Antibiotic prescription rates for upper respiratory tract infections at the Alain ambulatory healthcare centers, United Arab Emirates (2014–2016)

Background: Antibiotic resistance has been a global issue over the last two centuries. According to the WHO report on antimicrobial resistance, the antibiotic overuse in primary healthcare practice is a major cause of increasing resistance to antibiotics. In the UAE, there have been no studies targeting the overuse of, or prescription rates for antibiotics in primary healthcare centers. Objective: To estimate the rate of antibiotic prescription for upper respiratory tract infections (URTIs) in primary healthcare centers in the city of Alain for over a two-year period. To estimate the most common antibiotic used for URTI and to identify the determinants of giving particular antibiotics. Study Design: Retrospective cross-sectional study. Settings: : Data of all patients who visited ambulatory healthcare centers and received oral antibiotic prescriptions for URTIs, during the study period (November 2014–November 2016), were extracted from the medical electronic system, including patient demographics (age, gender), patient clinical examination (fever, presence of throat pain), and diagnostic assessments (rapid streptococcal antigen detection test, throat culture), diagnosis name and ICD 9 code, as well as the antibiotic name, dose and duration. Participants: All ambulatory healthcare centers in Alain were included in the study (n=18). Inclusion criteria: Patients who visited an ambulatory healthcare center in Alain during the study period, a diagnosis of URTI (acute pharyngitis, acute laryngitis, acute sinusitis, acute tonsillitis, acute otitis media, croup, acute nasopharyngitis), ICD 9 (462, 464, 461.9, 463, 465.9, 460, 382.9, 382.9), treated with oral antibiotics. Main outcomes and measures: The rate of antibiotic prescriptions for upper respiratory tract infections in primary healthcare centers. Results: : Approximately 461,926 individual patient visits from 18 ambulatory healthcare were included in the analysis. Acute nasopharyngitis was the most common URTI (89%), followed by acute pharyngitis (26.3%). Antibiotic prescription rates were 45.9% during the two-year period, with amoxicillin-clavulanate being the most common antibiotic prescribed for URTI (55%), followed by azithromycin and cefdinir (17.8% and 6.5%, respectively). Antibiotics were most frequently prescribed in the winter, and were not variable among different age groups. The presence of diagnoses such as acute otitis media, acute pharyngitis, and acute tonsillitis were significantly higher in antibiotic prescription rate as compared to other conditions. Patients presenting with fever are much more likely to be given antibiotics as compared to without fever. Conclusion: The knowledge of data concerning antibiotic prescriptions in primary healthcare centers can help to conduct effective intervention, with a decrease in the misuse of antibiotics for common URTI.