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EDUCATIONAL INTERVENTION TO
IMPROVE PRESCRIBING HABITS OF
PEDIATRICIANS IN TREATMENT OF
UNCOMPLICATED ACUTE UPPER
RESPIRATORY TRACT INFECTION
Ziganshina LE, Pikuza OI, Magsumova DR,
Galyautdinova AYu.
Kazan State Medical Academy and Kazan State
Medical University, Russia
Study questions
 To analyze the pattern of drug
prescribing in children with acute upper
respiratory tract infection and acute
bronchitis in outpatient clinics of Kazan
in 1998, 2000, 2002 in retrospective
studies
 To assess the appropriateness of drug
use to update practical guidelines
 To assess the impact of educational
intervention on prescribing habits of
pediatricians in pharmacotherapy of
acute uncomplicated upper respiratory
tract infections.
Methods
 7 outpatient clinics of Kazan in 1998.
 The period of education for the practicing
physicians in 1999-2000 followed (evaluation
planned).
 Pharmacotherapy courses (problem based
pharmacotherapy teaching methodology).
 The subsequent pharmacoepidemiological
survey was performed in 2000 and 2002.
 Out-patient medical charts of 750 children with
uncomplicated acute upper respiratory tract
infections were randomly chosen:
 in 1998 – 472 cases,
 in 2000 – 491 cases,
 in 2002 – 288 cases.
 The number of prescribed drugs per case,
antibiotics, dosage regimens were studied
The number of prescriptions (medicines) per
case for treatment of acute respiratory
infections in children in Kazan. 1998, 2000,
2002 (% ± SE)#
Years
of the
study
The number of prescriptions (medicines) per case
0-2 medicines
3-4 medicines
Number
of
patients
Number
of
patients
1998 71
2000 217
2002 121
# SE – Standart Error,
%
15.0± 322
1.6%
44.2± 229
2.2%*
*
42.0± 129
2.9%
* – p<0,05;
%
More than 5
medicines
Numbe
%
r of
patient
s
68.3± 79
2.0%
46.6± 45
2.3%*
*
44.8± 38
2.9%
** – p<0,01.
Total
number
of
patients
16.7± 472
2.9%
9.2±
491
1.3%*
13.2±
2.0%
288
amoxicilin
J01C
erythromycin
J01FA
1
2
3
4
lincomycin
J01FF
АТC
ampicillin
sulfanilamide
co-trimoxazole
J01E
J01A
J01G
gentamicin
J01MA
ciprofloxacin
0%
20%
40%
Figure 1. Prescription of antibacterial drugs for
treatment of acute respiratory infection in children in
1998 in Kazan
(АТC classification): .J01C - beta-lactams; J01FA - macrolides; J01FF
- lincosamides; J01E - sulfonamides and trimothoprim, J01A tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones. 1 oxacillin, 2 - benzylpenicillin, 3 - ampicillin/ oxacillin, 4 - spiramycin.
60%
J01C
amoxicillin
erythromycin
ampicillin
1 2
azithromycin
ATC
J01FF
co-trimoxazole
sulfadimidine
doxycycline
J01A
J01MA
0%
20%
40%
60%
Figure 2 Prescription of antibacterial drugs for
treatment of acute respiratory infections in children
in 2000 in Kazan
(ATC classification): .J01C - beta-lactames; J01FA - macrolides;
J01FF - lincosamides; J01E - sulfonamides and trimothoprim, J01A —
tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones. 1 oxacillin, 2 – benzylpenicillin.
amoxicillin
J01C
J01FA
erythromycin
1
3
5
lincomycin
J01FF
ATC
ampicillin
J01E
co-trimoxazole
J01A
doxycycline
J01G
J01MA
0%
20%
40%
60%
Figure 3. Prescription of antibacterial drugs for
treatment of acute respiratory infections in children
in 2002 in Kazan
(ATC classification): J01C - beta-lactams; J01FA - macrolides;
J01FF - lincosamides; J01E - sulfonamides and trimothoprim, J01A
— tetracyclines; J01G - aminoglycosides; J01MA - fluoroquinolones.
1 - oxacillin, 3 - ampicillin/oxacillin, 5 - midecamycin.
Discussion
 The antibiotics are needlessly overused in treatment
of acute upper respiratory tract infection in children.
 The educational intervention based on the results of
pharmacoepidemiological monitoring was an effective
measure to improve the prescribing habits of
practitioners (antibiotic use: 65.7+2.2% (1998)  35.2+2.2%
(2000)  31.3+2.7% (2002)).
 Despite of achieved results the usage of inappropriate
toxic medications and wrong dosage regimes
persisted.
 This proves the necessity of furthering educational
interventions for primary care physicians and the
importance of further pharmacoepidemiological
monitoring in this field.
Conclusion
A problem-based educational
intervention proved to be an effective
tool to improve the prescribing habits
of practicing physicians, and
pharmacoepidemiological monitoring
is important for furthering the
educational impact on prescribing.
Conclusion – 2
 Strength
 Choice of pharmacoepidemiological
methodology for evaluation of the educational
impact (retrospective study, medical charts)
 Weaknesses
 Medical charts – practitioners’ prescribing
habits only
 No information on the actual consumption of
medicines
 What to do next
 Evaluate drug consumption:
 Pharmacies
 Patients
 Monitor drug use and educate on regular
basis