الفهرس 
Title pageOnly 14 pages are availabe for public view
 |  | from | 93 |  |  |
| | | from | 93 | | |
Abstract
Antibiotic resistance, as a major public health problem, has its roots in the irrational use
of antibiotics, consequently causing treatment failure. It is commonly seen in treating of acute
upper respiratory tract infections. AURTI include sinusitis, pharyngitis and bronchitis. The
adherence to guidelines is not completely afforded due to poor knowledge of physicians for
management of AURTI. They fail to perform a definite differentiation between the viral and
the bacterial type of the infection. Consequently antibiotics are irrationally prescribed
regardless the guideline rules Acute upper respiratory tract infections’ proper diagnosis and
antibiotic prescribing is not completely achieved in Ministry of Heath Hospitals in
Alexandria, Egypt.
This study aims to increase physicians’ adherence to current clinical guidelines for
AURTIs regarding the use of antibiotics.
The study design is an intervention study.
The study is done in the ENT and chest outpatient clinics of six Ministry of Health
Hospitals in Alexandria, Egypt (Ras Eltin, Abou Kir, Elgomhoreya, Elamreya, Elagamy and
Bourg Elarab) covering the six districts of Alexandria. Questionnaires were used to evaluate
the adherence of physicians to guidelines before and after the intervention in each hospital to
evaluate the impact of the intervention.
The target population is physicians in outpatient clinics responsible for treating socioeconomic
equally patients with acute upper respiratory tract infections (including sinusitis,
pharyngitis and bronchitis).
Inclusion criteria for the prescriptions:
Acute Upper Respiratory Tract Infections
They are described to involve paranasal sinuses, pharynx and bronchi. The illness
is known as sinusitis, pharyngitis and bronchitis, respectively. Onset of symptoms
occurs from one to three days after exposure to the infectious agent. If the
infectious agent is of viral origin then symptoms would last for less than ten days,
while if it is a bacterial infection then symptoms would last more than ten days.
Adult patients in age from 18 years to 40 years old.
Exclusion criteria for the prescriptions:
Patients with chronic upper respiratory tract infections
Patients less than 18 years in age
Immunocompromised patients
Renal impairment patients
Hepatic impairment patients
A predesigned questionnaire will be used for the assessment of the physicians’ adherence to
the guidelines before and after the intervention.
Active and passive interventions to improve physicians’ adherence to guidelines as short
– sessions for physicians of didactic teaching and antibiotic guideline posters in respiratory
unit clinics
The interventions are in the form of:
a) Short – sessions for physicians of didactic guidelines’ explanation and discussion.
b) Antibiotic guideline posters and fliers in outpatient clinics.
c) Throat swab using Rapid Strep A Test strip (RADT)
Ethical considerations:
Ethical approval was obtained from Medical Research Institute before the beginning
of the research data collection.
Approval was obtained from Ministry of Health hospitals where the study was
conducted.
All study participants were informed and declared their approval in the participation
of the questionnaire
Confidentiality was ensured for participating physicians and patients. An informed
consent was taken from physicians and patients.
Improvements in the adherence rate to the guidelines for proper diagnosis and treatment
of acute upper respiratory tract infections can be achieved by using guideline posters and
sessions for physicians in respiratory outpatient clinics.
The improvement in overall adherence rate in all Ministry of Health Hospitals in all
types of acute upper respiratory tract infections was from 54.7% to 78.2%
The antibiotic prescription rate was significantly decreased in all types of acute upper
respiratory tract infections from 81.3% to 59.3% in all Ministry of Health Hospitals.
The significant factors affecting the adherence rate were:
Physician qualification
Use of rapid antigen strep A test (RADT)