Prescribing patterns for upper respiratory tract infections: a prescription-review of primary care practice in Kedah, Malaysia, and the implications

Abstract

Introduction and aims: It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014. Results: A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122). Conclusions: Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.

Keywords:

• antibiotics stewardship programs
• guidelines
• inappropriate use of antibiotics
• Malaysia
• primary healthcare centres
• upper respiratory tract infections

Acknowledgement

The authors would like to thank the Director General of Health Malaysia for permission to publish this paper. We would also like to thank Madam Noraini Mohamad from the Pharmaceutical Services Division, Ministry of Health, Malaysia, for her comments on National Antibiotic Guidelines.

Financial & competing interests disclosure

Faridah Md Yosof Aryani, Mardhiyah Kamal and Rosminah Mohd Din are employed by the Ministry of Health in Malaysia. There was a small grant from the Karolinska Institute to help with the writing of the paper. 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.

Key issues

• There have been recent initiatives in Malaysia to improve the prescribing of antibiotics for upper respiratory tract infections (URTIs) among prescribers in primary healthcare centers. These include guidelines and antibiotic stewardship programs.

• To assess the need for further initiatives to improve the prescribing of antibiotics for URTIs, it is necessary to ascertain current prescribing practices. Consequently, a retrospective analysis was conducted of all prescriptions for URTIs among primary healthcare centers from 1 January to 31 March 2014.

• During this period, 123,524 prescriptions were screened and analyzed, of which 7129 prescriptions were for URTIs, with 31.8% (n = 2269) containing antibiotics.

• There was an appreciable tendency among medical officers and assistant medical officers to prescribe antibiotics for the management of URTIs when a prescription was issued (34.0 and 29.5%, respectively) versus only 10.6% for family medicine specialists. Tonsillitis, otitis media and pharyngitis were the most common indications for antibiotics.

• Macrolides were the most commonly prescribed antibiotic, constituting 61% of total antibiotics prescribed, despite the fact that penicillins are the recommended first-line treatment. Erythromycin has been removed from national guidelines due to high resistance patterns and replaced with azithromycin and clindamycin.

• While there appears to be a reduction in the prescribing of antibiotics in primary healthcare centers in this study versus previous studies, there are areas of concern, which includes some prescribing of antibiotics being inconsistent with current guidelines. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use, and their impact needs to be monitored in the future.

Notes

ASP: Antibiotic stewardship program; URTIs: Upper respiratory tract infections.