Effects of applying Clinical Practice Guidelines for Antibiotic prescriptions for acute upper respiratory tract infection, acute diarrhea and simple wounds in the Outpatient Department and Emergency Room at Bangpakong Hospital in Chachoengsao province of Thailand

Abstract

Introduction: The misuse of antibiotics is a global concern, leading to antimicrobial resistance, adverse drug effects, and an increase in associated healthcare costs. Common ailments like acute upper respiratory tract infections, acute diarrhea or simple wounds often receive inappropriate antibiotic prescriptions, and contribute to this escalating worldwide problem. Bangpakong Hospital recognized this issue and has implemented Clinical Practice Guidelines for Antibiotic Usage, aligning with recommendations from the Ministry of Public Health.

Objective: This study was to evaluate the impact of these guidelines on antibiotic usage and prescription rates for patients with the aforementioned conditions, admitted to the hospital’s outpatient department and emergency room from October 1st, 2018 to September 30th, 2020.

Method: A retrospective observational study utilized data from the records at Bangpakong Hospital, focusing on antibiotic prescriptions for acute upper respiratory tract infections, acute diarrhea and simple wounds during the specified period. Demographic and prescription data were analyzed using descriptive statistics and Z-tests for proportional differences.

Results: In 2018, 4,594 patients received antibiotics for upper respiratory tract infections. However, in 2019, with the hospital’s guidelines in place, the number decreased to 2,481 people. Similarly, in 2018, 391 patients were prescribed antibiotics for acute diarrhea; in 2019 the number of patients was 333. In 2018, 4,307 patients were given prescriptions for simple wounds from accidents. In 2019, the number dropped to 3,463 people. The results showed a 7.3% decrease in antibiotic usage for acute upper respiratory tract infections (31.0% to 23.80%, p < 0.01, 95% CI = 5.10 - 9.50%), and a 10.8% decrease in prescriptions for acute diarrhea (30.9% to 20.1%, p < 0.01, 95% CI = 4.39-17.21%). However, antibiotic use for simple wounds from accidents increased non-significantly (1.89%, p = 0.07, 95% CI = -0.18-3.98%).

Conclusion: The implementation of antibiotic usage guidelines led to reduced antibiotic prescriptions for acute upper respiratory tract infections and acute diarrhea. Conversely, there was a slight increase in antibiotic prescriptions for simple wounds, possibly due to an increase in patients with injuries prone to infection. These findings underscore the importance of adhering to guidelines that promote rational drug use among medical personnel.