Pattern and appropriateness of antimicrobial prescription for acute respiratory tract infection in primary healthcare settings in Ethiopia

Background Acute respiratory tract infections (ARTIs) are the leading cause of antimicrobial misuse, contributing to the increasing problem of antimicrobial resistance. Little information exists about the pattern and appropriateness of antimicrobial prescribing in patients with ARTIs in the study area. Therefore, this study aims to investigate antimicrobial prescriptions and their appropriateness for ARTIs in primary healthcare settings in Ethiopia, as well as to identify potential risk factors for inappropriate antimicrobial prescriptions.

Methods A cross-sectional study was conducted in seven selected primary health centres. Data were collected through face-to-face structured questionnaire interviews with outpatients diagnosed with ARTIs and a review of their medical charts. To be eligible for this study, patients had to be diagnosed with one of the ARTIs as diagnosed by physicians. The appropriateness of antimicrobial prescription was evaluated by two experienced physicians based on national and international guidelines. Multivariable logistic regression was used to identify the significant factors, including sociodemographic and clinical characteristics, associated with inappropriate antimicrobial prescriptions. A p-value<0.05 was considered a level of statistical significance. We used Variance Inflation Factors (VIF) to check the multicollinearity of independent variables.

Results Among 420 patients included in the study, 55% were female. The mean age of the participants was 45.1 years (SD±16.8 years) with a range of 18–90 years. The most frequent diagnoses of ARTIs were acute bronchitis (24%), common cold (22.4%), and tonsillitis (15.2%). 352 (83.8%) of patients received antimicrobial prescriptions. The most frequently prescribed antimicrobial classes were penicillin (69.1%), macrolides (20.4%), and fluoroquinolones (6.2%). Moreover, amoxicillin (36.9%) and amoxicillin-clavulanic acid (32.4%) were the most inappropriately prescribed antimicrobials. The rate of inappropriate antimicrobial prescription was 64.2%. Among these, 71.7% of patients received antimicrobials that were not indicated, while the remaining 28.3% received an inappropriate dose and frequency. Patients diagnosed with common colds, acute bronchitis and tonsillitis had a higher rate of inappropriate antimicrobial prescriptions. The presence of fever (OR=5.42; 95% CI=3.36–8.75; P<0.001), patients with comorbidities (OR=1.31; 95% CI=1.23–3.93; P=0.001) and patient age≥60 years (OR=1.18; 95% CI=1.08–2.48; P<0.001) were associated with a higher likelihood of inappropriate antimicrobial prescribing.

Conclusion Overall, the study findings highlight a high rate of antimicrobial prescriptions for ARTIs, with the majority being prescribed inappropriately. These results underscore the need for targeted interventions, including antimicrobial stewardship programs and adherence to international guidelines, to reduce inappropriate prescriptions and combat antimicrobial resistance.