title: Prescription antibiotics for outpatients in Bangladesh: a cross-sectional health survey conducted in three cities.
abstract: BACKGROUND
  Antibiotics prescribing by physicians have gained due importance across the globe, mainly because of an increase in antibiotic usage, prevalence of infections and drug resistances. The present study is aimed to evaluate the physicians prescribing pattern of antibiotics, their usages by outpatients and disease conditions for which the antibiotics are prescribed in three cities of Bangladesh.
  
  
  METHODS
  This cross sectional health survey was carried out with a self designed standard questionnaire by manual data collection over a three months period (20.03.2013 to 20.06.2013) at three adjacent cities Jessore Sadar, Monirampur and Keshabpur upazila respectively. The data were collected from the patient's prescription and by directly interviewing the patients who were prescribed at least one antibiotic during the study period. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software. Modified Wald method was applied to calculate 95% CI.
  
  
  RESULTS
  A total of 900 prescriptions were analyzed during the study period. It was found that the prescriber prescribed antibiotics to the patients who were suffering mainly from cold and fever, infections, diarrhea and gonorrhea. The highest prescribed antibiotic groups were cephalosporins (31.78%), macrolides (27.33%), quinolones (16.33%), penicillins (7.11%), and metronidazoles (6.78%) respectively. Two or more antibiotics were prescribed in 25.44% of prescriptions. A total of 66.89% prescriptions had complete information on dosage form, 57% had complete direction for antibiotics use and 64.22% patients completed full course of antibiotics. Although 83% prescriptions have no clinical test for using antibiotics, even though the percentages of patients' disease recovery were 61.78% and in compliance were 38.22%.
  
  
  CONCLUSIONS
  From this research, it is observed that physicians prescribed antibiotics rationally in some cases but needs to ensure in all cases of prescription. Because irrational use leads to the spread of bacterial resistance to antibiotics and related health problems, our findings have important implications for public education and the enforcement of regulations regarding the prescription of antibiotics in Bangladesh.
authors.affiliation: Department of Pharmacy, University of Rajshahi, Rajshahi 6205, Bangladesh. biswas_07pharm@yahoo.com.
authors.forename: Mohitosh
authors.initials: M
authors.lastname: Biswas
authors.forename: Debendra Nath
authors.initials: DN
authors.lastname: Roy
authors.forename: Afsana
authors.initials: A
authors.lastname: Tajmim
authors.forename: Sheikh Shahriar
authors.initials: SS
authors.lastname: Rajib
authors.forename: Mosharraf
authors.initials: M
authors.lastname: Hossain
authors.forename: Fahamida
authors.initials: F
authors.lastname: Farzana
authors.forename: Nelufar
authors.initials: N
authors.lastname: Yasmen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D002947:Cities; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
references.citation: J Antimicrob Chemother. 1997 Jul;40(1):135-6
references.pmid: 9249217
references.citation: Rev Infect Dis. 1990 Jan-Feb;12(1):136-41
references.pmid: 2300735
references.citation: Ann Intern Med. 2001 Mar 20;134(6):487-9
references.pmid: 11255525
references.citation: J Antimicrob Chemother. 1984 Aug;14(2):149-56
references.pmid: 6501123
references.citation: Int J Antimicrob Agents. 1999 Jan;11(1):23-30
references.pmid: 10075274
references.citation: Ann Clin Microbiol Antimicrob. 2003 Jul 16;2:7
references.pmid: 12904265
references.citation: Int J Antimicrob Agents. 2000 Jul;15(2):131-5
references.pmid: 10854809
references.citation: Soc Sci Med. 2000 May;50(10):1445-50
references.pmid: 10741579
references.citation: J Gen Intern Med. 1987 Mar-Apr;2(2):102-7
references.pmid: 3559774
references.citation: Pediatr Infect Dis J. 1993 Dec;12(12):986-8
references.pmid: 8108225
references.citation: Rev Infect Dis. 1990 Jan-Feb;12(1):12-9
references.pmid: 2405465
references.citation: DICP. 1991 Jun;25(6):662-7
references.pmid: 1877278
references.citation: Soc Sci Med. 2002 Jun;54(12):1875-86
references.pmid: 12113442
references.citation: Pharmacol Rev. 2007 Dec;59(4):289-359
references.pmid: 18160700
references.citation: Clin Endosc. 2012 Jun;45(2):111-2
references.pmid: 22866247
references.citation: Euro Surveill. 2009 Aug 20;14(33):
references.pmid: 19712639
references.citation: J Antimicrob Chemother. 2002 Dec;50(6):989-97
references.pmid: 12461022
references.citation: Emerg Infect Dis. 2003 Sep;9(9):1096-102
references.pmid: 14519246