Patterns of antibiotic prescribing and appropriateness for respiratory tract infections in a teaching hospital in Jordan

Abstract

Background Inappropriate use of antibiotics is a public health concern that promotes antibiotic resistance globally. This study aimed to investigate the patterns of antibiotic prescribing for respiratory tract infections (RTIs) in Jordan to encourage judicious antibiotic prescribing. Methods The researchers conducted a retrospective secondary analysis of oral antibiotics prescribed in the family medicine clinics in a teaching university hospital in Jordan in 2017. Antibiotic prescribing rates and the types of antibiotics prescribed were analysed. Patients' age, gender, type of insurance, and the RTIs diagnosis were investigated as possible factors that could be associated with inappropriate antibiotic prescribing for RTIs. Results Our findings revealed that 20 133 prescriptions, (27.3%) of all the prescriptions issued in the family medicine clinics included an antibiotic. Penicillins accounted for 52.7% of all the antibiotics prescribed, followed by macrolides (21.6%) and cephalosporins (16.4%). The most common indication for prescribing the antibiotics was RTIs (51.1%). The majority of antibiotics prescribed for respiratory diagnosis were for upper RTIs (URTI) (61.5%), followed by otitis media (16.9%) and tonsillitis (15.4%). Only 28.8% of all the antibiotics prescribed were appropriate and indicated. Older patients were significantly more likely to be prescribed an antibiotic compared to the younger (P < .001). Also, hospital employees and university employees were significantly more likely to be prescribed an antibiotic compared to the Ministry of Health employees (P < .001). Conclusions Antibiotics were inappropriately prescribed, and their prescribing rate was high in the outpatient setting in the family medicine clinics studied in Jordan. This calls for policy‐level interventions to promote judicious antibiotic prescribing to minimise the avoidable burden of microbial resistance and unnecessary expenditure.

Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications

“…Our study found that penicillins were the predominant class of antibiotics prescribed, and these are typically from the ‘access’ group, followed by cephalosporins, and fluoroquinolones, similar to an earlier study in Zambia and Jordan, where penicillins were the most widely prescribed antibiotics, 65 , 128 with studies in Botswana, Cameroon, Ghana and Tanzania also showing high rates of prescribing of amoxicillin. 86 , 99 , 117 , 120 This was followed by metronidazole and ciprofloxacin, again similar to Botswana, Cameroon, Ghana and Tanzania.…”

“…This outcome aligns with findings from other studies, where RTIs were the most common conditions in which antibiotics were often prescribed. 99 , 116 , 128 , 129 A similar study conducted in Lusaka, Zambia also reported that most antibiotics were prescribed for RTIs. 74 …”

“… 86 , 99 , 117 , 120 This may reflect comparatively high rates of STIs as well as UTIs, in addition to RTIs, in these countries, with high rates of RTIs also seen in other countries. 99 , 116 , 128 , 129 Respiratory infections are prevalent in Southern Africa, including Zambia, due to the abundance of infectious agents (bacteria, viruses and fungi) and limited healthcare and sanitation access, creating conditions that favour pathogen transmission. Overcrowded living conditions could also worsen the spread of respiratory infections in the region.…”

Prevalence of Bacterial Pathogens among Symptomatic–SARS-CoV-2 PCR-Negative Patients

“…(29.1%) and Acinetobacter spp. (29%) were discovered to be the two most common microorganisms in Jordan [ 24 ]. In contrast to these investigations, E. coli (41%) was the most common bacterium to be isolated, followed by Klebsiella pneumoniae (45%), Klebsiella freundii (1.3%), Citrobacter freundii (2.1%), Streptococcus agalactiae (2.1%), P. aeruginosa (16%), and Serratia liquefaciens (2.1%) [ 8 ].…”

“…To determine the prevalence of AMR and antibiotic misuse, and to address the problem of Gram-negative bacterial resistance in patients admitted to tertiary hospitals, a study from Jordan [ 24 ] showed that the most prevalent and resistant pathogen in patients was P. aeruginosa . Nitrofurantoin, meropenem, and imipenem were more effective against infections caused by E. coli .…”