Abstract
Background: Compliance to the prescribed antibiotic treatment is a challenging issue in real world setting. The relationship between healthcare providers and patients is an important factor for compliance. The author conducted a prospective study to assess the adherence to antibiotic treatment in ambulatory respiratory infections.
Materials and Methods: A prospective observational study was conducted in five general medicine outpatient clinics from June 2017 to March 2018 in Hyderabad, India. The patients with uncomplicated, suspected acute bacterial pharyngitis and lower respiratory tract infections were included in the study. The data was processed through Power View program v. 1.3.2. (Aardex Ltd.).
Result: Out of total 60 patients enrolled, 26 patients answered the self-reported adherence question (good self-reported adherence) negatively (59.3%), while remaining patients answered either affirmatively or elicited an unclear response. During the study, 13 patients (30.4%) achieved 80% of all the adherence outcomes (excellent), 5 patients (12.4%) missed only one dose for achieving excellent adherence, 13 patients (28.7%) presented declining adherence over time. Excellent adherence was significantly associated with the number of daily doses of the antibiotic (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.15–0.32) and antibiotic duration (OR 0.77, 95% CI 0.61–0.96).This study compared self-reporting with objectively measured medication adherence using an evidence-based cut-off point in the same study population.
Conclusion: Approximately one in four patients presented with non-adherence to correct dosing and approximately one in four presented with declining adherence over time. The adherence outcomes were consistently and significantly worse with three times-daily antibiotic schedules and better with once-daily antibiotic regimens.
Keywords: Adherence, antibiotic treatment, observational, acute bacterial pharyngitis, lower respiratory tract infections.
References
- Sabate E. World Health Organization. Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization, 2003. ISBN 92 4 154599 2.
- Patient Compliance with statins, Bandolier. Archived from the originalIn 2015:05-12.
- Enhancing Patient Adherence: Proceedings of the Pinnacle Roundtable Discussion. APA Highlights. Newsletter. October 2004.
- Elliott RA, Marriott JL. Standardized assessment of patient’s capacity to manage medications: a systematic review of published instruments. BMC Geriatr 2009:9:27.
- Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Burgerhof JGM, MolPGM.Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - A study in ambulatory patients. Br J ClinPharmacol 2017: 83(9):2107-2117. doi: 10.1111/bcp.13312.
- Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB.Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014: 20(11):CD000011. doi: 10.1002/14651858.CD000011.pub4.
- Hansen RA, Voils CI, Farley JF, Powers BJ, Sanders LL, Sleath B, MaciejewskiML. Prescriber continuity and medication adherence for complex patients. Ann Pharmacother 2015:49:293-302.
- Llor C, Sierra N, Hernandez S, Moragas A, Hernandez M, Bayona C, Miravitlles M. The higher the number of daily doses of antibiotic treatment in lower respiratory tract infection the worse the compliance. J AntimicrobChemother 2009:63:396-399.
- Francis NA, Gillespie D, Nuttall J, Hood K, Little P, Verheij T, Coenen S, Cals JW, Goossens H, Butler CC, Group GP. Antibiotics for acute cough: An international observational study of patient adherence in primary care. Br J Gen Pract 2012:62:e429‑437.
- Fernandes M,Leite A,Basto M, Nobre MA, Vieira N, Fernandes R, Nogueira P, Nicola PJ.Non-adherence to antibiotic therapy in patients visiting community pharmacies. Int J Clin Pharm 2014:36:86–91.
- Skliros E, Merkouris P, Papazafiropoulou A, Gikas A, Matzouranis G, Papafragos C, Tsakanikas I, Zarbala I, Vasibosis A, Stamataki P. Self-medication with antibiotics in rural population in Greece: A cross-sectional multicenter study. BMC FamPract. 2010:11:58.doi: 10.1186/1471-2296-11-58.
- Carrasco-Garrido P, Jimenez-Garcia R, Barrera V, Gil de Miguel A. Predictive factors of self-medicated drug use among the Spanish adult population. Pharmacoe-pidemiol Drug Saf 2008:17:193–199.
- Pechere JC. Patient’s interviews and misuse of antimicrobial drugs. Clin Infect Dis 2001:33(3):S170-173.doi: 10.1086/321844.
- Wright JM, Htun Y, Leong MG, Forman P,Ballard RC. Evaluation of the use of calendar blister packaging on patient compliance with STD syndromic treatment regimens. Sex Transm Dis 1999:26:556-563.
- Gonzales R, Steiner JF,Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997:278: 901-904.
- StolzD,Tamm M. Discriminate use of antibiotics for exacerbation of COPD. CurrOpinPulm Med 2009:15:126-132.
- Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patient’s expectations on antibiotic management of acute lower respiratory tract illness in general practice: Questionnaire study. BMJ 1997:315:1211-1214.
- Hawkings NJ, Butler CC, Wood F. Antibiotics in the community: A typology of user behaviours. Patient EducCouns 2008:73:146–52.
- Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008:(2):CD000011.
- Knafl GJ, Delucchi KL, Bova CA, Fennie KP, Ding K, Williams AB. A systematic approach for analyzing electronically monitored adherence data. In: Ekwall B, CronquistM, ed.: Micro Electro Mechanical Systems (MEMS) Technology, Fabrication Processes and Applications. Hauppauge (NY): Nova Science; 2010:1–66.
Corresponding Author
Dr Amrut Kumar Mohapatra
Department of Respiratory Medicine, KIMS, Patia, 751024, Bhubaneswar, India
Mobile: 09776326476, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.81
