Prescribing Patterns for Acute Respiratory Infections in Children in Primary Health Care Centers, Makkah Al Mukarramah, Saudi Arabia

Abstract

Acute respiratory infections (ARI) are a major public health problem and one of the commonest reasons for visiting primary health care centers (PHC). In developing countries, seventy-five percent of the cases are treated with antibiotics, although the majority are caused by viral infection. Our aim was to observe the pattern of physician practices with respect to ARI, in comparison to WHO protocols and to provide recommendations for health promotion enhancement. The study was conducted in Makkah PHC centers, for 2 months. A total 14 PHC centers were randomly selected. And 908 prescriptions were obtained randomly from general practitioners (GP) and analyzed. We found that males were 522 and females were and 386. Weights were not recorded in 224 (24.7%) cases. In 87 cases (9.6%) no diagnosis was recorded. In 515 (62.34%) of cases, antibiotics were prescribed; most of these cases were of simple common cold, with antibiotics not recommended. To conclude, many physicians in Makkah are not following the WHO guidelines for Acute Respiratory Infection. Educational health programs should be conducted to sensitize the physicians regarding the appropriate method of diagnosis and rational use of antibiotics.

Systematic Review: Study of the Prescribing Pattern of Antibiotics in Outpatients and Emergency Departments in the Gulf Region

“…Cephalosporins are widely prescribed in outpatient settings in the Gulf region. Overall, 30-40% of all antimicrobials prescribed in the Gulf region are cephalosporins with few exceptions (Senok et al, 2009;John et al, 2014;Al-Balushi et al, 2014;Al Alawi et al, 2015;al Salman et al, 2016;Oqal et al, 2015;Alshakka et al, 2016;Butt et al, 2017;Shaheen et al, 2018;Alanazi, 2018;Almasoudi et al, 2019;Alanazi et al, 2019;Ahmed, 2020c). Highly prescribed cephalosporins are ceftriaxone and cefuroxime.…”

“…A study in Saudi Arabia in 2019 shows high consumption of azithromycin due to the per piece count. Variation is there, but on average, 17-20% of prescribed drugs are macrolides (Senok et al, 2009;John et al, 2014;Al-Balushi et al, 2014;Al Alawi et al, 2015;Al Salman et al, 2016;Oqal et al, 2015;Alshakka et al, 2016;Butt et al, 2017;Shaheen et al, 2018;Alanazi, 2018;Almasoudi et al, 2019;Alanazi et al, 2019). Azithromycin is the most common macrolide prescribed in the Gulf region; others are clarithromycin and erythromycin, and one study shows the prescribing of clindamycin in outpatients.…”

“…In another study on prescribing patterns of antibiotics in upper respiratory tract infections, Butt et al (2017) found that cephalosporins are prescribed about 43%, penicillins and co-amoxiclave 28%, macrolide 19%, flouroquinolones 9%, and 5% of drugs are intravenou. Shaheen et al (2018) studied the prescribing pattern of antibiotics in OPAT in children for acute respiratory tract infection. The study found that amoxicillin is highly prescribed in 53.3% of cases, the second choice was ceftriaxone in 15.7%, followed by Augmentin in 8.7%, various other antibiotics in 17.5%, and last more than one antibiotic was prescribed in 14/515 cases.…”

“…No pharmacy and therapeutic committee to oversee the use and prescribing practices of antibiotics, and lack of practice of sensitivity testing before prescribing antibiotics contribute to inappropriate prescribing of antibiotics.” Butt et al (2017) divided diagnosis into two types—1 in which antibiotics are indicated (bacterial infections) and diagnosis for which antibiotics are not indicated (viral infections)—through expert opinions, and they studied upper respiratory tract infection prescribing patterns of antibiotics in Qatar and found that 45% ( n = 75,733) of antibiotics prescribed are deemed inappropriate least in the emergency department with 2% and were the highest for family physicians. Shaheen et al (2018) measured appropriateness by comparing prescriptions with WHO guidelines on recommendation for acute respiratory tract infections in Saudi Arabia and stated, “Many physicians in Makkah Al Mukarramah are not following the WHO guidelines for Acute Respiratory Infection.” Ahmed et al studied the outpatient prescribing pattern of cefuroxime, doxycycline, ciprofloxacin, and metronidazole in Saudi Arabia and concluded that a high percentage of antibiotics prescribed is inappropriate, and doxycycline is appropriately prescribed in the outpatients ( Ahmed, 2020a ; Ahmed, 2020b ; Ahmed, 2020c ; Ahmed, 2020d ).…”

“…Alsakka et al (2016) studied the antibiotic-prescribing pattern in Yemen and found that cephalosporins (ceftriaxone, cefotaxime, cefixime) were prescribed as 132/338 (39%) of all prescriptions Butt et al (2017). studied the antibiotic-prescribing pattern in upper respiratory tract infections in Qatar and found that cephalosporins were 43% of all 75,733 claims Shaheen et al (2018). studied the antibiotic-prescribing pattern in acute respiratory tract infections in Saudi Arabia and found that cephalosporins (ceftriaxone, first and second generation) were prescribed as 116/515 (22.5%) of all prescriptions Alanazi et al (2018).…”