Assessment of the rational use of the most commonly prescribed antibiotics at the Department of Health of Ramallah in Palestine

Abstract

Introduction: Appropriate antibiotic use requires using the right antibiotic, at the right dose, for the right duration, and at the right time. Drug-resistant diseases cause numerous deaths globally a year, and antibiotic stewardship is a cornerstone in fighting antibiotic resistance. This study focuses on tracking the antibiotic prescribing practices in Palestine and improving future antibiotic prescribing.

Methodology: Data from prescriptions of the most commonly prescribed antibiotics was collected from the Health Department of Ramallah and Al-Bireh clinics between January 1 to March 31, 2020. The prescriptions were divided into three categories according to the diagnosis status: unwritten, unspecific, and precise diagnosis. The precise prescriptions were further divided into two categories: appropriate or inappropriate indication. Only appropriate prescriptions were candidates for the assessment of dose and duration appropriateness.

Results: The percentages of the three categories of diagnosis precise, unspecific, and unwritten were 23.4%, 20.4%, and 56.2%, respectively. The percentage of appropriate prescriptions was 16.2%. Azithromycin was the most over-utilized antibiotic, followed by co-amoxiclav (amoxicillin/clavulanic acid). Amoxicillin and co-trimoxazole (trimethoprim/sulfamethoxazole) were under-prescribed. All the prescriptions indicated for urinary tract infections (UTIs) were inappropriate.

Conclusions: Most prescriptions were not candidates for analysis due to missing diagnosis. Amoxicillin, co-amoxiclav, cefuroxime, azithromycin, and ciprofloxacin were the most commonly prescribed antibiotics and were mostly indicated for pharyngitis. The duration of all sinusitis regimens was inappropriate. More rational antibiotic use in the Department of Health could be achieved by improving documentation, following updated guidelines, choosing cost-effective agents, and keeping track of local resistance patterns and antibiograms.