Antibiotic prescribing practices in primary and secondary health care facilities in Uttar Pradesh, India.
BACKGROUND
Emerging antibiotic resistance in common pathogens is a worldwide problem known to be related to inappropriate overuse of antibiotics. Wide variability in antibiotic use throughout the world is because of various factors, including socio-cultural differences.


OBJECTIVE
To study the rate of antibiotic prescribing for common outpatient illnesses and the various disease, patient, physician and health facility characteristics, which influence this in primary and secondary healthcare settings in Uttar Pradesh.


METHODS
After sampling of health facilities - both private and government, rural and urban, a cross-sectional survey of prescriptions for patients presenting with runny or blocked nose, cough, sore throat, diarrhoea or fever without localizing symptoms was conducted. Information on disease, patient, physician and facility characteristics was collected. Outcome factors: antibiotic prescription and group of antibiotic prescribed. No intervention was made.


RESULTS
Overall antibiotic prescription rate was 81.8%. It was significantly higher in urban private than in government settings, and higher in rural than in urban settings. Presence of fever prompted antibiotic use across all strata. Lower age of patients and higher socioeconomic status were associated with higher antibiotic use. Patient requests for antibiotics were very rare. Specialist practices with staff with higher qualifications and better opportunities for updating knowledge were associated with lower antibiotic prescribing. Government health-facilities with larger staff complement and better infrastructure was associated with lower prescribing rates. The most common antimicrobial agents used were the penicillin, sulfonamides and fluoroquinolones. Injection use paralleled antibiotic use.


CONCLUSIONS
These data on overprescribing of antibiotics can be used to design educational programs for physicians working in these settings.
Kumar
R
R
Department of Pediatrics, King George's Medical University, Lucknow, India. rashmik2005@gmail.com
Indira
K
K
Rizvi
A
A
Rizvi
T
T
Jeyaseelan
L
L
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017149:Private Sector; D017150:Public Sector; D019035:Rural Health Services / Q000592:standards; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000592:standards; D055815:Young Adult
D000900:Anti-Bacterial Agents