Appropriate Use of Antibiotics in Ranong Province: A Stepwise Approach to Rational Drug Use

Abstract

     Irrational use of antibiotics is a global problem contributing to the development of resistance of microorganisms to standard treatments with increased morbidity and mortality rates. Rational drug use policy and guideline manual have been implemented by the Ministry of Public Health of Thailand since 2017. The objective of this study was to evaluate the impact of the implemented policy on antibiotic prescription, and in addition, the healthcare expenditure on antibiotic usage in the five main hospitals in Ranong Province. Four infectious diseases were focused in the study, i.e.,upper respiratory tract infection and acute bronchitis, acute diarrhea, fresh traumatic wound, and antibiotic prophylaxis in vaginal delivery of normal term labor. Relevant information on antibiotics use in the four focused diseases were collected by healthcare personnel from the electronic databases of the five focused hospitals. Multifaceted interventions were implemented to promote appropriate use of antibiotics in all relevant partners. After policy implementation, the average rates of antibiotics prescribed in all of the four target diseases have been continuously decreased from 2016 to 2018. The prescription rates in acute diarrhea and prophylaxis use in vaginal delivery of normal term labor were found to be significantly decreased below the target levels (20%). The daily doses (DDDs) of oral antibiotics prescribed in out-patients per1,000 visit perday and the daily doses (DDDs) of injectable antibiotics use in in-patients per100 patients-bed day as well as average cost of antibiotics use (per month) were generally decreased continuously. The key factors contributing to successful implementation of appropriate antibiotic use were promotion of awareness and provision of education and training of physicians, healthcare personnel, patients and communities as well as close monitoring and evaluation of the implemented program.