Yousef Z Abuowda, Maha S Alfaqawi, Alaa Eldeen M Elmassry and Bettina Bottcher
Palestinian Ministry of Health, Gaza
Nasser Hospital Medical Director, Gaza.
Islamic University of Gaza, Gaza
Posters & Accepted Abstracts: Intern Med
During the last decade, antimicrobial utilization increased by 36% globally. As a result, there has been a marked increase in multidrug-resistant pathogens associated with poor patient outcomes, motivating the World Health Organization (WHO) of warning about the post antibiotic era. A time in the near future, when antibiotics will not be effective. Nasopharyngitis, bronchitis or bronchiolitis, viral pneumonia, influenza and simple lacerations were identified as not requiring antibiotics and the use of antibiotics in viral illnesses has not been shown to improve patient outcomes. Aim and Objective: The aim of this audit is to assess the current practice of antibiotic prescribing for simple lacerations as well as ARTIs in the Gaza-Strip and comparing it with best practice. Methods: This audit was conducted at Nasser Hospital Emergency Room(ER). Patients with ARTIs were included randomly and retrospectively during the winter 2017. All patients with uncomplicated lacerations presenting in March 2016 also included. In addition to this, another 40 patients were also asked about their use of antibiotics, as well as their believes. Results: ARTIs Results: 53 cases were included. The age was 32.1�?�?�?�?�?�?�?±64 years. 9.4% of cases had chronic illnesses, (56.6%) had cough, (41.5%) had sore throat, (39.6%) had malaise, (37.7%) had fever, (32%) had headache, (20.7%) had runny nose and (5.6%) had purulent nasal discharge. 41.5% of cases had a throat examination, of which 81.8% were normal. 86.7% of cases had antibiotics prescribed for 3.8�?�?�?�?�?�?�?±7 days. Patient communication done in 34% of cases. The assessment of patient believes and use of antibiotics involved 40 patients. 56% use antibiotics for every episode, believing that antibiotic use is essential for a good and speedy recovery. 42% added their fear of complications. 87% of patients stated that they would stop this overuse of antibiotics if they received information and education on more useful alternatives in the treatment of URTI. Uncomplicated Lacerations: 60 cases were included. The age was 14.5�?�?�?�?�?�?�?±10.3 old, 85% were males and 98.8% of patients presented within the first hour following their injury. 61.6% of patients had face and head injuries and 98.8% were closed by sutures. 95% received good irrigation and cleaning for their injuries before sutures. Strikingly, all patients who had sutures also received an antibiotic prescription, mostly Ampicillin & Flucloxacillin for five days. The type of antibiotics was used regardless of wound length or site. 86.6% of patients believed that antibiotics accelerate wound healing and are necessary even in uncomplicated lacerations. Conclusions: Both physicians and patients are unaware of recent evidence for the appropriate use of antibiotics. A collective and multidisciplinary effort to address the shocking overuse of antibiotics is urgently needed in the Gaza-Strip. The development of a local, evidence based guideline will expedite improvements in patient care and support antibiotic efficiency in the future. This should be coupled with a patient education and awareness campaign to address patients�?�?�?¢�?�?�?�?�?�?�?�? misperceptions. A Re-audit should be completed 6 months following this action.
Yousef Z Abuowda is Intern-ship Medical Doctor, Palestinian Ministry of Health.