Optimizing Clinical Diagnosis and Antibiotic Prescribing for Common Respiratory Tract Infections, Fanara Family Health Center- Rural Egypt | ||||
| The Egyptian Journal of Community Medicine | ||||
| Article 8, Volume 36, Issue 1, January 2018, Page 105-115 PDF (223.62 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejcm.2018.6873 | ||||
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| Abstract | ||||
| Background: Antibiotic prescribing for respiratory tract infections (RTI) by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance, increased incidence of adverse effects and the attendant cost to healthcare especially in developing countries like Egypt. Despite the majority of these infections being viral it seems that many determinants other than the etiology are the main factors that influence a high rate of prescribing antibiotic for these self-limiting infections. Objective: We aimed to assess the impact of a physician- based educational intervention to improve clinical diagnosis of bacterial causes of RTIs and reduce unnecessary antibiotic prescription for these infections. Methods: This is a clinical trial, where 11 family medicine residents working at a rural family health center in Egypt participated in an educational program to improve their antibiotic prescribing skills when treating common RTI. Their patterns of prescribing antibiotic have been studied among all patients 3 months old or above who attended the family center with RTI, for 2 months before and after the educational intervention (1st of December 2015 to 10th of March 2016). The educational intervention comprised 4 hours, 2 lectures and another 4 hours, 2 small group discussions in updated management of RTI and health education principles based mainly on NICE guidelines and Health Belief Model (HBM) respectively. The primary outcome was measuring the impact of the educational intervention on rates of prescribing antibiotic for 4 RTI [Acute otitis media (AOM), tonsillopharyngitis, rhino sinusitis and acute bronchitis], the appropriateness of using clinical diagnostic criteria of bacterial causes of these infections and the appropriate selection of antibiotic when its use was justified. Results: The overall antibiotic prescription was significantly reduced (8.3%) from base line ( 80.3%( to post intervention (72%) period, (P=0.007). This reduction was significant for both tonsillopharyngitis (12.2%, P=0.019) and otitis media (14.2%, P= 0.033). There were also significant improvement in using clinical diagnostic criteria for bacterial causes of the four studied RTI with 12.5% overall improvement (P=0.001). There was also improvement in the overall appropriateness of selecting first line antibiotic when its use was justified this improvement was achieved for both tonsillopharyngitis (17.8%, P= 0.004) and AOM (P= <0.001). Conclusion: Clinical diagnosis of bacterial causes of common RTIs and appropriate antibiotic use for these infections can be improved in primary health care settings using a physician based educational program. | ||||
| Keywords | ||||
| antibiotic; acute respiratory tract infections; health education; health belief model; proper prescribing | ||||
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