Background: In Thailand, acute diarrhea is one of the most common problems among ambulatory patients at the outpatient department (OPD). Overuse of antibiotics is associated with increased rates of antibiotic-resistant bacteria, unnecessary increased cost of treatment, and significant incidence of adverse effects. In Thailand, how frequently antibiotic is prescribed in adult patients with acute diarrhea is not known.
Material and method: The authors performed a retrospective study in all adult patients with acute diarrhea attending at the OPD of King Chulalongkorn Memorial Hospital, Bangkok, Thailand between August 2009 and January 2010 as ambulatory basis. All data regarding epidemiology, clinical features, and treatment were evaluated.
Results: There were 390 [255 females (65.4%) and 135 males (34.6%)] patients during the study period. There were 91 (23.3%) with inflammatory diarrhea and 209 (76.7%) patients with non-inflammatory diarrhea. Only 36 (9.2%) patients had stool examination and culture results. Of 13 (36.1%) patients with positive stool cultures, four (11.1%) patients had Vibrio parahaemolyticus, two (5.7%) patients each had non-O1 Vibrio cholerae, Cryptosporidium parvum, or Plesiomonas shigelloides and V. parahaemolyticus, and one (2.9%) patient each had P. shigelloides, P. shigelloides and Salmonella, or group D Salmonella. Three hundred fifty three (90.5%) and 37 (9.5%) patients were treated by residents and faculty staffs, respectively One hundred and seventy-six (45.1%) patients received antibiotics, which included norfloxacin (128 patients, 72.7%), ciprofloxacin (34, 19.3%), ceftriaxone and ciprofloxacin (6, 3.4%), ceftriaxone (5, 2.8%), ceftriaxone and norfloxacin (2, 1.1%), amoxicillin (1, 0.6%), and ofloxacin (1, 0.6%). One hundred and forty-eight of 353 (41.9%) residents and 28 of 37 (75.7%) faculty staffs prescribed antibiotics. According to the recommendations by WHO, the rate of overuse of antibiotics was 48.9% (86 of 176 patients).
Conclusion: There is a very high rate of overuse of antibiotics in Chulalongkorn Hospital. Both attributing physician- and patient-related factors should be evaluated before implementing an effective strategy to change prescribing behavior.