Antibiotic prescribing for outpatients with respiratory tract infections in public and private clinics of a resource-constrained setting, northern Ethiopia: a cross-sectional study.

BACKGROUND: Respiratory tract infections (RTIs) are the most common reason for antibiotic prescribing and overuse. Ethiopia is a country with a high burden of acute RTIs, and the pattern of antibiotic prescribing has not been thoroughly studied. This study aimed to compare the patterns of antibiotic prescribing for RTI in public and private outpatient clinics in Mekelle, northern Ethiopia. METHOD: A cross-sectional study was conducted by reviewing filled prescriptions. The participants were adult outpatients with RTIs such as acute bronchitis, common cold, nonspecific upper respiratory infections, pharyngitis/tonsillitis and community acquired pneumonia, from both public and private clinics. Prescription concordance with treatment guidelines was assessed based on national treatment guideline. Patterns of antibiotic prescribing were described by the WHO AWaRe classification of antibiotics. A two proportion Z test and binary logistic regression analysis were used to compare antibiotic prescription rates in public and private clinics. The results of the logistic regression were expressed as odds ratios with 95% confidence intervals. A p value of less than 0.05 was considered statistically significant. RESULTS: A total of 320 participants were included in the study, with approximately half (51.3%) being male. The proportion of antibiotic prescriptions for RTIs was 75.3% (private, 70.7% and public, 80.1%). According to the WHO AWaRe classification, prescriptions containing Access and Watch antibiotics were 79.7% and 20.3%, respectively. The most commonly prescribed antibiotics were amoxicillin and amoxicillin-clavulanic acid. Among antibiotic prescriptions for community acquired pneumonia, acute bronchitis, common cold and nonspecific upper respiratory infections, 22% were not in accordance with the guidelines. The odds of receiving a non-concordant prescription, broad-spectrum antibiotic, brand name prescription or having an upper RTI were higher in participants who visited a private clinic compared to public clinic (p < 0.05). CONCLUSIONS: This study has identified the presence of a high antibiotic prescribing rate for outpatients with RTIs. Patients visiting the private sector were more likely to receive prescriptions non-concordant with guidelines, with brand names, and broad-spectrum antibiotics. Decision makers in the private sector should be actively involved in promoting the responsible use of antimicrobials to prevent antimicrobial resistance.