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Siritree Suttajit, Ruangthip Tantipidoke, Chitr Sitthi-amorn
Chulalongkorn University
Care Seeking and Treatment
for Adults with
Upper Respiratory Infections (URIs)
in Congested Communities in Bangkok:
Where Problems Occur
Anita Wagner, Dennis Ross-Degnan
Harvard Medical School
Introduction
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
Most of URIs are caused by viruses

Antibiotic are not recommended in most cases

Widely use of antibiotics for URIs treatment

Understanding where in the care process
patients receive antibiotics may help in
designing interventions to reduce drug
resistance in low-income & high-risk
communities
Objectives
1. To measure patterns of antibiotic use in adults
with URIs, and
2. To identify where inappropriate use of
antibiotics occurs in the community
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Methods
 Cross-sectional study (Oct02)
 Visit 3,973 hhs, 2 congested communities, BKK
 Interview 779 adults with URIs within 2 prior wks.
 Ask about URIs symptoms, health seeking
behavior, drugs taken and cost, knowledge and
attitudes

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Identify possible viral or bacterial URIs cases
with GAS score1 and signs for sinusitis2
McIsaac WJ, White D, Tannenbaum D, Low DE. 1998. A clinical score to reduce unnecessary antibiotic use
in patients with sore throat. Canadian Medical Association Journal 158: 75-83.
2 William JW Jr, Simel DL. 1993. Does this patient have sinusitis?: Diagnosing acute sinusitis by history and
physical examination. Journal of the American Medical Association 270(10):1242-1246.
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Results
 81.6% of URI cases were likely of viral origin
 Same starting of health seeking behavior in
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viral and bacterial URIs, but different ending


6%
24%
Self-care/ self-med, then clinical settings
Bacterial URIs: more visiting and ending at
clinical setting
4% No treatment
29% Self-med &
Self-care
53% 50% Self-care
only
Viral Bact.
Home
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22% Clinic
21% 21% Self-med
16%
26%
13% 21% Hospital
(p-value=0.019)
26% Ask for advice
Viral Bact.
Drug store
13% 10% Health center
Viral Bact.
Clinical settings
Results

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Where did URIs cases receive antibiotics?
 44% of viral cases and 54% of bacterial
cases had used an antibiotic
 Antibiotic use was clearly higher among
those who sought care outside their home
% received antibiotic
Self-med
@home
Self-med
@drugstore
Ask for advice
@drug store
Ask for advice
@Clinical settings
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11%
10%
Viral URIs
Bacterial URIs
21%
36%
66%
65%
61%
72%
Results
 Some misconception about URIs and
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antibiotics use
% correct answer
Cold normally caused from bacterial
Antibiotic reduces sore throat
17%
11%
42%
Antibiotic reduces rhinitis
43%
Antibiotic rapids recovery of cold
49%
Antibiotic reduces cough
49%
Antibiotic should be taken at least 5-7 days
I can stop taking antibiotic when I feel better
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23%
Results
 People agree that URIs is common, but still
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rely on health providers than themselves
% agree
Common cold is normal
97%
It's better to rely on myself,
if it is only a common cold
89%
If it cost the same, I should see
doctor rather than doing self-care
74%
It's better to trust the doctor
than to question their treatment
84%
Taking drug for cold is easier
than doing self-care
Drug seller should give drug info.
and let me decide my treatment
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65%
38%
Results
 Lost in viral URIs treatment from…
 self-prescribing with antibiotic
5

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= 23.3 baht ($0.6)
unnecessary visiting of clinical settings
= 88.7 baht ($2.3)
Discussions

Limitations



problem in identifying type of drug use
Application of the results



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misclassification of diagnoses
Use in encouraging the civic group
Designing of intervention
Adding about patterns of care seeking and
antibiotic use in adults of developing
country
Conclusions
 Antibiotics are misused for viral URIs by selfmedication at home, but more frequently
misused at drug stores and clinical settings

Interventions should be implemented to
promote i) symptomatic self-treatment of URIs
and ii) appropriate antibiotic use in drug stores
and clinical settings as well.
Acknowledgement: Ms. Ratana Somrongthong, Project coordinator
Funding:
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