A Survey on Current Attitude of Practicing Physicians Upon Usage of Antimicrobial Agents in Southern Part of India

G. Sivagnanam, MD; P. Thirumalaikolundusubramanian, MD; J. Mohanasundaram, MD; A. Anusha Raaj, II Year MBBS Student; K. Namasivayam, MD; S. Rajaram, MD


Medscape General Medicine. 2004;6(2):1 

In This Article

Abstract and Introduction

Context: Antimicrobial resistance is a serious public health concern worldwide. Inappropriate prescribing, including the wrong drug, incorrect dose/duration, and poor compliance, contributes to it.
Objective: To identify factors determining the attitudes and practices of prescribers regarding antibiotic usage and to suggest measures that contain antibiotic resistance.
Design and Setting: With a convenient sample, general practitioners and specialists of both sexes from 5 districts of Tamilnadu state, India, were approached for the study. A slightly modified, self-administered, anonymous questionnaire of the Alliance for the Prudent Use of Antibiotics was used. The deciding factors to prescribe an antibiotic and the reasons for the attitude to prescribe a broad-spectrum antibiotic were elicited.
Results: Out of the 285 participants 120, 110, and 47 practiced at city, semiurban, and rural areas, respectively. The responses were graded with a total possible score of 150. There was no significant difference between men and women or between specialist and nonspecialists in scores. The majority believed that antibiotics are overprescribed. Purulent discharge (65%), antibiotic-resistance concerns (48%), fever (40%), and patient satisfaction (29%) were the strong influences to prescribe an antibiotic. Similar reasons were cited for the belief of prescribing a broad-spectrum antibiotic. The 3 most commonly prescribed antimicrobials were amoxicillin (21%), ciprofloxacin (18%), and co-trimoxazole (11%). About 42% used an antibiogram only to the extent of less than 10%.
Conclusion: Patient requests/expectations, patient satisfaction, purulent discharge, and fever strongly pressurized practitioners to prescribe antibiotics. Patient and time pressures, diagnostic and treatment uncertainties, and the poor utilization and/or ill-affordable antibiogram facility all point to an urgent, multidimensional approach to contain antibiotic resistance.

Wider and more prevalent usage of antibiotics is not only a concern for the community or to certain nations but all over the world. As a result of this wide usage, the people are at a high risk of antibiotic resistance. The problem of multidrug resistance in recent times because of unregulated sale and self-medication has created a great public health concern.[1] As has been rightly pointed, "Antimicrobial resistance is a risk that threatens to turn back the clock to a darker age in the industrialized countries and to block health progress in the developing world."[2] The problem of antimicrobial resistance has snowballed to a serious public health concern with economic, social, and political implications worldwide. The rate of drug-resistant bacteria is dramatically increasing.[3] Our challenge is to slow the rate at which resistance develops and spreads.[4]

Containment of antimicrobial resistance, although not easy, is not impossible. The importance of the judicious use of antibiotics in limiting the spread of antibiotic resistance[5] cannot be overemphasized because this strategy minimizes any unnecessary, inappropriate, or irrational use of antimicrobials. Among the core groups, the major potential players with a leading role in the above strategy are prescribers. Inappropriate prescribing practices, including the wrong choice of drug, the incorrect dosage or duration of treatment, poor compliance, and the use of poor-quality drugs, all contribute to antimicrobial resistance.[6] Only by understanding the reasons underlying inappropriate prescribing can one define effective interventions.[7]

Hence, the present study was aimed at identifying prevalent practices and attitudes of prescribers, especially private-sector medical practitioners in city, semiurban, and rural regions of Tamilnadu (a southern state of India).