Ahmad, Azmi
(2020)
Patient factors influencing inappropiate antibiotic prescribing for upper respiratory tract infection (URTI) in Emergency Department, Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Upper respiratory tract infection (URTI) is a common clinical presentation for nonemergency
cases in the emergency department. Increased numbers of the non-emergency
cases such as URTI may contribute to inappropriate antibiotic prescribing. Most of the
study done in Malaysia regarding URTI was done in the outpatient department. The
objective of this study is to determine patient factors associated with inappropriate
antibiotic prescribing for URTI in emergency department Hospital USM.
Methods
This was an observational, cross sectional study involving patients diagnosed as URTI
admitted in the green zone in the emergency department of a tertiary teaching hospital in
the east coast of Malaysia. Data collected included patient’s demography (age, gender,
race), duration of illness, working days, working shift, frequency of health visit, patient’s
symptom and signs. Patients were categorized into two groups: positive McIsaac (score
≥2) and negative McIsaac (score <2). Factors associated in influencing antibiotic
prescribing in the negative McIsaac group (inappropriate prescription) were determined.
Results
A total of 261 subjects were included. There were 127 positive and 134 negative McIsaac
score. From the total, most common URTI symptoms presented were fever (85%) and
cough (76%). Highest antibiotic prescriptions were for acute tonsillitis and acute
pharyngitis (42% and 36% respectively). Both groups showed higher prescription of
amoxicillin (33%) and amoxicillin/clavulanate acid (34%). The overall inappropriate
antibiotic prescribing based on negative McIsaac score was 29%. Duration of symptoms,
symptoms of chill and specific diagnosis of acute tonsillitis were associated with
inappropriate antibiotic prescription.
Conclusion
Emergency doctors should be aware of the influence of patient’s symptom and specific
final diagnosis in prescribing antibiotic for URTI. The occurrence of inappropriate
antibiotic prescribing in the emergency department can still be improved with
intervention to re-educate, retraining and academic detailing which address prescribers
regarding the importance of scoring system coupled with good clinical assessment in
managing URTI.
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