Treatment of infection: a cross-sectional survey of antibiotic drug utilisation in the Ramallah district of Palestine

Objective To characterise the use of antibiotics in outpatients treated for infection in the Ramallah district of Palestine. Setting A purposive sample of general and specialist outpatient clinics in the public and private sector in Ramallah. Method A prospective, cross-sectional survey over 3 months (February-May 2000) of patients diagnosed with infection, conducted through questionnaires to treating physicians (n = 25) and patients (n = 575). Key findings Infection associated with the respiratory tract was the most common type of infection diagnosed, accounting for over 80% of all infections, followed by urinary tract infection and otitis media (14% and 10%, respectively). Amoxicillin was the antibiotic prescribed most often, prescribed for 44% of all patients and for infection of all types and across all age groups. A wide variety of other antibiotics was prescribed, and in the private sector there was more use of newer, more expensive antibiotics. Antibiotic use was rated as appropriate in only 35% of patients, with inappropriate prescribing largely resulting from inappropriate indication (73%) and to a lesser extent choice of drug (17%) or cost (9%). Duration of therapy was seldom specified by the prescriber and depended on pack size dispensed. Seventy-six per cent of patients followed up at 1 week had recovered partially or completely, but lack of compliance was noted in 30%. Conclusions There was considerable evidence of inappropriate use of antibiotics, including prescribing for likely self-limiting or non-bacterial infection and failure to specify duration of therapy. A number of patients failed to complete the course. Strategies to promote optimal antibiotic use should be targeted initially to respiratory tract infection, and both physicians and patients require educational input. The community pharmacist can play a lead role on account of both drug expertise and ability to advise health professionals and patients.