Discussion
Prescription by a doctor may be taken as a reflection of physician’s
attitude to the disease and role of the drug in treatment. It also
provides an insight into the nature of health care delivery system.
Little information exists about the prescriptive behaviour of physicians
and the misuse of antibiotics in the management of outpatient and
inpatient with ENT infections.
In general practice, the therapeutic approach for ENT infections is
nearly empirical and the main aim of physicians is to treat as
specifically as possible, while covering the most likely pathogens. The
present descriptive study indicates general trends of prescribing in the
OPD and IPD of ENT department
Demographic characteristics showed that percentage of males suffering
from ENT infections was more than females. Many other studies showed
that females are more sensitive to ENT infections than males; the reason
might be their exposure to kitchen smoke. In our study, the observed
percentage of males was predominant which might be due to the
occupational reasons.
Further, it was found that a majority of the patients were in the age
group of 16–25 years and the lowest percentages were in geriatric
group. It indicates that ENT infections are more prevalent in young
adults. Few studies have reported that majority of patients fell in
different age groups like 35 - 55 years.
Patients suffering from various acute and chronic ENT infections were
treated with different antibacterial agents. In our study, the number of
patients with OM was maximum, however the cases of acute and chronic
suppurative OM (ASOM and CSOM) observed. The cases sinusitis , DNS (
DEVIATED NASAL SPETUM) ,allergic rhinitis predominate in nose-infected
patients , Thyroglossal Fistula and Chronic Rhinosinusitis Polyposis.
However, sore throat, acute pharyngitis were the maximum cases of
throat-infected patients. It was an interesting observation that a
significant number of patients with combination of ENT patients suffered
from URTIs alone or along with OM and other infections.
Most commonly prescribed categories of antibiotics were found to be
β-lactam (32.05%),followed by cephalosporins (36.53%) ,
Aminoglycosides ( 27.56%) and macrolides (1.92%). The chloramphenicol
and tetracyclines constituted only 1.28 and 0.64%, respectively. Among
the individual antibiotic drugs, maximum patients received a combination
of amoxicillin with clavulanic acid (25%), followed by Cefixime
(28.84%), amikacin (27.56) chloramphenicol (1.28%), azithromycin
(2.56%), clarithromycin (1.92%) ceftriaxone (3.84%) and doxycycline
(0.64%). So, the use of azithromycin and clarithromycin should be
indicated only when their broad coverage is required or when other
antibiotic use is prohibited due to allergy, etc.
However, a change in the prescribing patterns from a small spectrum to
penicillin to amoxicillin/clavulanate, as indicative in our study, could
be due to an increase in antibiotic resistance which encourages
physicians to choose a broader and safer option. Further, 7.61
%patients received antibacterial monotherapy; whereas 91.8 % patients
were on multiple drug therapy.