Pattern of Upper Respiratory Tract Infections and Physicians' Antibiotic Prescribing Practices in Bahrain

Objective: To evaluate the pattern of antibiotic prescriptions for paediatric upper respiratory tract infections (URTI) and determine the associated predictors for such antibiotic use in the Kingdom of Bahrain.

Subjects And Methods: From March 2005 to March 2006, demographic data, clinical presentation, investigations and antibiotic prescription for children with URTI (n = 184) at the Bahrain Defence Force Hospital was recorded. To assess the factors which influence physician antibiotic prescription for URTI, a cross-sectional survey of doctors was carried out using a pre-tested questionnaire which was administered to paediatricians, general practitioners and emergency room physicians.

Results: Antibiotics were given to 95 of the 184 (51.6%) patients, mainly children <3 years (40/95). Significant association was demonstrated for antibiotic prescription, age and diagnosis of tonsillitis or acute otitis media (p < 0.05). Amoxicillin (37/95) was the most frequently prescribed antibiotic, followed by beta-lactam/beta-lactamase combination and second-generation cephalosporins. Fever, younger age, sore throat and presence of earache increased the likelihood of antibiotic prescription. Data from the cross-sectional survey of doctors revealed that lack of national guidelines, parental pressure and diagnostic uncertainty contributed to antibiotic overuse.

Conclusion: Antibiotic overuse for the treatment of paediatric URTI remains a problem in our setting. We suggest the development of national guidelines which are integrated with structured continuing medical education courses, public awareness campaigns and the introduction of rapid streptococcal antigen tests in the outpatient clinic.