Non-Steroidal Anti-Inflammatory Drugs and Antibiotics Prescription Trends at a Central West Bank Hospital

Abstract

Objectives: We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. Methods: This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Results: Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. Conclusion: These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents.

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“…Mainstream drugs (such as antibiotics, anti-inflammatories and opioids) have been used to treat inflammatory processes originated from a variety of sources. However, despite their widespread use and clinical acceptance [ 2 ], their long-term utilization is commonly associated with adverse side effects that include changes in salivary flow and saliva composition [ 3 , 4 ], gastric ulceration, increased bleeding, nephrotoxicity, retention of sodium, development of drug-resistant bacterial strains [ 5 ] and drug abuse (heroin in particular) [ 6 , 7 ].…”

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“…Non-Steroidal Anti-Inflammatory drugs known as (NSAIDs) are commonly used as antiinflammatory and analgesic agents around the world, also some NSAIDs are used to relieve the fever as antipyretic [1]. Clinically, they are useful in reducing pain and inflammation in many conditions, As a case of arthritis, headache, abdominal cramps, dental pain, muscle aches, and stiffness as analgesic agents [2].…”