| Overuse of antibiotics is a worldwide phenomenon
(1, 2) and it contributes to the emergence of antimicrobial
resistance (3, 4, 5). Unnecessary use of antibiotics
also leads to an increased risk of side effects (6),
high costs (7) and medicalising effects (8).
In
the Fifty-eighth World Health Assembly held in May
2005, it was resolved and agreed by more than 60 countries
(including Hong Kong and China) that the containment
of antimicrobial resistance is one of the internationally
agreed health-related goals but the strategy for it
has not been widely implemented. It urges Member States
(a) to enhance rational use of antimicrobial agents,
including through development and enforcement of national
standard practice guidelines for common infections,
in public and private health sectors, (b) to monitor
regularly the use of antimicrobial agents and the level
of antimicrobial resistance in all relevant sectors,
and (c) to share actively knowledge andexperience on
best practices in promoting the rational use of antimicrobial
agents.
Primary care doctors prescribe most of all
antibiotics and many of these are for infections of
the respiratory tract (9) despite research studies
demonstrating little or no clinical benefits (10-17).
Surveys done by Lam & Lam revealed that antibiotics
are frequently used in patients with respiratory tract
infections in Hong Kong (18) and many doctors also
acknowledged that they might be prescribing antibiotics
too often for upper respiratory tract infections (URTI)
(19).
There are many possible reasons why primary
care doctors in Hong Kong are prescribing antibiotics
for URTI, for example, their misconceptions about the
significance of fever, discoloured sputum or nasal
discharge, exudates and lymphadenopathy (18), as well
as patients' expectations (19). These findings were
based on the primary care doctors' report of their
clinical behaviours. They may therefore under estimate
or even over estimate their use of antibiotics in these
previous studies. There is otherwise no current information
available on the actual usage of antibiotics by primary
care doctors in Hong Kong.
The proposed study represents
a step forward in the understanding of the use of antibiotics
by primary care doctors in Hong Kong. It aims to examine
the primary care doctors' clinical behaviour in the
use of antibiotics by detailing the type of antibiotics
they use, including the dosage and duration, and the
illnesses that they use the antibiotics. Similar study
provided useful information to help reduce antibiotics
use in Scadinavia (20).
Objectives of the proposed
study:
1. To document the level of use of antibiotics
by primary care doctors in Hong Kong, including the
types of antibiotics, dosage and duration.
2. To
examine the primary care doctors' use of antibitocs
and its relation to common infections in the community.
3.
To examine the relationship between patients' expectation
of antibiotics and the prescription of antibiotics
by primary care doctors.
4. To identify the characteristics
of primary care doctors e.g. age, gender, vocational
training in general practice/family medicine and the
use of antibiotics in the community.
Hypotheses
It
is hypothesized that:
1. Antibiotics are too frequently
used for common infections in primary care setting
in Hong Kong.
2. Patients' expectation of antibiotics
are associated with higher level of use of antibiotics
by primary care doctors.
3. There is a close association
between the level of use of antibiotics and certain
characteristics of primary care doctors e.g. age, gender
and vocational training experience.
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B, Goodyear-Smith F. General practitioner management
of upper respiratory tract infections: when are antibiotics
prescribed? New Zealand Medical Journal 2000;113(1122):493-496.
2.
Wang EE, Einarson TR, Kellner JD, Conly JM. Antibiotics
prescribing for Canadian preschool children: evidence
of overprescribing for viral respiratory infections.
Clinical Infectious Disease 1999;29(1):155-160.
3.
Schwartz B, Bell DM, Hughes JM, et al. Preventing
the emergence of antimicrobial resistance. JAMA 1997;278:944-945.
4.
Belongia EA, Schwartz B. Strategies for promoting
judicious use of antibiotics by doctors and patients.
BMJ 1998;317:668-671.
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B, Kenealy T. Antibiotics for the common cold. Cochrane
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G, Hueston WJ. The cost of antibiotics in treating
upper respiratory tract infections in a Medicaid population.
Arch Fam Med 1999;7:45-9.
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I, Warner G, Gantly M, Kinmonth AL. Reattendance and
complications in a randomised trial of prescribing
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I, Warner G, et al. Open randomised trial of prescribing
strategies in managing sore thoat. BMJ 1997;314:722-727.
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Orr PH, Scherer K, MacDonald A, et al. Randomized
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M. What will it take to stop physicians from prescribing
antibiotics in acute bronchitis? Lancet 1995;345:665-666.
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Verjeij TJM, Hermans J, Mulder JD. Effects of doxycycline
in patients with acute cough and purulent sputum: a
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A placebo-controlled, double-blind trial of erythromycin
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J Fam Pract 1996;42:601-605.
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Kaiser L, Lew D, Hirschel B, et al. Effects of antibiotic
treatment in the subset of common-cold patients who
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18. Lam TP, Lam KF. Why do family
doctors prescribe antibiotics for upper respiratory
tract infection? International Journal of Clinical
Practice 2003:57(3):167-169
19. Lam TP, Lam KF.
What are the non-biomedical reasons which make family
doctors over-prescribe antibiotics for upper respiratory
tract infection in a mixed private/public Asian setting?
Journal of Clinical Pharmacy and Therapeutics. 2003;28:197-201.
20. Mikstra Programme - antimicrobial treatment
strategies (Accessed in June 2005 http://www.stakes.fi/mikstra/e/) |