Optimizing Clinical Diagnosis and Antibiotic Prescribing for Common Respiratory Tract Infections, Fanara Family Health Center- Rural Egypt

Background: Antibiotic prescribing for respiratory tract infections (RTI) by primary care
doctors has received renewed interest due to the continuing emergence of antibiotic
resistance, increased incidence of adverse effects and the attendant cost to healthcare
especially in developing countries like Egypt. Despite the majority of these infections
being viral it seems that many determinants other than the etiology are the main factors
that influence a high rate of prescribing antibiotic for these self-limiting infections.
Objective: We aimed to assess the impact of a physician- based educational intervention
to improve clinical diagnosis of bacterial causes of RTIs and reduce unnecessary antibiotic
prescription for these infections. Methods: This is a clinical trial, where 11 family
medicine residents working at a rural family health center in Egypt participated in an
educational program to improve their antibiotic prescribing skills when treating common
RTI. Their patterns of prescribing antibiotic have been studied among all patients 3
months old or above who attended the family center with RTI, for 2 months before and
after the educational intervention (1st of December 2015 to 10th of March 2016). The
educational intervention comprised 4 hours, 2 lectures and another 4 hours, 2 small group
discussions in updated management of RTI and health education principles based mainly
on NICE guidelines and Health Belief Model (HBM) respectively. The primary outcome
was measuring the impact of the educational intervention on rates of prescribing antibiotic
for 4 RTI [Acute otitis media (AOM), tonsillopharyngitis, rhino sinusitis and acute
bronchitis], the appropriateness of using clinical diagnostic criteria of bacterial causes of
these infections and the appropriate selection of antibiotic when its use was justified.
Results: The overall antibiotic prescription was significantly reduced (8.3%) from base
line ( 80.3%( to post intervention (72%) period, (P=0.007). This reduction was significant
for both tonsillopharyngitis (12.2%, P=0.019) and otitis media (14.2%, P= 0.033). There
were also significant improvement in using clinical diagnostic criteria for bacterial causes
of the four studied RTI with 12.5% overall improvement (P=0.001). There was also
improvement in the overall appropriateness of selecting first line antibiotic when its use
was justified this improvement was achieved for both tonsillopharyngitis (17.8%, P=
0.004) and AOM (P= <0.001). Conclusion: Clinical diagnosis of bacterial causes of
common RTIs and appropriate antibiotic use for these infections can be improved
in primary health care settings using a physician based educational program.