title: Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.
abstract: Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia.
  
  
  
  We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic.
  
  
  
  Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics.
  
  
  
  Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing inappropriate prescribing.
authors.affiliation: Healthcare Statistics Unit, Clinical Research Centre, 3rd Floor MMA Building, 124 Pahang Road, 53000, Kuala Lumpur, Malaysia. norazida@crc.gov.my.
authors.forename: Norazida
authors.initials: N
authors.lastname: Ab Rahman
authors.affiliation: Department of Family Medicine, International Medical University, Seremban, Malaysia.
authors.forename: Cheong Lieng
authors.initials: CL
authors.lastname: Teng
authors.affiliation: Healthcare Statistics Unit, Clinical Research Centre, 3rd Floor MMA Building, 124 Pahang Road, 53000, Kuala Lumpur, Malaysia.
authors.forename: Sheamini
authors.initials: S
authors.lastname: Sivasampu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing; D018942:Macrolides / Q000627:therapeutic use; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms; D010406:Penicillins / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011331:Private Practice / Q000706:statistics & numerical data; D015363:Quinolones / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides; D010406:Penicillins; D015363:Quinolones; D017963:Azithromycin
keywords: Anti-bacterial agents; Antibiotic stewardship; Drug prescriptions; Primary healthcare; Private practice; Public health practice