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Physician
Antibiotic Prescribing Practices and Knowledge in Seven Countries
in Latin America and the Caribbean
A
PAHO/APUA Report, January 2002
Aníbal
Sosa, MD and Karin Travers, DSc
Full text
Summary
- The survey results
showed a general lack of physician training on antibiotic use
in Latin America (46% of physicians took informal courses and
17.9% received formal training). The length of formal training
(whether short- or long-term) had no significant effect on appropriate
antibiotic usage.
- A general lack
of antibiotic resistance surveillance information points to
a need for more surveillance networks, increased linkages where
they exist, and increased dissemination of data. Reference laboratories,
likewise, are either lacking and/or physicians are unaware of
their existence; 62.9% of respondents stated that they do not
have access to such a lab.
- There is an urgent
need for consumer education as self-medication rates are high
in these targeted countries and availability of written educational
materials for consumers on proper compliance with antibiotic
treatment is low. Almost 91% of physicians stated that there
were no consumer education efforts in their countries that address
antibiotic use and abuse and its consequences.
- There is a significant
need for the collection and dissemination of more local antibiotic
resistance data to improve prescribing patterns and patient
outcomes. Physicians have little geographically pertinent information
available regarding their local disease specific resistance
levels. Physicians also cite a lack of access to information
on local resistance patterns (only 16% say they have this type
of information) and to written information on infectious diseases
of local importance and recommended treatments for them (less
than 20% say they have this type of information).
- There is an acute
need to raise physician awareness regarding resistance patterns.
One-third or less of physicians surveyed was aware of resistance
patterns for shigella, salmonella & S.
pneumoniae. Seventy-four percent of respondents did not
know if the resistance information was applicable to the geographic
area where they work.
- There is a general
lack of information for physicians to appropriately treat ARI
(acute respiratory infections) and ADI (acute diarrheal infections)
empirically. Only 57.5% and 33.8% of responders demonstrating
such knowledge when presented with ARI and ADI clinical cases,
respectively.
- Respondents report
that ARI/pneumonia was the primary reason for prescribing antibiotics
(27%), followed by pharyngotonsillitis (15%) and UTIs (9%).
- When faced with
a gram-positive bacteria, most physicians reported using penicillins
(PCN, semi synthetic penicillins, beta-lactams) as their first
option (64%), followed by cephalosporins (12%) and quinolones
(6%).
This
publication was made possible through support provided by the
Pan American Health Organization (PAHO). The opinions expresses
herein are those of the authors and do not necessarily reflect
the views of the Pan American Health Organization. Contributors
to this report included Stuart Levy, MD, APUA President, Kathy
Young, Executive Director, Kerry West, APUA International Program
Assistant, Laura Raymond, APUA Program Manager and Laura Krech,
MPH, Consultant.
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