Effect of Educational Intervention for Antibiotic Prescription practices of family physicians in Treatment of Acute Upper Respiratory Tract Infections in Children In Primary Health Care (PHC) Unit in Giza Governorate

Abstract

Antibiotics have a major role in the treatment of bacterial infections, which have led to significant reduction in child morbidity and mortality rates worldwide. Inappropriate use of antibiotics is contributing factor to the creation of multidrug resistant bacteria which can develop resistance to multiple antibiotics and cause life threatening infection. URTIs are mostly caused by both viruses and bacteria, viral agents account for 90% of URTIs. Despite a viral aetiology antibiotics continue to be used as a treatment for 50%-70% of patients with URTIs. Educational intervention may be effective in improving antibiotic prescription patterns for upper respiratory tract infections in children by developing campaigns for both physicians and parents at local and nationwide levels. The aim of this study was to measure the rates of antibiotic prescription and inappropriate antibiotic prescriptions in treatment of URTIs in children, to implement an educational session for physicians about guidelines of antibiotic use and evaluating the impact of this educational intervention on the appropriateness and rates of antibiotic prescription in treatment of URTIs in children. The study was done in one PHC unit in Giza governorate using a self-administered questionnaire for physicians measuring their knowledge, attitude and practice toward antibiotic prescription in URTIs in children , and a patient sheet including the diagnosis and the antibiotic prescribed for measuring the rate of antibiotic prescription and it's appropriateness according to the AAFP guidelines of antibiotic use. 114 Eleven physicians working in the selected PHC unit filled the self-administered questionnaire at the beginning of the study and about 150 of children suffering from URTIs were enrolled in the pre intervention phase to assess the prevalence of antibiotic use and rate of appropriate antibiotic prescription. An educational intervention about the AAFP guidelines of antibiotic use was conducted in form power point presentation and booklets were distributed for physicians at the end of the educational session for evaluating the effect of This intervention on appropriateness and rates of antibiotic prescriptions. Another 150 of children suffering from URTIs were included in the post intervention phase to clarify the impact of the educational intervention by assessment of prevalence of antibiotic use and rate of appropriate antibiotic prescriptions again after the intervention. Results of this study showed significant reduction in rate of antibiotic prescriptions from79.2% in pre intervention phase to 60.7% in post intervention phase, while rate of appropriate antibiotic prescriptions were significantly increased from 22.9% in pre intervention phase to 48.4% in post intervention phase. The majority of cases were of pharyngitis which were (58%) before the intervention phase, and (53.3%) after the intervention then cases of bronchitis which were (16%) before the intervention, and (7.3%) after the intervention. In pre intervention phase the most commonly used antibiotic groups were cephalosporins then amoxicillin/ clavulanic acid group, while in post intervention phase amoxicillin/ clavulanic acid group use increased by about (21%) and cephalosporins use decreased by about (24.2%) 115