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

Abstract

Purpose: To study the prescribing pattern of antibiotics in outpatients and emergency departments in the Gulf region. To compare the appropriateness of prescriptions and antibiotics commonly prescribed for respiratory tract infection.Method: The search was limited to the years 2008–2020, and articles had to be in English. Articles were searched from various resources and evaluated using PRISMA. Forty-one articles were selected and screened, and in the end, 17 articles were included in the study. All articles were selected from the gulf region of six countries: UAE, Saudi Arabia, Qatar, Oman, Yemen, and Bahrain. Only primary literature were included. Inpatient and literature from other countries outside the gulf region were excluded.Result: Penicillins, cephalosporins, and macrolides are highly useful antibiotics for respiratory tract infections. Ceftriaxone IV is recommended in acute respiratory tract infection if therapy with penicillin fails. Most of the antibiotic prescriptions in Gulf countries are inappropriate. Inappropriate antibiotic prescribing in the gulf region varies from place to place and reaches a maximum of 80%. Antibiotics may be prescribed with the wrong dosage or frequency and inappropriate guidelines. Penicillins are prescribed at about 50–60%; the most common penicillins prescribed are amoxicillin and co-amoxiclave. Cephalosporins are prescribed at about 30%, and the most common are third-generation. Macrolides are prescribed at about 17–20%, and the most common macrolides are azithromycin and clarithromycin. Fluoroquinolones are prescribed at about 10–12%, of which levofloxacin and ciprofloxacin are more commonly prescribed with metronidazole at 10%.Conclusion: It is suggested that the antibiotic-prescribing pattern in outpatient and emergency departments in the Gulf region are highly inappropriate and need improvement through education, following guidelines, annual vaccination, and stewardship programs; the most prescribed antibiotic is amoxicillin/co-amoxiclave, and the most often encountered infection in outpatients is acute respiratory tract infection.

WHO Point Prevalence Survey to Describe the Use of Antimicrobials at a Tertiary Care Center in Pakistan: A Situation Analysis for Establishing an Antimicrobial Stewardship Program

“…The common contributing factors to the development of antimicrobial resistance are injudicious use of antibiotics, incorrect dosage, and duration [ 7 , 8 , 9 ]. Additional reasons cited in the literature include knowledge gaps among physicians prescribing antibiotics, unregulated pharmacy practices, availability of over-the-counter (OTC) antibiotics, lack of or poor regulations on antibiotic sales in the community, limited availability and cost of diagnostics, and last but not the least, poor literacy, enabling inappropriate use among consumers where prescription sharing and refills without consultation are common.…”

“…Additional reasons cited in the literature include knowledge gaps among physicians prescribing antibiotics, unregulated pharmacy practices, availability of over-the-counter (OTC) antibiotics, lack of or poor regulations on antibiotic sales in the community, limited availability and cost of diagnostics, and last but not the least, poor literacy, enabling inappropriate use among consumers where prescription sharing and refills without consultation are common. Most of these reasons are applicable before a patient is admitted to a hospital, however, the major determinants of antibiotic utilization become the treating physician’s knowledge and implementation of an AS program’s recommendations once the patient is admitted to a healthcare facility [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. However, there is no formal data on the existence and outcomes of antimicrobial stewardship programs in the country.…”

Identifying Targets for Antibiotic Use for the Management of Carbapenem-Resistant Acinetobacter baumannii (CRAb) in Hospitals—A Multi-Centre Nonlinear Time-Series Study

“…Previous studies in Oman and the region reported frequent prescribing of third-generation cephalosporins, piperacillin/tazobactam, and fluoroquinolones [ 35 , 36 , 37 , 38 , 39 , 40 ]. In a recent point prevalence survey in the Middle East region, the authors demonstrated high prevalence rates of infections and high levels of resistance to antimicrobials [ 41 ].…”

Assessment of Knowledge Regarding Safety Profile, Use, and Boxed Warnings of Fluoroquinolones Among Healthcare Professionals in Saudi Arabia: A Potential Implication for Drug Regulatory Authorities

“…Antibiotics contribute to a substantial proportion of prescriptions for both inpatients and outpatients (1). Approximately, half of the patients admitted to the hospital receive antibiotics, particularly for pneumonia and urinary tract infection (UTI) (2).…”

“…In addition, the widespread use of ciprofloxacin in KSA has been observed among all patients regardless of their age (18). The recent estimates from KSA showed that the FQs accounted for 5% of antibiotics prescribed in the emergency department, 22% of prescriptions for UTIs, 19% of antimicrobial prescriptions in ambulatory care, and 19% of antibiotic prescriptions in outpatient departments (1). The excessive or irrational use of FQs might be associated with the lack of awareness and knowledge among healthcare professionals (HCPs) regarding the safety profile, prescribing guidelines, and BW.…”