Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand

Rachel C Greer, Daranee Intralawan, Mavuto Mukaka, Prapass Wannapinij, Nicholas P J Day, Supalert Nedsuwan, Yoel Lubell, Rachel C Greer, Daranee Intralawan, Mavuto Mukaka, Prapass Wannapinij, Nicholas P J Day, Supalert Nedsuwan, Yoel Lubell

Abstract

Introduction: Antibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the use of antibiotics in primary care in low-resource settings.

Objective: To describe the presentation of acute infections and the indications for antibiotic prescription.

Design: A 2-year retrospective review of routinely collected data.

Setting: All 32 primary care units in one district in northern Thailand.

Participants: Patients attending primary care with a history of fever, documented temperature, International Statistical Classification of Diseases 10 code for infection or prescribed a systemic antibiotic. Patients attending after the initiation of a study on C-reactive protein testing in four centres were excluded.

Outcome measures: The proportion of patients prescribed an antibiotic and the frequency of clinical presentations.

Results: 762 868 patients attended the health centres, of whom 103 196 met the inclusion criteria, 5966 were excluded resulting in 97 230 attendances consisting of 83 661 illness episodes.46.9% (39 242) of the patients were prescribed an antibiotic during their illness. Indications for antibiotic prescription in the multivariable logistic regression analysis included male sex (adjusted OR (aOR) 1.21 (95% CI 1.16 to 1.28), p<0.001), adults (aOR 1.77 (95% CI 1.57 to 2), p<0.001) and a temperature >37.5°C (aOR 1.24 (95% CI 1.03 to 1.48), p=0.020). 77.9% of the presentations were for respiratory-related problems, of which 98.6% were upper respiratory tract infections. The leading infection diagnoses were common cold (50%), acute pharyngitis (18.9%) and acute tonsillitis (5%) which were prescribed antibiotics in 10.5%, 88.7% and 87.1% of cases, respectively. Amoxicillin was the most commonly prescribed antibiotic.

Conclusions: Nearly half of the patients received an antibiotic, the majority of whom had a respiratory infection. The results can be used to plan interventions to improve the rational use of antibiotics. Further studies in private facilities, pharmacies and dental clinics are required.

Keywords: Thailand; antibiotic use; fever; primary care; respiratory infections.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Chiang Rai and the 32 primary care units (PCUs).
Figure 2
Figure 2
A Venn diagram to show the inclusion criteria. ICD, International Statistical Classification of Diseases.
Figure 3
Figure 3
Trend and seasonality of antibiotic prescriptions overlaid by mean antibiotic prescription rates per primary care unit (PCU).
Figure 4
Figure 4
Number of acute presentations by single systems and whether antibiotics were prescribed.

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