Making Health care safer 2004 (MHC SO4)


Location: LONDON, United Kingdom

Event Date/Time: Oct 21, 2004 End Date/Time: Oct 22, 2004
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Antibiotics kill bacteria, but not viruses. But antibiotics are extensively commonly prescribed for viral infections.

A major contribution towards morbidity and mortality in developing countries is from infectious diseases. Bacterial infections are more critical and antibiotics play significant role in saving lives and reducing morbidity. Viral infections are important mostly because of its commonness, but antibiotics are not effective. Despite the availability of potent antibiotics, mortality and morbidity due to bacterial infections is very high in developing countries. The major set back is that most antibiotics are costly and not affordable to the majority of the patients who pay out of pocket for their treatment expenses. Emerging antibiotic resistance further compromises the effectiveness of treatment. It is reported that there is a 60 fold increase in antibiotic resistance since 1980s.

Excepting a few, most antibiotics is costly. Hence in countries like India access and affordability are important where majority of people pay out of their pocket for their treatment. Penicillin’s, the first group of antibiotics were introduced in 1940s during the II world war. This resulted in miraculous recovery for many and saved the lives of thousands of soldiers. This was followed by introduction of more varieties of antibiotics and the use of these drugs roared up all over the world. Unfortunately, development of antibiotic resistance parallels the excess use of antibiotics. Many bacteria including those producing common infections of throat, lungs, skin and urinary tract are becoming resistant to the commonly available antibiotics, leading to increasing treatment failures, sufferings and death.

Antibiotic resistance is inevitable with its increasing use in the community. The extent of antibiotic resistance varies from country to country, region to region and from time to time. The problem becomes aggressive when there is haphazard and irrational use. When an antibiotic is used less, the resistant strain slowly disappears and the antibiotic regains its potential to kill the bacteria. The best example is that of pneumococci. Perhaps the most potent and cheapest drug for this infection is penicillin, co-trimoxazole ranking the second position. Currently in many countries nearly 100% of pneumococcal infections have become resistant to penicillin and co-trimoxazole.

There are major implications to spread of antibiotic resistance in the community. The usual and less costly antibiotics recommended for the common community acquired infections are currently ineffective because of development of resistance. Unfortunately these are the only antibiotics stocked in our hospitals and clinics. This necessitates prescription of more costly newer generations of antibiotics for common bacterial infections. The situation is worse in hospital settings where patients acquire nosocomial infections upon prolonged hospitalization. Currently the most important cause of death in an intensive care setting is nosocomial infections with organisms resistant to multiple antibiotics.

Acute fever and upper respiratory infections are most often caused by viral infections and contribute to major bulk of out-patient hospital attendance. Only a small proportion of such patients (<20%) require antibiotic therapy. On the other hand, data from many studies indicate clear over use of antibiotics in these illnesses. This not only increases the cost of therapy, but also exposes patients to unwanted side effects, reducing treatment efficacy and quality of treatment. Although most costly antibiotics are consumed by high economy nations, for demographic and epidemiological reasons, the developing nations consume a significant volume of these products. Antibiotics by itself consume a major volume of health budget in both Government and private sector and costly antibiotics account for more than three fourths of all antibiotic expenses.

One of the major causes of antibiotic overuse is over prescribing, although over the counter sales is a major part of this problem. There are many factors why physicians prescribe more antibiotics than what is required. The prescribing behavior of physicians is greatly influenced by the provider setting where they practice. Lack of knowledge and experience, lack of national or institutional guidelines for antibiotic use, poor access to updating scientific knowledge etc. lead to indiscrimination and over prescribing of antibiotics. Because of lack of confidence in provider settings with poor administrative support and inadequate of facilities most physicians to over-prescribe antibiotics is a reflection of their habit of over-prescribing in general. This indicates that despite the adverse circumstances in which doctors work, there is lot of potential to reduce antibiotic use by targeting physicians to improve their prescribing practices.

In this scenario, the APP project was initiated to delineate the extent and the factors that contribute to over prescribing of antibiotics in acute upper respiratory infections that are usually of viral etiology.


To determine rate and pattern of antibiotic prescription in acute fever, sore throat, running nose and diarrhea of short duration and to identify the underlying factors.


The overall goal of the study is to reduce morbidity and mortality of infectious diseases and to improve cost effectiveness in treatment of infective diseases. Rational antibiotic use reduces cost of treatment, thereby increases affordability and availability of antibiotics. The problem of rising drug resistance can be effectively controlled by judicious use of antibiotics, thus effective cure can be ensured with less expensive and commonly available antibiotics. The results of the study would help in planning promotional activities for improving rational antibiotic use with relevant policy changes and administrative support.


To determine the rate of antibiotic use in acute illnesses(fever, cough,sore throat,nasal symptoms and diarrhea of < seven days duration)
To determine the pattern of antibiotic use in these illnesses
To determine the factors related with antibiotic use
1. Patient factors – a) disease related
b) non-disease related
2. Physician factors
3. Provider factors


Cross sectional study

Urban Government
Urban Private
Rural Government
Rural Private
Ratio of Government to private = 50:50


London NW1 4LE
United Kingdom