Abstracts

Antibiotic use in acute upper respiratory tract infections

and uncomplicated lacerations in the Gaza Strip:
clinical audit and re-audit
Maha Alfaqawi, Yousef Abuowda, Bettina Böttcher, Khaled Alserr, Alaa Eldeen Elmassry

Abstract
Background Overuse of antibiotics is increasing worldwide and has led to a marked increase in multidrug-resistant Published Online
pathogens. Acute upper respiratory tract infections and uncomplicated lacerations do not require antibiotics. We July 5, 2021

assessed adherence to the best international standards of antibiotic prescribing for these conditions. Faculty of Public Health,
Al-Quds University, Gaza Strip,
occupied Palestinian territory
Methods We did an audit and reaudit at Nasser Hospital in the Gaza Strip. The audit included patients presenting (M Alfaqawi MD); Faculty of
from January to March, 2017, with acute upper respiratory tract infections or uncomplicated lacerations. Random Medicine, Islamic University of
selection, stratified by condition, was used to assign patients to the audit or reaudit. After the audit an action plan was Gaza, Gaza Strip, occupied
Palestinian territory
implemented focusing on education of health-care providers and patients for one year. The reaudit was done in 2018, (Y Abuowda MD B Böttcher PhD);
from January to March. Ethics approval was obtained from the Palestinian Ministry of Health. and Nasser Medical Complex,
Gaza Strip, occupied
Findings 240 patients were included overall, 60 with each condition in the audit and 60 with each condition in the Palestinian territory
(A Elmassry PhD, K Alserr MD)
reaudit. The 60 patients in the first audit with acute upper respiratory tract infections had a mean age of 32·1 (SD 6·4)
Correspondence to:
years. 25 (42%) had throat examinations, of which 20 (33%) were normal. 52 (87%) of these 60 patients were prescribed Dr Maha Alfaqawi, Faculty of
antibiotics, which were used by 29 (48%) who cited that they believed it was important to do so. The 60 patients Public Health, Al-Quds
presenting with uncomplicated lacerations had a mean age of 14·5 (SD 10·3) years. Injuries were closed by sutures in University, Gaza Strip, occupied
59 (98%) patients, who all received antibiotics. 52 (87%) of 60 patients with lacerations believed that antibiotics Palestinian territory
maha.alfaqawi@gmail.com
accelerate healing. Reaudit after the action plan was implemented showed that antibiotics were prescribed to 43 (71%)
patients with acute upper respiratory tract infections (p=0·002) for difference and to 50 (84%) with uncomplicated Editorial note: the Lancet
Group takes a neutral
lacerations.
position with respect to
territorial claims in
Interpretation Despite some improvement in appropriate antibiotic use for acute upper respiratory tract infections published maps and
after hospital-based quality improvement efforts, physicians did not generally follow international guidelines for institutional affiliations.
appropriate antibiotic use and patients believed that their use was important. Development of evidence-based
guidelines and education of patients are needed.

Funding None.
Contributors
MF designed the study, MF, YA, and KS collected the data. MF and YA did the data analysis and interpretation. MF, YA, and BB wrote the Abstract.
All authors approved the final version.
Declaration of interests
We declare no competing interests.

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