A one-year study in four select cities in the country on the prescription patterns of antibiotics for common viral infections revealed that the doctors were prescribing antibiotics at a rate of more than 70 per cent mainly due to various external factors including aggressive marketing undertaken by the pharma companies.
As per a World Health Organisation (WHO) guideline, common viral infections like fever and upper respiratory tract infections require minimum antibiotics at a rate of less than 20 per cent. The study was to assess the prescription pattern of doctors for select diseases, K S Indira, Associate Professor, Respiratory Medicine, Amritha Institute of Medical Sciences (AIMS), Kochi, and one of the principal investigators of the study told Pharmabiz.
The study was held in Chennai, Thiruvananthapuram, Lucknow and Vellore involving 353 doctors and 8910 patients. The Indian arm of the International Clinical Epidemiology Network (ICEN) of the United States with funding from the parent organization conducted the project, in co-ordination with the Clinical Epidemiology unit of the Thiruvananthapuram Medical College.
Though the study did not assess the brands prescribed by the doctors or the impact of their prescriptions, it revealed that aggressive marketing of the pharma companies have a significant influence on the prescription patterns of doctors. The doctors who themselves update the latest treatment methodologies through the scientific journals, Internet or through proper CME programmes, prescribed less antibiotics. On the other hand, the doctors who mainly follow only the literature provided by the pharmaceutical companies were eager to prescribe more antibiotics.
Contrary to the popular belief that the educated patients prefer to consume fewer antibiotics, the study showed that the middle and upper income groups were prescribed more antibiotics. The rate of prescription was very high among the patients who had a third party like insurance companies or employer to pay their medical bills. Interest of the patients in getting fast cure from the diseases also could have played an important role in the prescription pattern, said the study. The study sample of patients and doctors were equally distributed among the public and private sector and the income groups, said Dr.Indira.
Interestingly, the study revealed that the doctors working in the Government sector with fewer infrastructure were also over prescribing antibiotics. This could be mainly due to their insecurity in the workplace and unwillingness to take risks, reasoned Dr.Indira.
Though the basic characteristics of the patients and doctors were same in all the four locations, regional differences were found to have influenced the prescription patterns. In Kerala, which has a literacy rate of 100 per cent and a very high concentration of healthcare institutions per population, the prescription rate of antibiotics was low at 48 per cent. Contrary to this, it was high at 78 per cent in Lucknow and above 70 per cent in the other two centers. In places like Lucknow, accessibility of health care centers was a major problem, and the patients would have compelled the doctors for fast relief, noted Dr.Indira.
Dr.Indira said she and Dr. S. Remadevi, Associate Professor, Community Medicine, Thiruvananthapuram Medical College coordinated the studies. The results are being evaluated by the ICEN, and will be soon published in scientific journals.