Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance?
BACKGROUND
Inappropriate antibiotic prescribing exposes patients to the risk of side effects and encourages the development of drug resistance across antimicrobial groups used for respiratory infections including tuberculosis (TB).


OBJECTIVE
Determine among Russian general practitioners and specialists: (1) sources of antimicrobial prescribing information; (2) patterns of antimicrobial prescribing for common respiratory diseases and differences between primary and specialist physicians; (3) whether drug resistance in TB might be linked to over-prescribing of anti-TB drugs for respiratory conditions.


METHODS
Point-prevalence cross-sectional survey involving all 28 primary care, general medicine and TB treatment institutions in Samara City, Russian Federation. In this two-stage study, a questionnaire was used to examine doctors' antimicrobial (including TB drugs) prescribing habits, sources of prescribing information, management of respiratory infections and a case scenario ('common cold'). This was followed by a case note review of actual prescribing for consecutive patients with respiratory diseases at three institutions.


RESULTS
Initial questionnaires were completed by 81.3% (425/523) of physicians with 78.4% working in primary care. Most doctors used standard textbooks to guide their antimicrobial practice but 80% made extensive use of pharmaceutical company information. A minority of 1.7% would have inappropriately prescribed antibiotics for the case and 0.8-1.8% of respondents would have definitely prescribed TB drugs for non-TB conditions. Of the 495 respiratory cases, 25% of doctors prescribed an antibiotic for a simple upper respiratory tract infection and of 8 patients with a clinical diagnosis of TB, 4 received rifampicin monotherapy alone. Ciprofloxacin was widely but inappropriately used.


CONCLUSIONS
Doctors rely on information provided by pharmaceutical companies; there was inappropriate antibiotic prescribing.
KIL Consortium Sustainable TB Service Project, Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's King's and St Thomas' Medical School, King's College, King's College Hospital (Dulwich), East Dulwich Grove, London, UK.
Yanina
Y
Balabanova
Ivan
I
Fedorin
Sergey
S
Kuznetsov
Catriona
C
Graham
Michael
M
Ruddy
Rifat
R
Atun
Richard
R
Coker
Francis
F
Drobniewski
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D005194:Family Practice; D006801:Humans; D008508:Medication Errors; D012140:Respiratory Tract Diseases / Q000188:drug therapy* / Q000453:epidemiology; D012426:Russia / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents