AUDIT ON ANTIBIOTICS PRESCRIBING FOR

UPPER RESPIRATORY TRACT INFECTIONS

IN PRIMARY HEALTHCARE FACILITIES
IN KEDAH
(NMRR ID : NMRR-16-315-29590)
TEOH CHERH YUN, PHARMACIST, KK BANDAR ALOR SETAR
AIZAMIN BINTI ANUAR, PHARMACIST, KK BANDAR SG PETANI
DR. HABSHOH BINTI HAT, FAMILY MEDICINE SPECIALIST, KK BANDAR SG PETANI
DR. MAHANI BINTI KAMARUDIN, FAMILY MEDICINE SPECIALIST, KK JENIANG
DR. ALYANI BINTI MOHAMED MOHSIN, FAMILY MEDICINE SPECIALIST, KK POKOK SENA
 OVERALL 36%
INCREASE IN
ANTIBIOTICS CONSUMPTION
UPPER RESPIRATORY TRACT
INFECTION
 GENERAL OBJECTIVE OF
THE AUDIT
 To assess the appropriateness of antibiotic prescribing
for Upper Respiratory tract Infection (based on
clinical indications) in government health clinics with
resident Family Medicine Specialists (FMS) in Kedah.
 SPECIFIC OBJECTIVES

TO EVALUATE TO COMPARE

THE CHOICE OF
EACH OF THE URTI ANTIBIOTIC REGIME
NUMBER OF URTI CASES CASES WITH THEIR PRESCRIBED + THEIR
PRESCRIBED WITH AND CLINICAL DOSE, FREQUENCY AND
INDICATIONS FOR DURATION WITH LATEST
WITHOUT ANTIBIOTICS NATIONAL ANTIBIOTIC
ANTIBIOTIC THERAPY
GUIDELINE
METHODOLOGY : STUDY DESIGN

CROSS-
MULTICENTRE
RETROSPECTIVE SECTIONAL
(n=24)
AUDIT

RESIDENT
CONVENIENT
FAMILY
KEDAH SAMPLING
MEDICINE
(23-27/08/2015)
SPECIALISTS
 Respective case
Prescriptions Eligible notes were
dated
23-27/08/2015 prescriptions traced from
were selected Medical Records
are screened
Department

Evaluation of Evaluation of
documented antibiotic Documentation
symptoms and prescriptions of data
clinical (choice, dose,
indications frequency, duration)
 INCLUSION CRITERIA

TREATED AT ANY PRESCRIPTIONS WRITTEN WRITTEN

OF THE STUDY DATED DIAGNOSIS : DIAGNOSIS :
SITES 23-27/08/2015 “URTI” “PHARYNGITIS”

WRITTEN WRITTEN WRITTEN

DIAGNOSIS : DIAGNOSIS : DIAGNOSIS :
“TONSILITIS” “RHINOSINUSITIS” “OTITIS MEDIA”
EXCLUSION CRITERIA

ANY MISSING DATA MISSING CASE

INCLUDING INCOMPLETE
DOCUMENTATON OF NOTES DURING
CLINICAL SYMPTOMS STUDY PERIOD
 DATA COLLECTION TOOL

SERIAL NUMBER OF
REG. NUMBER GENDER AGE
PRESCRIPTION

EVALUATION ON EVALUATION OF THE

CLINICAL CLINICAL THE ANTIBIOTIC DOSING REGIME OF
DIAGNOSIS INDICATIONS FOR CHOICE (IF ANY) THE ANTIBIOTICS
ANTIBIOTICS PRESCRIBED
 STATISTICAL ANALYSES

1. AGE GROUP 2. PROPORTION 3. ANTIBIOTIC

DISTRIBUTION OF CASES CHOICES

INDICATED FOR ABX NOT INDICATED FOR ABX

PRESCRIBED NOT PRESCRIBED PRESCRIBED WITH NOT PRESCRIBED

WITH ABX WITH ABX ABX WITH ABX

DOSAGE FREQ. DURATION

 ANALYSIS AND RESULTS

TOTAL NUMBER OF CASES PRESCRIBED

GENDER
DIAGNOSIS NUMBER OF WITH ANTIBIOTICS
CASES
MALE FEMALE FREQUENCY PERCENT.

ACUTE PHARYNGITIS /
TONSILITIS 1203 1149 2352 863 36.69%

ACUTE RHINOSINUSITIS 152 187 339 34 10.03%

ACUTE OTITIS MEDIA 27 31 58 47 81.03%
TOTAL 1382 1367 2749 944 34.34%
 600

AGE GROUP DISTRIBUTION OF THE STUDY POPULATION

500

400

300

37.37%

200
36.92%
35.79%

100 31.60%
40.97% 38.89%
29.75% 31.25% 29.73% 31.15%
17.57% 27.14% 17.50%
30.77% 31.25%
0
0-5 6-12 13-18 19-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80
NUMBER OF CASES 455 594 447 269 144 144 121 112 111 122 74 70 40 26 16
NUMBER OF CASES WITH
168 222 160 85 59 56 36 35 33 38 13 19 7 8 5
ANTIBIOTICS
 EVALUATION ON CLINICAL INDICATIONS
FOR ANTIBIOTICS PRESCRIBING
1800
1700
1600
1500
1400
1300
1200
1100
1000
900 1737
800 353
700 (96.23%)
(37.39%)
600
500
400 525
300
200 (55.61%) (0.05%)
100
0 66 1 67 (3.77%)
(6.99%) Yes Antibiotic Prescription No
Indicated For antibiotics Possibly Indicated for antibiotics Not indicated
 ACUTE PHARYNGITIS/TONSILLITIS ACUTE RHINOSINUSITIS ACUTE OTITIS MEDIA
1500

1400

1300

1200

6 (12.77%) (9.09%)
1100
(36.00%) 1
1000
9
900

1422
800

700
338 (95.50%)
41
(39.16%)
600
25 (87.23%) 10
(64.00%)
500 (90.91%)
400

300
525
200
(60.84%)
100
305
0 67(4.50%)
Antibiotic Yes No Yes No Yes No
Prescription Indicated For antibiotics Possibly Indicated for antibiotics Not indicated
 REASONS OF NON-ADHERENCE IN
ANTIBIOTICS PRESCRIBING

INDICATED FOR ANTIBIOTICS

NOT INDICATED
FOR CORRECT
CLINICAL INAPPROPRIATE ANTIBIOTIC
ANTIBIOTICS BUT ANTIBIOTICS NOT
DIAGNOSIS ANTIBIOTICS CHOICE OF CHOICE BUT
PRESCRIBED
PRESCRIBED ANTIBIOTICS INCORRECT
DOSAGE REGIME
ACUTE
PHARYNGITIS / 338 67 229 22
TONSILITIS
ACUTE
RHINOSINUSITIS 9 0 19 2
ACUTE
OTITIS MEDIA 6 1 12 1
SUMMARY OF THE ADHERENCE OF ANTIBIOTIC
AND NON-ANTIBIOTIC PRESCRIBING
 LIMITATIONS OF THE STUDY

 Our study did not include ALL government health clinics in Kedah , as
we realized that certain antibiotics listed can ONLY be prescribed by
Family Medicine Specialists --- Amoxicillin/Clavulanate & Cefuroxime.
 Did not evaluate eligibility of the prescriber
(e.g. : Medical assistants are not allowed to prescribe antibiotics unless
with countersign from Medical officers)
 Quite a number of cases with incomplete and missing data : power of
the study might be affected
 We could only evaluate clinical indications for antibiotics based on
written documentations in their case notes
 CONCLUSION

 It warrants a more aggressive and continuous approach on promoting

judicious use of antibiotics, as inconsistencies were still present and
persistent from the comparison against current guidelines.
 Dissemination of updated information to healthcare professionals
regarding antimicrobial resistance is in fact very important and the
approach needs to be intensified.
 Role of microbiological evaluations such as RADT in determining the
bacterial cause of URTI infection needs to be emphasized extensively
to aid the judicious use of antibiotics.
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