Fazli maula*, M. said, Safeer zaman, khurshid Anwar, M.Adil ,M Nadeem, Alamzeb, Arshad javaid

Assistant professor pulmonology Khalifa Gulnawaz Teaching hospital
Bannu Medical College, Bannu, KPK, Pakistan

ABSTRACT

Objective: To determine the trends of drugs prescribing practices for upper respiratory tract infections among general practitioners, ENT surgeons and chest physicians in Bannu.

Study design: Descriptive observational study.

Place and duration: Among the doctors of Bannu city and periphery from 1^stapril 2011 to 25^th july 2011.

Methodology: A self administered questionnaire was distributed among the general doctors (GPs), ENT surgeons and chest physicians of Bannu city and periphery using the pharmaceutical personnel as a source for distribution and collection of Performa after one week. Data was entered in SPSS version 16 and analyzed.

Results: A total of 127 doctors were given proformas and 118(92.92%) responded with 90(76.28%) male and 28(23.72%) females. Eighty three (70.34%) were GPs and remaining were specialists. They suspected organisms as Streptococcus in 68(57.67%), viral 41(34.75%), Staphylococcus aureus 02(1.7%) and mix bacterial in 07(5.94%). The use of antibiotics was Quinolones in 33(27.97%), Cephalosporin’s 57(48.31%), Penicillin’s 20(16.95%) and no antibiotics were recommended in 08(6.78%) cases. Antihistamines were advised in 100% patients as follows, Fexofenadine in 37(31.35%), Cetrizine 62(52.54%) and others in 19(16.11%). Intranasal decongestants were recommended in102(86.45%) and steroids in 43(36.45%) of the patients.

Conclusion: All the doctors especially working in remote areas of the country like Bannu should have repeated workshops and training programs regarding the use of different drugs especially antibiotics. They must treat every condition according to the local guidelines and antibiotics should be used according to culture and sensitivity or local known prevalence of organisms.

INTRODUCTION:

Misuse and over consumption of drugs especially antibiotics is on the rise and is considered to be the most important cause of antibiotics resistance and reduced effectiveness of the drugs as well as a lot of emergency visits due to side effects¹.The habits of prescribing drugs is affected by the doctors knowledge, patients education, cultural believes, past experiences, economic factors and pharmaceutical incentives².

This challenge is faced by the whole world but the importance of developing communities cannot be neglected where majority of the world population belong to these countries³. The other factor responsible for the over use of drugs is the availability of these drugs over the counter which is easily accessible to everyone.

In a study conducted by Gonzeire et al it was found that every fifth prescription for upper respiratory tract infection contained antibiotics and they were almost always viral in aetiology⁴. Similar is the case of other drugs like analgesics, antipyretics and long lasting use of steroids.

This study is an attempt to know the magnitude of this problem in a small southern district, Bannu (Pakistan), so that we could be able to help to some extent in the solution of this multifaceted problem.

METHODOLOGY:

A self administered questionnaire was distributed among all the GPs, ENT surgeons and chest physicians of Bannu city and periphery through the pharmaceutical people. One week time was given for filling and recollection. All other doctors were excluded. Actual study population was difficult to calculate due to the non availability of its prevalence. Non responders and incomplete proformas were not included. DATA was entered in SPSS version 16 and analyzed for frequencies and percentages.

RESULTS:

A total of 127 doctors were given proformas and 118(92.92%) responded with 90(76.28%) males and 28(23.72%) females. Eighty three (70.34%) were GPs and remaining were specialists. They had suspicion of organisms as Streptococcus in 68(57.67%), viral 41(34.75%), Staphylococcus aureus 02(1.7%) and mix bacterial in 07(5.94%). The use of antibiotics was Quinolones in 33(27.97%), Cephalosporin’s 57(48.31%), Penicillin’s 20(16.95%), and no antibiotics were recommended in 08(6.78%) cases. Antihistamines were advised in 100% patients as follows Fexofenadine in 37(31.35%), Cetrizine 62(52.54%) and others in 19(16.11%). Intranasal decongestants were recommended in 102(86.45%) and steroids in 43(36.45%) of the patients. Analgesics commonly used were Paracetamol and Diclofenacs. Results are presented in TABLE I, II and III.

TABLE I: SEX AND SPECIALITY DISTRIBUTION OF DOCTORS

TABLE II: DISTRIBUTION OF SUSPECTED ORGANISMS, BY THE DOCTORS

TABLE III: RECOMMENDED DRUGS FOR UPPER RESPIRATORY TRACT INFECTIONS IN THE STUDY

TABLE 03: KEY

QNL---------Quinolones CEPH------Cephalosporines PENECIL--Penicillines NO.ANTI---No.Antibiotics FEXO-------Fexofenadine CETRI------Cetrizine

MISCEL---Miscellaneous Antihistamines Decont-----Decongestants STERDS--Steroids

DISCUSSION:

The prescription of every drug is important for the patient as well as for the doctors but antibiotics is the key medicines to be used very cautiously to prevent resistance. Many of the doctors are considering URTI as viral but still they are in favour of using antibiotics. Even in the US and UK, studies have shown that in >80% of the viral infections antibiotics are used^4.

Subjects with easy availability of the drugs over the counter will use it without the prescription of the physician⁵.

The most commonly recommended antibiotics are Cephalosporin and Quinolones and these are the drugs which have acquired a lot of resistance internationally. In a study conducted by Bilal NE and colleagues in Saudi Arabia, they found that 4% of the organisms are resistant to these antibiotics and 90% are multi drugs resistant⁶.

In the same study they have shown that in 57.2% of the cases the cause of resistance was misuse of drugs⁶.

The over use of drugs as shown by Van Saene HK and his friends in his study, leads to over growth and de novo developments of new clones, following increased spontaneous mutations, leading to resistance of organisms⁷.

In our study no culture was advised to any patient, which should ideally be done for all non responding patients. This is comparable with the results of the research work done by Rodriguez O, and his colleagues in which 57.7% of the antibiotics were prescribed emperically⁸.The main reason is, that there are no regular CME courses for the doctors especially general practitioners. With the increasing resistance we are just loosing the game against the microbes as shown by the international studies and may also be found in our study if we do cultures for all patients ⁹.The different types of organisms suspected by the doctors do not correlate with the multinational studies. In one study it was found that the frequency of organisms was as Streptococcus, Mycoplasma and Neisseria in the swabs of upper respiratory tract¹⁰.

Like antibiotics all the drugs are misused, for example antihistamines, analgesics and steroids, every one of which carries its own risk of side effects proved by many studies. Luckily in this study Cetrizine was the most frequently prescribed antihistamine which does not affect performance and psychomotor status of the patients as compared to other group partners and with very rare or no cardiac effects¹¹.

Danniel EB and James CP has summarized in his beautiful article that it is necessary for every practitioner to understand the pharmacological features of each drug and careful selection of a drug regimen must be made according to the disease severity and patient expectations to prevent the stress and anxiety associated with the disease¹².

Conclusion:

All the doctors especially working in remote areas of the country like Bannu should have repeated workshops and training programs regarding the use of different drugs especially antibiotics. They must treat every condition according to the local guidelines and antibiotics should be used according to culture and sensitivity or local prevalence of organisms.

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