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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 1 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 1 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 1 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. 2 Results 81.6% of URI cases were likely of viral origin Same starting of health seeking behavior in 1 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 3 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 2 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 4 11% 10% Viral URIs Bacterial URIs 21% 36% 66% 65% 61% 72% Results Some misconception about URIs and 3 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 5 23% Results People agree that URIs is common, but still 4 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 6 65% 38% Results Lost in viral URIs treatment from… self-prescribing with antibiotic 5 7 = 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 8 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: 9