrum antibiotics in the non-teaching hospital, with a peak-prescribing rate (75%) during the summer, while the teaching hospital had a peak prescribing rate (70%) during the rainy season. Conclusions: The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings.

Keywords::

• Outpatient
• diagnosis
• antibiotic prescribing
• pharmacoepidemiology
• India

Acknowledgements

We thank all the participating physicians and patients for their co-operation during data collection and Dr V. K. Mahadik, Medical Director, R. D. Gardi Medical College, for administrative support during the project. This project is funded by the Swedish Research Council (VR; project No. K2007-70X-20514-01-3) and the Asia Link. Ashish Pathak received an Erasmus Mundus External Co-operation Window Lot 15 India scholarship and a Swedish Research School for Global Health scholarship for doctoral studies at Karolinska Institutet.

Declaration of interest: No conflict of interest.