The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated...

Area of Science:

• Infectious Diseases
• Pharmacology
• Public Health

Background:

• First-level healthcare settings manage frequent community illnesses like acute pharyngitis (AP), acute diarrhea (AD), and uncomplicated acute urinary tract infections (UAUTIs).
• Inappropriate antibiotic use in these common conditions significantly contributes to the development of antimicrobial resistance (AMR).

Purpose of the Study:

• To assess prescription patterns for AP, AD, and UAUTIs in pharmacies' adjacent medical offices.
• To evaluate diagnostic accuracy and therapeutic management in these primary care consultations.

Main Methods:

• Utilized an adult simulated patient (SP) methodology to represent AP, AD, and UAUTI scenarios.
• Collected data from 280 consultations in the Mexico City area, adhering to national clinical practice guidelines (CPGs).
• Assessed diagnostic accuracy and therapeutic management provided during consultations.

Main Results:

• High rates of antibiotic/antiviral prescriptions for AP (89.1%) and antibiotics for UAUTIs (98.1%) were recorded.
• A significant proportion of AD consultations (81.8%) involved antiparasitic drugs or intestinal antiseptics.
• Aminopenicillins, co-trimoxazole, and quinolones were the most frequently prescribed antibiotic classes for AP, AD, and UAUTIs, respectively.

Conclusions:

• Findings indicate highly inappropriate antibiotic prescribing for AP and AD, suggesting a potentially widespread issue.
• Urgent need to update UAUTI antibiotic prescriptions based on local resistance patterns is highlighted.
• Supervision of CPG adherence and increased awareness of rational antibiotic use and AMR threats are crucial at the primary care level.