Abstract:
Background: Bacterial resistance is nowadays a growing problem of public health in hospitals and community. Antibiotic dispensation over the counter without any control in most developing countries is a risk factor of inducing bacterial resistance. This study aims to evaluate the antibiotic treatment taken by patients in the 3 months period before an Infectious Diseases consult in a community setting in a developing country.
Materials/methods: This is a prospective cohort study in a community setting in the IDs consultation offices in a developing country from October 1st 2017 until January 1st 2018. Every consultation with previous antibiotic treatment for the same reason in the last 3 months is included with patients’ demographics and the identity of the prescriptor. The data were collected on excel and served for statistics.
Results: 68 eligible cases accounting for 95 courses of antibiotics. The sex ratio F/M is 5/2. The main used molecules are 17 cephalosporins, 8 macrolides, 25 penicillins, 34 quinolones and 11 other different classes.
Fever is present in only 20% of the indications: 6 flu like viral syndromes, one rhinosinusitis, 2 pneumonia, one bursitis, 3 cases of viral mononucleosis, one acute hepatitis B and 5 fever of unknown origin. 4/19 cases are true indications for antibiotic treatment, 5 of uncertain indications and the rest is not an indication.
Nevertheless, antibiotics were prescribed even-though the patients were non febrile in 80% of the cases: one conjunctivitis, one finger wart, 4 superficial infections of the fingers, one onycomycosis, 3 cystitis, 2 asymptomatic bacteriuria in non-pregnant women, 2 prostatitis, 5 laryngitis, 11 dry coughs, 5 odynophagia, 14 upper airway hypersensitivity with sneezing and bilateral rhinorrhoea, 6 common colds, one otalgia, one epistaxis, 4 pelvic pains, one headache, 2 episodes of myalgia, 2 acute exacerbations of chronic bronchitis (AECB), one episode of candida positive stool culture, 3 upper limb oedema, one face oedema, 3 furuncles, one varicose ulcer and one by habit.
Only 3 cystitis, 2 prostatitis and 2 AECBs are true indications and the other 69 are not indications for antibiotherapy. Besides, the dose is incorrect in 11 episodes including 8 with inappropriate duration of therapy. Inversely, the duration of therapy is incorrect in 32 courses of antibiotic treatment including 8 with inappropriate dosage of the medication.
Totally, 35 courses of treatment were either with a wrong dosage or duration of therapy and were taken OTC by the patients themselves in 11 cases or prescribed by the pharmacist in one case or the physician in 23 cases.
Cultures were performed in only 9 cases and were positive in 5: one nail culture positive for citrobacter Koseri, one candida in a stool culture, and 3 gram negative bacteria in urine cultures.
Finally, the prescriptors were physicians in 49/95 episodes, pharmacists in 16/95 episodes and the patients themselves in 30/95 of the cases.
Conclusions: We clearly need more public health awareness for the misuses of the antibiotics, a proper and urgent education for physicians along with a law regulating the dispensation of antibiotics by the pharmacists.
Biography:
Dr Jacques Choucair is an Infectious diseases consultant in Hotel Dieu de France teaching hospital in Beyrouth affiliated to the Saint Joseph University, School of Medicine. He graduated from The Saint Joseph University in Beyrouth and from the University of Paris VII faculty of Medicine and University of Paris V, faculty of Pharmacy. Since December 2018, he is the head of division of the Infectious diseases department at Hôtel Dieu de France de Beyrouth teaching hospital and an associate professor of Medicine at the Saint Joseph School of Medicine. He also has a Medical Teaching diploma from the University of Montreal in Canada in 2003. He published more than 40 articles and is a reviewer in international journals. His main topics of interest are bacterial resistance and the proper use of antibiotics.He is member of the scientific committee of the Lebanese Society of Infectious Diseases, member in the Arab association for the proper use of antibiotics, member of the international Society of Infectious Diseases, and member of ESCMID.
