Antibiotic prescribing trends in patients with upper respiratory tract infections reporting to tertiary care hospitals of Lahore.

To estimate the antibiotic utilization and treatment compliance in URTIs reported to tertiary care hospitals of Lahore. A cross-sectional study was conducted by including 423 prescription files from public and private hospitals of Lahore. Descriptive statistics were used to estimate percentage frequencies. The reporting frequency of URTIs, tonsillitis, pharyngitis and otitis media, was higher in public hospitals (JH; 27.4%, LGH; 25.8%) compared to private (NHMC;16.3%, DHMC;15.1%) hospitals in patients aged 21-40 years. Patients aged 18-40 years (59%) received most antibiotics. Broad spectrum antibiotics (95%) were prescribed in both public (JH; 27.4%, LGH;25.9%) and private hospitals (NHMC;16.3%, DHMC;14.8%) - co-amoxiclave (30%) in penicillin class, ceftriaxone (15.4%) and cefixime (11.6%) in cephalosporin class, levofloxacin (11.3%) in quinolone class and clarithromycin (10.4%) in macrolide class, in tonsillitis, pharyngitis and otitis media. The diagnosis that received most antibiotics included tonsillitis (30%), pharyngitis (29.1%) and otitis media (11.1%). Superior treatment compliance was observed in public hospitals compared to private hospitals. The highest treatment non-compliance was observed in laryngitis (36.4%), otitis media (34%) and pharyngitis (26%). 1st line and over all treatment compliance was superior in public hospitals - sore throat, tonsillitis, sinusitis, otitis media and pharyngitis received the most appropriate choices.

Patterns of physicians' knowledge, attitude and prescribing trends against upper respiratory tract infections in Lahore, Pakistan.

Although viruses cause most of upper respiratory tract infections but still antibiotics are irrationally prescribed in mild infections, especially in upper respiratory tract infections. To identify gaps among prescribers, due to lack of standard guidelines and antimicrobial stewardship programs, it is needed to check knowledge, attitude, perception and current prescribing pattern of antibiotics. Based on the data recommendations can be specified to overcome the prescribing deficiencies and increasing rates of antimicrobial resistance. It is inevitable to educate patients about ineffectiveness of antibiotics in viral infections, and to develop guidelines for prescribing antibiotics, running continuing medical education and establishing antibiotic stewardship programs. We conducted a cross-sectional survey-based study by engaging physicians of public and private sector hospitals in Lahore, Pakistan. About 66% agreed for semi-structured interview and met the inclusion criteria. Fifty percent of physicians have an understanding that antibiotics should be prescribed in URTIs, otherwise symptoms may get worsen. The only encouraging thing is that 78.8% believe that antibiotics are being misused and are major cause of increasing rate of resistance. Most of prescribers have an understanding that antibiotics should be prescribed in upper respiratory tract infections. They are prescribing antibiotics ignoring Center for Disease Control guidelines for the treatment or prophylaxis of upper respiratory infections.

Antibiotic susceptibility patterns of bacterial isolates of patients with upper respiratory tract infections

Abstract To evaluate the antibiotic susceptibility patterns in URTIs reporting to tertiary hospitals of Lahore. A cross-sectional study employing 259 culture sensitivity reports obtained from tertiary care hospitals of Lahore. Using SPSS, descriptive statistics were used to estimate frequencies and percentages. In URTIs, S. aureus (5%) was the frequent gram-positive isolate followed by MRSA (1.5%) and MSSA (1.5%), while P. aeruginosa (15.8%) was the prevalent gram-negative isolate followed by Klebsiella (13.1%) and E. coli (6.9%). Against P. aeruginosa, ceftazidime (7.7%), cefuroxime/ceftriaxone (4.6%), amoxicillin (4.3%) and ciprofloxacin (4.2%), were tested resistant, while imipenem (11.2%), ciprofloxacin (9.2%), amikacin (9.2%), meropenem/ levofloxacin/gentamicin (8.1%) and piptaz (6.9%) were found sensitive. Against Klebsiella, carbepenems (7.3%), amikacin (6.5%), ciprofloxacin (5.4%) and gentamicin (5%) were tested sensitive, whereas, ceftazidime (8.5%), ceftriaxone (5.8%), cefaclor (5.5%), ampicillin (4.6%), co-amoxiclave (4.2%) and ciftazidime/ciprofloxacin (3.8%) were found resistant. Overall, imipenem (35%), meropenem (30.8%) and amikacin (31.9%) were the three most sensitive antibiotics, while ceftazidime (25.4%), ceftriaxone (19.2%) and ampicillin (18.5%) were the three most resistant antibiotics. Data suggested that P.aeruginosa and Klebsiella, were the most frequent bacterial isolates in URTIs of Lahore. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycosides