JAC Advance Access originally published online on August 18, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(3):673-679; doi:10.1093/jac/dkh383
JAC vol.54 no.3 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.
Antimicrobial prescribing patterns for respiratory diseases including tuberculosis in Russia: a possible role in drug resistance?
1 KIL Consortium Sustainable TB Service Project, Mycobacterium Reference Unit, Department of Microbiology and Infection, Guy's King's and St Thomas' Medical School, King's College, King's College Hospital (Dulwich), East Dulwich Grove, London SE22 8QF; 4 Epidemiology and Statistics Core, Wellcome Trust Clinical Research Facility, Edinburgh; 5 KIL Consortium Sustainable TB Service Project, Centre for Health Management, The Management School, Imperial College, 53 Prince's Gate, London; 6 KIL Consortium Sustainable TB Service Project, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; 2 Samara Regional Tuberculosis Service, 154 Novo-Sadovaya str, Samara 443068; 3 Ministry of Health, Samara Region Administration, Samara, Russia
* Corresponding author. Tel: +44-20-86931312; Fax: +44-20-73466477; Email: francis.drobniewski{at}kcl.ac.uk
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.
Keywords: antibiotics , tonsillitis , bronchitis , pneumonia
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