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