Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance?


Balabanova, Y; Fedorin, I; Kuznetsov, S; Graham, C; Ruddy, M; Atun, R; Coker, R; Drobniewski, F; (2004) Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance? The Journal of antimicrobial chemotherapy, 54 (3). pp. 673-679. ISSN 0305-7453 DOI: 10.1093/jac/dkh383

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Abstract

Background: Inappropriate antibiotic prescribing exposes patients to the risk of side effects and encourages the development of drug resistance across antimicrobial groups used for respiratory infections including tuberculosis (TB). Aim: Determine among Russian general practitioners and specialists: (1) sources of antimicrobial prescribing information; (2) patterns of antimicrobial prescribing for common respiratory diseases and differences between primary and specialist physicians; (3) whether drug resistance in TB might be linked to over-prescribing of anti-TB drugs for respiratory conditions. Methods: Point-prevalence cross-sectional survey involving all 28 primary care, general medicine and TB treatment institutions in Samara City, Russian Federation. In this two-stage study, a questionnaire was used to examine doctors' antimicrobial (including TB drugs) prescribing habits, sources of prescribing information, management of respiratory infections and a case scenario ('common cold'). This was followed by a case note review of actual prescribing for consecutive patients with respiratory diseases at three institutions. Results: Initial questionnaires were completed by 81.3% (425/523) of physicians with 78.4% working in primary care. Most doctors used standard textbooks to guide their antimicrobial practice but 80% made extensive use of pharmaceutical company information. A minority of 1.7% would have inappropriately prescribed antibiotics for the case and 0.8-1.8% of respondents would have definitely prescribed TB drugs for non-TB conditions. Of the 495 respiratory cases, 25% of doctors prescribed an antibiotic for a simple upper respiratory tract infection and of 8 patients with a clinical diagnosis of TB, 4 received rifampicin monotherapy alone. Ciprofloxacin was widely but inappropriately used. Conclusion: Doctors rely on information provided by pharmaceutical companies; there was inappropriate antibiotic prescribing.

Item Type: Article
Keywords: antibiotics, tonsillitis, bronchitis, pneumonia, community-acquired pneumonia, tract infections, care, physicians, management, children, guidelines, adults, trends, Anti-Bacterial Agents, therapeutic use, Antitubercular Agents, therapeutic use, Cross-Sectional Studies, Drug Resistance, Bacterial, Drug Utilization, Family Practice, Human, Medication Errors, Prescriptions, Drug, statistics & numerical data, Questionnaires, Respiratory Tract Diseases, drug therapy, epidemiology, Russia, epidemiology, Support, Non-U.S. Gov't, Tuberculosis, drug therapy, epidemiology
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Antimicrobial Resistance Centre (AMR)
PubMed ID: 15317742
Web of Science ID: 223944600015
URI: http://researchonline.lshtm.ac.uk/id/eprint/14205

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