Factors determining antibiotic prescription for patients with febrile illness among first contact doctors in Gampaha District

Abstract

BACKGROUND: Antibiotics are being over-prescribed in general practice. Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing. Illness (e.g.: presence of high fever), and consumer (e.g.: patients' demand) and prescriber (e.g.: hope patient expects) related factors have been identified for over prescription of antibiotics. The factors-influencing antibiotic prescription for patients with febrile illness among first contact doctors in Sri Lanka has not been documented before. METHODS: We conducted a pre-tested questionnaire based survey among 100 randomly selected first contact doctors (45 full time GPs) from 6 different areas of the Gampaha District to identify the factors influencing antibiotic prescription in patients with febrile illness. Questionnaires were distributed to be filled in and handed over the same day by 6 selected pre-intera doctors. RESULTS: Out of the 100 selected doctors, 81 (21 females) participants could be visited during the study period. Thirty four were in full time general practice (GP), 47 were working in a hospital in addition to GP. Mean duration of practice was 10.2 years (SD 9).The mean number of febrile patients seen per week 159 (SD 153). The mean duration of illness at the time of presentation was 2.5 days (SD 0.5), The % of doctors who would have a >50% chance of prescribing an antibiotic in patients with; mild fever 19%, fever body aches 23%, high fever 52% and fever with cough 68%, yellow sputum 73%, sore throat 83%, and who looks very ill 84%, due to fear of no improvement 52%, loosing patient 14% and on patients demand 10%. CONCLUSIONS: The antibiotic prescription among first contact doctors in Gampaha District seems to depend more on doctor's knowledge based illness related factors rather than on non-illness related factors.