Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics

Overview

Journal Malays J Med Sci

Specialty General Medicine

Date 2022 Mar 14

PMID 35283676

Authors

AbdulRahman Muthanna

Siti Zulaikha Zakariah

Aneesa Abdul Rashid

Sazlina Shariff Ghazali

Rukman Awang Hamat

Maliza Mawardi

Hani Syahida Salim

Nurainul Hana Shamsuddin

Affiliations

Soon will be listed here.

Abstract

Background: Over-prescription of antibiotics for upper respiratory tract infection (URTI) is a continuing problem in Malaysia, leading to increased antimicrobial resistance and unnecessary cost incurred for treatment. In a patient presenting with a sore throat, it is recommended to only prescribe antibiotics to group A streptococcus (GAS) pharyngitis confirmed by a throat culture, rapid antigen test or in patients with a Centor score of 4.

Methods: This cross-sectional study assessed the proportion of antibiotics prescribed and antimicrobial susceptibility patterns of GAS pharyngitis in the Malaysian primary care setting. Two-hundred and fifteen adult patients presenting with sore throat were recruited in three primary care clinics. Demographic data and clinical information were collected and analysed. Centor scores were calculated according to the clinical information and throat swabs were collected from all participants for GAS identification.

Results: Only six throat swabs isolated GAS and indicated for antimicrobial treatment (2.8%). However, 48 participants (22.3%) were prescribed antibiotics out of which only four (8.3%) patients with isolated GAS, including three (6.2%) patients who clinically had a Centor score of 4 and one patient with a score of 3. Amoxicillin and erythromycin were the most commonly prescribed antibiotics (58.3% and 25% of all antibiotics, respectively).

Conclusion: There is a high proportion of antibiotic prescriptions which were not indicated in patients with sore throat in this study. This may reflect a common practice of antibiotic overuse for sore throat in primary care settings in Malaysia. Concerted interventions to reduce the inappropriate prescribing of antibiotics are urgently needed.

References

Allen K, Farah C . Screening and referral of oral mucosal pathology: a check-up of Australian dentists. Aust Dent J. 2015; 60(1):52-8. DOI: 10.1111/adj.12261. View

. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388(10053):1545-1602. PMC: 5055577. DOI: 10.1016/S0140-6736(16)31678-6. View

Orden B, Martinez R, Lopez de los Mozos A, Franco A . [Antibiotic resistance to erythromycin, clindamycin and tetracycline of 573 strains of Streptococcus pyogenes (1992-1994)]. Enferm Infecc Microbiol Clin. 1996; 14(2):86-9. View

Andersson D, Hughes D, Kubicek-Sutherland J . Mechanisms and consequences of bacterial resistance to antimicrobial peptides. Drug Resist Updat. 2016; 26:43-57. DOI: 10.1016/j.drup.2016.04.002. View

Hersh A, Fleming-Dutra K, Shapiro D, Hyun D, Hicks L . Frequency of First-line Antibiotic Selection Among US Ambulatory Care Visits for Otitis Media, Sinusitis, and Pharyngitis. JAMA Intern Med. 2016; 176(12):1870-1872. PMC: 6364667. DOI: 10.1001/jamainternmed.2016.6625. View

Palla A, Khan R, Gilani A, Marra F . Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012; 12:70. PMC: 3517306. DOI: 10.1186/1471-2466-12-70. View

Traub W, Leonhard B . Comparative susceptibility of clinical group A, B, C, F, and G beta-hemolytic streptococcal isolates to 24 antimicrobial drugs. Chemotherapy. 1997; 43(1):10-20. DOI: 10.1159/000239529. View

Mohd Fozi K, Kamaliah M . The effect of profiling report on antibiotic prescription for upper respiratory tract infection. Malays Fam Physician. 2015; 8(2):26-31. PMC: 4170469. View

Tyrstrup M, van der Velden A, Engstrom S, Goderis G, Molstad S, Verheij T . Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators. Scand J Prim Health Care. 2017; 35(1):10-18. PMC: 5361413. DOI: 10.1080/02813432.2017.1288680. View

10.

Petkovic H, Lukezic T, Suskovic J . Biosynthesis of Oxytetracycline by : Past, Present and Future Directions in the Development of Tetracycline Antibiotics. Food Technol Biotechnol. 2017; 55(1):3-13. PMC: 5434370. DOI: 10.17113/ftb.55.01.17.4617. View

11.

Hraoui M, Boutiba-Ben Boubaker I, Rachdi M, Slim A, Ben Redjeb S . Macrolide and tetracycline resistance in clinical strains of Streptococcus agalactiae isolated in Tunisia. J Med Microbiol. 2012; 61(Pt 8):1109-1113. DOI: 10.1099/jmm.0.037853-0. View

12.

Muthanna A, Salim H, Hamat R, Shamsuddin N, Zakariah S . Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits. Malays J Med Sci. 2019; 25(6):6-21. PMC: 6422577. DOI: 10.21315/mjms2018.25.6.2. View

13.

Van Boeckel T, Gandra S, Ashok A, Caudron Q, Grenfell B, Levin S . Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014; 14(8):742-750. DOI: 10.1016/S1473-3099(14)70780-7. View

14.

Calle-Miguel L, Perez-Mendez C, Miguel-Martinez M, Lombrana-Alvarez E, Garcia-Garcia E, Solis-Sanchez G . [Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)]. Rev Esp Quimioter. 2017; 30(2):90-95. View

15.

Mathur P, Bhardwaj N, Mathur K, Behera B, Gupta G, Kapil A . Clinical and molecular epidemiology of beta-hemolytic streptococcal infections in India. J Infect Dev Ctries. 2014; 8(3):297-303. DOI: 10.3855/jidc.3216. View

16.

Page-Sharp M, Coward J, Moore B, Salman S, Marshall L, Davis T . Penicillin Dried Blood Spot Assay for Use in Patients Receiving Intramuscular Benzathine Penicillin G and Other Penicillin Preparations To Prevent Rheumatic Fever. Antimicrob Agents Chemother. 2017; 61(8). PMC: 5527604. DOI: 10.1128/AAC.00252-17. View

17.

Zafar A, Hasan R, Nizamuddin S, Mahmood N, Mukhtar S, Ali F . Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002-15. J Antimicrob Chemother. 2016; 71 Suppl 1:i103-9. PMC: 4890355. DOI: 10.1093/jac/dkw076. View

18.

Al-Charrakh A, Al-Khafaji J, Al-Rubaye R . Prevalence of β-hemolytic groups C and F streptococci in patients with acute pharyngitis. N Am J Med Sci. 2012; 3(3):129-36. PMC: 3336899. DOI: 10.4297/najms.2011.3129. View

19.

Lin F, Azimi P, Weisman L, Philips 3rd J, Regan J, Clark P . Antibiotic susceptibility profiles for group B streptococci isolated from neonates, 1995-1998. Clin Infect Dis. 2000; 31(1):76-9. DOI: 10.1086/313936. View

20.

Mathan J, Ekart J, Houlding A, Payinda G, Mills C . Clinical management and patient persistence with antibiotic course in suspected group A streptococcal pharyngitis for primary prevention of rheumatic fever: the perspective from a New Zealand emergency department. N Z Med J. 2017; 130(1457):58-68. View