Over prescription of antibiotics in children with acute upper respiratory tract infections: A study on the knowledge, attitude and practices of non-specialized physicians in Egypt

• Published in: PloS one 2022-11, Vol.17 (11), p.e0277308
• Main Authors: Amin, Mariam Taher, Abd El Aty, Mahmoud Attia, Ahmed, Sabra Mohamed, Elsedfy, Ghada Omar, Hassanin, Ebtisam Shawky, El-Gazzar, Amira Fathy
• Format: Article
• Language: English
• Subjects: Adult; Agriculture; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Attitudes; Biology and Life Sciences; Child; Children; Communicable diseases in children; Cross-Sectional Studies; Drug resistance; Drug therapy; Drugs; Egypt; Epidemiology; Family physicians; Fever; Global health; Health Knowledge, Attitudes, Practice; Health risks; Humans; Infections; Knowledge; Medical errors; Medicine and Health Sciences; Microbiota; Microorganisms; Observational studies; Pediatrics; Penicillin; People and Places; Physicians; Practice; Practice Patterns, Physicians; Prescribing; Prescription drugs; Prescriptions; Public health; Questionnaires; Rationality; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory tract infections; Respiratory Tract Infections - drug therapy; Social Sciences; Surveys; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0277308

Antimicrobial resistance (AMR) is currently one of the global public health threats. Increased antibiotic consumption in humans, animals, and agriculture has contributed directly to the spread of AMR. Upper respiratory tract infections (URIs) are one of the most common conditions treated by antibiotics, even if unnecessary as in cases of viral infections and self-limited conditions which represent the most cases of URIs. Investigating physicians' knowledge, attitudes, and practice regarding antibiotic prescriptions in children with acute URIs may reflect the problem of antibiotic over prescription. This study aims to assess the problem in our community and provide information for further planning of appropriate interventions to optimize antibiotic prescriptions. This is a cross-sectional study for all non-specialized physicians dealing with acute upper respiratory tract infections (URIs) in pediatrics sittings in Assiut district, Egypt. We used a self-administered questionnaire to assess physicians' knowledge, attitudes, and practice. In addition, four clinical vignettes addressing different URI scenarios were included in the questionnaire to assess the patterns of antibiotic prescriptions in common cases. Our study included 153 physicians whose mean age was 32.2 ± 8.7, most of whom were pediatric residents in different health institutes in Assiut district. They had good knowledge as out of the 17 knowledge questions,the mean number of correct answers was 12.4 ± 2.9. Regarding their attitudes, mean attitude scores for inappropriate antibiotic prescribing were low. However, of those scores, the responsibility of others had the highest score (3.8 ± 0.61). Prescribing practice in special conditions of URIs showed that 80% of participants prescribed antibiotics if fever continued for more than five days and 61.4% if the child had a yellowish or greenish nasal discharge. Among 612 clinical vignettes, 326 contained antibiotic prescriptions (53.3%), and appropriate antibiotic prescriptions represented only 8.3% overall. Physicians dealing with acute URIs in outpatients' clinics in the Assiut district have good knowledge about antibiotic use and resistance and demonstrate a good attitude toward appropriate antibiotic use. Although the percentage of inappropriate prescriptions in clinical vignettes in high, more research is required to investigate the factors of antibiotic inappropriate prescribing practice and non-adherence to guidelines. Also, it is essential to