Evaluation of antibiotic prescription in the Lebanese community: a pilot study

Figures & data

Table 1 Characteristics of the study population

Characteristic	n (%)
Gender of patients Male Female	133 (49.3) 137 (50.7)
Age category 1–11 12–21 21–50 ≥51 Missing	53 (19.6%) 36 (13.3%) 142 (52.6%) 34 (12.6%) 5 (1.9%)
Residence Beirut Mount Lebanon Bekaa South North	24 (8.9) 71 (26.3) 3 (1.1) 119 (44.1) 51 (18.9)
Education level Elementary Intermediate Secondary University Missing	37 (13.7) 31 (11.5) 65 (24.1) 87 (32.2) 50 (18.5)
Type of infection Respiratory infection Urinary tract infection Gastrointestinal (diarrhea) Oral infection Skin and soft tissue infection Post-operation wound infection Reproductive system infection Unknown	112 (41%) 37 (14%) 31 (11%) 26 (10%) 11 (4%) 6 (2%) 5 (2%) 42 (16%)
Associated medical condition Yes Hypertension Asthma Renal failure COPD Diabetes Allergy to penicillin Diabetes and asthma Pregnancy No	30 (11.2%) 7 (2.6%) 5 (1.3%) 2 (0.7%) 1 (0.4%) 1 (0.4%) 1 (0.4%) 1 (0.4%) 12 (4.4%) 240 (88.9%)

Table 2 List of prescribed antibiotics

Prescribed antibiotic^a	n (%)
Penicillins (J01C) Amoxicillin–clavulanic acid fixed combination	82 (30.6%) 82 (30.6%)
Cephalosporins (J01D) Cefixime Cefuroxime Ceftriaxone Cefpodoxime Cefadroxil Cefdinir Cephalexin Cefadoxime	87 (32%) 44 (16.1%) 17 (6.3%) 14 (5.2%) 5 (1.9%) 3 (1.1%) 2 (0.7%) 1 (0.4%) 1 (0.4%)
Quinolones (J01M) Levofloxacin Ciprofloxacin Norfloxacin Moxifloxacin	55 (20%) 27 (10%) 25 (9.3%) 2 (0.7%) 1 (0.4%)
Macrolides (J01F) Azithromycin Clarithromycin	22 (8%) 15 (5.6%) 7 (2.6%)
Metronidazole–spiramycin combination (P01AB51)	15 (5.6%)
Lincosamide (J01F) Clindamycin Lincomycin	5 (2%) 3 (1.1%) 2 (0.7%)
Tetracycline (J01A) Doxycycline	2 (0.7%) 2 (0.7%)
Rifaximin (A07AA11)	2 (0.7%)

^aATC index codes are shown. Available at: www.whocc.no/atc_ddd_index/

Fig. 1.  Percentages of conformity and non-conformity of antibiotic choice, dose, duration of treatment, and global conformity to Infectious Diseases Society of America guidelines.

Table A.1. Antibiotics prescribed and their corresponding diagnostics

Antibiotic	Diagnostic (n)
Amoxicillin–clavulanic acid	Pharyngitis (21) Otitis (2) Acute bronchitis (4)	Dental infections and gingivitis (16) Uncomplicated cystitis (UTI) (5) Post-operative wound infection (5)
Cefixime	Pharyngitis (5) Acute bronchitis (5) Otitis (3) Rhinosinusitis (2) Community acquired pneumonia (1)	Diarrhea (14) Uncomplicated cystitis (11) Clostridium difficile infection (1) Skin and soft tissue infection (1) Orchitis (1)
Levofloxacin	Community acquired pneumonia (10) Rhinosinusitis (5) Acute bronchitis (4) Flu (1)	Chronic bronchitis acute exacerbation (3) Prostatitis (1) Uncomplicated cystitis (UTI) (1)
Ciprofloxacin	Community acquired pneumonia (1) Rhinosinusitis (1) Uncomplicated cystitis and pyelonephritis (UTI) (14)	Prostatitis (1) Diarrhea (6)
Cefuroxime	Acute bronchitis (2) Pharyngitis (5) Community acquired pneumonia (1) Otitis (3) Rhinosinusitis (1)	Uncomplicated cystitis (UTI) (1) Dental infection (1) Knee surgery (1) Rectal abscess (1) Delivery (1)
Metronidazole–spiramycin	Diarrhea (5) Dental infections and gingivitis (8) Vaginal infection (1)	Skin and soft tissue infection (1)
Azithromycin	Community acquired pneumonia (4) Sore throat (2) Pharyngitis (3)	Acute bronchitis (4) Bronchiolitis (1) Asthma-related infection (1)
Ceftriaxone	Community acquired pneumonia (1) Pharyngitis (3) Otitis (1)	Uncomplicated cystitis (UTI) (2)
Clarithromycin	Pharyngitis (1) Community acquired pneumonia (1)	Acute bronchitis (2) Diarrhea (2)
Cefpodoxime	Rhinosinusitis (1) Pharyngitis (1)	Acute bronchitis (2) Uncomplicated cystitis (UTI) (1)
Clindamycin	Skin and soft tissue infection (3)
Cefadroxil	Skin and soft tissue infection (3)
Norfloxacin	Uncomplicated cystitis (UTI) (2)
Rifaximin	Diarrhea (2)
Lincomycin	Dental infection (1)	Pharyngitis (1)
Cefdinir	Pharyngitis (2)
Doxycycline	Skin and soft tissue infection (1)
Cephalexin	Skin and soft tissue infection (1)
Moxifloxacin	Acute bronchitis (1)
Cefadoxime	Skin and soft tissue infection (1)

Table A.2. Choice of drug conformity to guidelines

		Conformity	Non-conformity	P
Doctors type	General practitioner	54 (63.5%)	31 (36.5%)	0.765
	Specialist practitioner	114 (61.6%)	71 (38.4%)
Gender of patients	Male	90 (67.7%)	43 (32.3%)	0.069
	Female	78 (56.9%)	59 (43.1%)
Age category	1–11	25 (47.2%)	28 (52.8%)	0.035
	12–21	26 (72.2%)	10 (27.8%)
	21–50	88 (62.0%)	54 (38.0%)
	≥51	25 (73.5%)	9 (26.5%)
Residence	Beyrouth	14 (58.3%)	10 (41.7%)	0.311
	Mount Lebanon	50 (70.4%)	21 (29.6%)
	Bekaa	1 (33.3%)	2 (66.7%)
	North	32 (62.7%)	19 (37.3%)
	South	70 (58.8%)	49 (41.2%)
Level of education of patients	Elementary	24 (64.9%)	13 (35.1%)	0.555
	Intermediate	18 (58.1%)	13 (41.9%)
	Secondary	41 (63.1%)	24 (36.9%)
	University	59 (67.8%)	28 (32.2%)
Is there any fever?	Yes	98 (64.5%)	54 (35.5%)	0.316
	No	66 (58.4%)	47 (41.6%)
How long did fever persist?	1 day	22 (53.7%)	19 (46.3%)	0.012
	2 days	37 (64.9%)	20 (35.1%)
	3 days	25 (75.8%)	8 (24.2%)
	1 week	8 (88.9%)	1 (11.1%)
Laboratory culture	Yes	34 (63%)	20 (37%)	0.931
	No	134 (62.3%)	81 (37.7%)

Table A.3. Dose conformity to guidelines

		Conformity	Non-conformity	P
Doctors	General practitioner	44 (51.8%)	41 (48.2%)	0.471
	Specialist	87 (47%)	98 (53%)
Gender of patient	Male	77 (57.9%)	56 (42.1%)	0.002
	Female	54 (39.4%)	83 (60.6%)
Age category	1–11	22 (8.3%)	31 (11.69%)	0.216
	12–21	21 (7.92%)	15 (5.66%)
	22–50	64 (24.15%)	78 (29.43%)
	≥51	22 (8.3%)	12 (4.52%)
Residence	Beyrouth	12 (50%)	12 (50%)	0.771
	Mount Lebanon	34 (47.9%)	37 (52.1%)
	Bekaa	2 (66.7%)	1 (33.3%)
	North	20 (39.2%)	31 (60.8%)
	South	62 (52.1%)	57 (47.9%)
Level of education	Elementary	20 (64.9%)	17 (35.1%)	0.903
	Intermediate	14 (58.1%)	17 (41.9%)
	Secondary	32 (63.1%)	33 (36.9%)
	University	44 (67.8%)	43 (32.2%)
Is there any fever?	Yes	85 (55.9%)	67 (44.1%)	0.004
	No	43 (38.1%)	70 (61.9%)
How long did fever persist?	1 day	21 (51.2%)	20 (48.8%)	0.158
	2 days	31 (54.4%)	26 (45.6%)
	3 days	20 (60.6%)	13 (39.4%)
	1 week	7 (77.8%)	2 (22.2%)
Laboratory culture	Yes	31 (57.4%)	23 (42.6%)	0.153
	No	100 (46.5%)	115 (53.5%)

Table A.4. Conformity of the duration of the antibiotic course to guidelines

		Conformity	Non-conformity	P
Doctors	General practitioner	32 (37.6%)	53 (62.4%)	0.778
	Specialist	73 (39.5%)	112 (60.5%)
Age category	1–11	14 (5.28%)	39 (14.71%)	0.124
	12–21	16 (60.3%)	20 (7.54%)
	22–50	58 (21.88%)	84 (31.69%)
	≥51	14 (5.28%)	20 (7.54%)
Gender of patients	Male	60 (45.1%)	73 (54.9%)	0.39
	Female	45 (32.8%)	92 (67.2%)
Residence	Beyrouth	11 (45.8%)	13 (54.2%)	0.238
	Mount Lebanon	30 (42.3%)	41 (57.7%)
	Bekaa	1 (33.3%)	2 (66.7%)
	North	20 (39.2%)	31 (60.8%)
	South	42 (35.3%)	77 (64.7%)
Level of education	Elementary	15 (40.5%)	22 (59.5%)	0.754
	Intermediate	13 (41.9%)	18 (58.1%)
	Secondary	26 (40%)	39 (60%)
	University	38 (43.7%)	49 (56.3%)
Is there any fever?	Yes	56 (36.8%)	96 (63.2%)	0.435
	No	47 (41.6%)	66 (58.4%)
How long did fever persist?	1 day	11 (26.8%)	30 (73.2%)	0.107
	2 days	23 (40.4%)	34 (59.6%)
	3 days	15 (45.5%)	18 (54.5%)
	1 week	4 (44.4%)	5 (55.6%)
Laboratory culture	Yes	21 (38.9%)	33 (61.1%)	0.981
	No	84 (39.1%)	131 (60.9%)

Table A.5. Global conformity to guidelines

		Conformity	Non-conformity	P
Doctors	General practitioner	25 (29.4%)	60 (70.6%)	0.755
	Specialist	51 (27.6%)	134 (72.4%)
Gender of patient	Male	44 (33.1%)	89 (66.9%)	0.76
	Female	32 (23.4%)	105 (76.6%)
Age category	1–11	12 (4.52%)	41 (15.47%)	0.425
	12–21	12 (4.52%)	24 (9.05%)
	22–50	40 (15.09%)	102 (38.49%)
	≥51	11 (4.15%)	23 (8.67%)
Residence	Beyrouth	10 (41.7%)	14 (58.3%)	0.432
	Mount Lebanon	20 (28.2%)	51 (71.8%)
	Bekaa	0 (0%)	3 (100%)
	North	11 (21.6%)	40 (78.4%)
	South	34 (28.6%)	85 (71.4%)
Level of education	Elementary	12 (32.4%)	25 (67.6%)	0.539
	Intermediate	10 (32.3%)	21 (67.7%)
	Secondary	20 (30.8%)	45 (69.2%)
	University	24 (27.6%)	63 (72.4%)
Is there any fever?	Yes	46 (30.3%)	106 (69.7%)	0.413
	No	29 (25.7%)	84 (74.3%)
How long did fever persist?	1 day	9 (22%)	32 (78%)	0.153
	2 days	18 (31.6%)	39 (68.4%)
	3 days	13 (39.4%)	20 (60.6%)
	1 week	3 (33.3%)	6 (66.7%)
Laboratory culture	Yes	19 (35.2%)	35 (64.8%)	0.207
	No	57 (26.5%)	158 (73.5%)