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Profile Of Antibiotic Use At The Health Centre
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CHAPTER ONE
INTRODUCTION
1.1 Background of Study
Antibiotics
account for the most commonly prescribed drugs in the hospital setting.
Inappropriate antibiotic prescribing and the increasing levels of
resistance are now issues of global concern (Charani et al., 2010).
According to Davy et al., (2005), a significant proportion of antibiotic
prescriptions within hospitals have been described as inappropriate. Up
to 50% of antibiotic use is inappropriate (Ashiru-Oredope et al.,
2012).
Information about antimicrobial prescribing patterns is
necessary for a constructive approach to challenges that arise from the
multiple antibiotics that are available (Srishyla, et al., 1994).
Excessive and inappropriate use of antibiotics in hospitals, health care
facilities and the community contributes to the development of
bacterial resistance (Shankar et al., 2003).
Irrational prescribing
habits for antibiotics lead to ineffective and unsafe treatment of
medical conditions. Moreover, irrational prescribing may worsen or
prolong the illness thereby leading to distress and harm to the patient.
As Sharma and Kapoor (2003) argued, not only does irrational
prescribing lead to exorbitant costs of medicines, its occurrence is
common in clinical practice.
The decision model of prescribing
antibiotics is rather complex and multiple factors other than clinical
considerations can influence the decision to prescribe. These factors
include patient characteristics, physician characteristics, and medical
environments such as competition for clients. Patient characteristics
such as age, lower socio-economic status, and higher co-morbidity have
significant effects on the antibiotic prescription rate. Physician
characteristics, including gender, age, time since graduation, and
volume of practice, also significantly influence antibiotic prescription
(Choi et al., 2008). They also pointed out that an urban location of a
medical practice and patient income level also influence antibiotic
prescription rates. Other significant predictors are the physician
expertise (that is specialist or generalist). Choi et al., (2008)
further argued that medical environment variables such as the number of
primary care clinics and number of hospital beds affect the rate of
antibiotic prescription.
Sharma and Kapoor, (2003) attributed
irrational prescribing to lack of knowledge about drugs, unethical drug
promotions, high patient load, ineffective laboratory facilities,
availability of drugs, and ineffective law enforcement by governments
with subsequent failure to ensure compliance to guidelines. The
irrational prescribing of antibiotics (particularly broad-spectrum
antibiotics), in primary care is a major contributing factor to reduced
drug efficacy, increased prevalence of resistant pathogens in the
community, and the appearance of new co-infections (Sharma and Kapoor,
2003).
Antimicrobial resistance is currently the greatest challenge
to the effective treatment of infections globally. Resistance adversely
affects both financial and therapeutic outcomes with effects ranging
from the failure of an individual patient to respond to therapy and the
need for expensive or toxic alternative drugs to the social costs of
higher morbidity and mortality rates, required or longer durations of
hospitalisation, increased health care costs and the need for changes in
empirical therapy (Essack, 2006).
Previous studies on prescribing
patterns have looked at the evaluation of rational therapy, the
appropriateness of prescribing antibiotics and antibiotic use,
resistance development and environmental factors. These factors
addressed the characteristics of individual patients and doctors,
related with prescription episodes. Most studies have shown that there
is inappropriate prescribing. The use of antibiotics and a large number
of prescriptions did not conform to the ideal pattern (Baktygul et al.,
2011).
Medicines consume a significant portion of the total health
care budget. Equitable access to affordable medicines remains a
challenge. The Standard Treatment Guidelines and Essential Medical List
ensure the cost-effective treatment options are available to citizens of
the country, and seek to build capacity in health care workers at the
Primary Health Care level.
Antibiotics are among the most frequently
used drugs worldwide. They are particularly utilized in developing
countries, where an average of 35% of the total health budget is spent
on antibiotics (Isturiz & Carbon., 2000, cited in Makhado, 2009). In
Zambia for instance, the University Teaching Hospital alone spends well
over 15.28 % of its medicines budget on antibiotics per quarter of the
financial year (UTH Pharmacy records, 2013-unpublished data).
Monitoring
of prescriptions and drug utilisation studies can identify the problems
and provide feedback to prescribers and other stake holders so as to
create awareness about irrational use of antibiotics. This study was
undertaken to investigate the prescribing and profile of antibiotics use
at the Health centre of delta state University, Abraka.
This study
aimed at describing the patterns of antibiotic prescribing and to
suggest modifications in practitioners prescribing habits so as to make
medical care rational and cost-effective.
Rational prescribing and
appropriate drug use are the keys to achieving optimum therapeutic goal.
This is because inappropriate prescribing can lead to therapeutic
failure, toxicity, drug interactions and even death of the patient (for
which the physician and the dispensing pharmacist can be held
responsible for professional misconduct), which then provides basis for a
claim for compensation (Brahams, 1989). Poly-pharmacy is a recipe for
adverse drug interactions (Irshaid et al, 2005); increase risk of
bacterial resistance (Yousif et al., 2006; WHO, 2000); non-compliance
(Pearson,1982) and increased burden/ cost to both patient and the health
care delivery system (George-Kutty et al., 2002).
Inappropriate
prescribing is known all over the world to be a major problem to health
care delivery; and tactless prescribing is widespread (Rashid et al.,
1986). It is a feature in health care settings in developing countries
and is characterized by poly-pharmacy, excessive use of antibiotics, and
injections (Laing, 1990; Isah et al., 2001, Ohaju-Obodo et al., 1998;
Akande and Ologe, 2007).
Inappropriate prescribing will have an
important economic and medical impact on health care as it makes
treatment of patients more costly, more risky and less rewarding.
Increased generic prescribing would rationalize drug use and reduce cost
of treatment to the patient and lessen the burden on the health care
delivery system (Quick et al., 2002; Hogerzveil, 1995).
Rational drug
prescribing has remained a global concern such that countries have
established health regulations to guard against irrational,
inappropriate or negligent prescribing, which is regardless of the
considerable improvements that has been made in the availability and
control of drugs in hospitals over time (Laing, 1990; Hogervzeil, 1995).
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ABSRACT - [ Total Page(s): 1 ] The indiscriminate use of antibiotics has become a global problem with implications for effective therapy of infections and dose resistance. The objective of this study is to determine the profile of antibiotic use at the health centre of Delta State University, Abraka. This study was a retrospective study of 592 patient prescriptions from January – June 2015. The data used for this study was obtained by assessing patients’ medical record file from the Medical Record Department a ... Continue reading---
