| Abstract [eng] |
The aim of this study was to describe prescription of antimicrobials to treat adult respiratory tract infections in Lithuanian primary health care. The tasks of the investigation: 1. To define the structure of respiratory tract infections (RTIs). 2. To rate the use of microbiological and other diagnostic tests in adult patients with RTIs. 3. To determine the antibiotic prescription rates for adult RTIs in private centers and polyclinics. 4. To define the structure of prescribed antibiotics for the treatment adult RTIs in private centers and polyclinics. Methods and volume of the investigation. The retrospective prevalence study was carried. Randomly selected 1767 medical records of adult pacients, who visited physician during 2004 year were analysed. Data about patients (age, sex), infection, antimicrobial treatment, diagnostic tests were registered and analysed. Data were managed and analysed using Epi Data, SPSS, Win Pepi, Epi 6 statistical programmes. Results. There were 1141 infections diagnosed overall. RTIs were the most prevalent and composed 84,1% (959) of all diagnosed infections. Upper respiratory tract infections (URTIs) were more frequent (66,0%, 633) than lower respiratory tract infections (LRTIs) (34,0%, 326). The most frequent diagnoses were acute viral respiratory tract infection (41,5%), pharyngitis (28,9%) among URTIs and acute bronchitis (52,1 %) among LRTIs. Prevalence of RTIs was higher in private centers (74,1%0 than in polyclinics (36,0%) (p<0,001). Prevalence of RTIs among males and females was similar (53,0% and 55,1%). URTIs were more frequent both in males and females (67,3% ir 65,2%). Among patients over 65 years old LRTIs were more freguent (69,4%) than URTIs (30,6%). At least once antimicrobial drug was prescribed to 589 (33,3%) patients of 1767. 83,0% prescriptions of antibiotics were for RTIs. Overall 62,6% RTIs were treated with antibiotics: LRTIs more frequently (81,3%) than URTIs (53,0%) (p<0,001). 90,6% of pneumonia, 88,1% of pharyngitis, 83,5% of acute bronchitis were treated with antibiotics. Antimicrobials were prescribed in 41,8% cases of acute viral RTIs. More frequently antibiotics were prescribed in polyclinics (67,1%) than in private medical centers (60,3%) (p=0,041). Antibiotic prescription rates among males and females, between age groups were similar. The most frequently prescribed antimicrobials for RTIs were broad spectrum penicillins (62,3%), tetracyclines (11,3%), macrolides (10,0%). The structure of prescribed antibiotics in private centers and polyclinics, between males, females and age groups was similar. Diagnostic tests were more frequently performed in polyclinics (70,3% from all RTIs) than in private centers (46,6% from all RTIs) (p<0,001). Microbiological tests were done 3 times (0,3% from all RTIs). No one strepA test was performed. Conclusion. Antimicrobials to treat adult RTIs in Lithuanian primary health care are prescribed too often and unjustified. The most frequently prescribed are broad spectrum antibiotics. Such use of antibiotics to treat RTIs may contribute to the increase of antibiotic resistance in Lithuania. |
