The role of inadequate prescribing for the development of drug resistance in respiratory infections in Russia
Abstract number: 1134_01_127
Balabanova Y., Fedorin I., Kuznetzov S., Coker R., Drobniewski F.
Incorrect antimicrobial prescribing increases the risk of the development of drug resistance in pathogen. There have been few studies to detect levels of resistance in respiratory pathogens in Russia but a recent study in Samara Region of resistance among M. tuberculosis strains showed very high levels of resistance including multi-drug resistance.
To determine the patterns of antimicrobial prescribing for respiratory prescribing including tuberculosis (TB) among Russian physicians in Samara Region and it's possible role in development of resistance.
1) point-prevalence cross-sectional survey involving 28 primary care, general and TB institutions; in total 425 physicians took part in the questionnaire-based survey which aimed to look at empirical management of patients with respiratory diseases including the common cold. 2) Subsequently analysis of clinical notes of 491 consecutive patients with respiratory diseases were reviewed to assess actual prescribing habits.
Only a small group of doctors (1.7%) said that they would prescribe antibiotics for the simple cold. Review of clinical cases showed that antibiotics (ABs) were prescribed for 20% of patients with a simple upper respiratory tract infection. At least one AB was prescribed for the majority of patients (90.8%) with acute bronchitis; 80.0% of patients with exacerbation of chronic obstructive pulmonary diseases received one AB and 18.0% received two. When there was no clear evidence base for an AB in treatment of acute tonsillitis, Russian doctors prescribed at least one AB for nearly all (98.9%) of these patients and 18.0% received two ABs. Ciprofloxacin was widely but inappropriately used. Eight out of twelve patients with suspected but unconfirmed tuberculosis received rifampicin monotherapy alone.
Current AB over prescribing in Russia may contribute to the development of resistance in respiratory pathogens. There remains a need to restrict the prescribing of antibiotics by doctors in general and to provide further training. Further studies are needed to assess the level of patients expectations in receiving an AB as well as the role of over-the-counter prescribing and the true levels of resistance in TB and other respiratory pathogens.
|Session name:||XXIst ISTH Congress|
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