Effectiveness of Multifaceted Interventions on Rational Use of Antibiotics for Patients with Upper Respiratory Tract Infections and Acute Diarrhea
Adhiratha Boonyasiri MD*, Visanu Thamlikitkul MD**
Affiliation : * Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To implement multifaceted interventions to promote rational use of antibiotics for out-patients with upper respiratory
tract infection (URI) and acute diarrhea.
Material and Method: The present study was conducted at ambulatory care facility for patients under Social Security
Healthcare Benefit Scheme and Universal Health Coverage Scheme of Siriraj Hospital from January to April 2012. Multifaceted
interventions were: Training responsible healthcare personnel on rational use of antibiotics, Clinical practice guidelines, Pre-
printed medical record forms for patients, Throat swab or stool culture to be taken from the patients (if responsible physicians
needed these); and provision of brochures containing causes, necessity and harm of antibiotics for URI and acute diarrhea
to patients as well as their relatives while waiting for receiving care. Pre-printed medical records were collected every day.
Each patient was called on day 3 after receiving care by an investigator to determine clinical responses.
Results : There were 1,241 episodes of URI and 210 episodes of acute diarrhea during the study period. Rates of antibiotic
prescriptions were 13.0% for URI and 19.1% for acute diarrhea. Throat swab cultures recovered group A beta-hemolytic
streptococci in 3.8% of URI patients and non-typhoidal Salmonella spp. in 14.6% of acute diarrhea patients. Clinical
responses of the patients on day 3 after receiving care revealed that more than 97% of the patients who received antibiotics
and who did not receive antibiotics were cured or improved.
Conclusion : Multifaceted interventions are very effective for promoting rational use of antibiotics for out-patients with URI
and acute diarrhea at Siriraj Hospital.
Keywords : Antibiotics, Out-patient, Upper respiratory tract infection, Acute diarrhea
