Misuse of antibiotics for viral fevers by first contact doctors

Abstract

BACKGROUND: Inappropriate use of antibiotics has led to a steady increase in microbial antibiotic resistance. METHODS: We conducted a survey during the recent outbreak of dengue fever (three months from June 2004), when doctors should be aware the most likely cause for fever is viral, to study the antibiotic prescription pattern at primary contact. Drugs prescribed were identified by analysing the prescriptions or unused drugs provided by the patients. RESULTS: Of the 412 patients with fever admitted to professorial medical unit, 146 patients [(121 males), mean age 26 yrs (SD;9.4yrs)j were randomly selected for the study. Their first contact medical care was: general practitioner (GP) in 122(84.1%); out patient department of the hospital (OPD) in 20( 13.8 %) and a specialist physician in 4(2.1 %). The mean duration of fever at the time of first contact was 1.6 days (SD:0.9). 105(72%) patients had been prescribed an antibiotic; 99 from the GP (81% where GP was first contact) and 6 from the OPD (30% wh«re OPD was first contact). The mean duration of antibiotic use at the time of admission to hospital was 3.5 days (SD;1.9). The most likely diagnoses at the time of admission were dengue fever or viral fever in 128(88%), and of them 93 patients (73%) had taken an antibiotic. Of the patients who had taken an antibiotic only 9(8%) required continuation of the treatment. The antibiotic prescribed was identified in 89(85%): Amoxycillin 61(58%); ciprofloxacin 17(16%); cephalexin 9(8%); erythromycin 3(3%). CONCLUSIONS: There was a high rate of inappropriate use of antibiotics at the first contact.