Point-prevalence survey of outpatient antibiotic prescription at a tertiary medical center in Sri Lanka: opportunities to improve prescribing practices for respiratory illnesses

BMC Infect Dis. 2021 Jan 21;21(1):97. doi: 10.1186/s12879-021-05804-6.


Background: Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka.

Methods: This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy's electronic prescribing system.

Results: Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies.

Conclusions: A high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.

Keywords: Antibiotic stewardship; Antibiotic use; Outpatients; Respiratory tract infections; Sri Lanka.

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care / statistics & numerical data*
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Child
  • Cross-Sectional Studies
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Outpatients
  • Practice Patterns, Physicians'
  • Prescriptions / statistics & numerical data*
  • Prevalence
  • Respiratory Tract Diseases / diagnosis
  • Respiratory Tract Diseases / drug therapy*
  • Respiratory Tract Diseases / epidemiology
  • Sri Lanka / epidemiology
  • Tertiary Care Centers
  • Young Adult


  • Anti-Bacterial Agents