A point-prevalence study (PPS) found a high rate of antibiotic use in hospitals in Thailand, with more than a quarter of antibiotics used for infection prevention, researchers reported last week in JAC-Antimicrobial Resistance.
The cross-sectional survey, using the standardized World Health Organization PPS protocol, was conducted from March to May 2021 at 41 primary (11), secondary (19), and tertiary (11) hospitals in Thailand. Out of 8,958 inpatients, 4,745 (53%) received antibiotics on the survey date. The prevalence of antibiotic use ranged from 14.3% to 74.3% and increased according to the level of hospital (primary 49.4%, secondary 51.9%, and tertiary 55.0%). Antibiotic use was highest among inpatients aged 65 years and older (57.1%), followed by children (54.9%) and newborns (32.5%).
Overall, the top three commonly used antibiotics were third-generation cephalosporins (30.1%), first-generation cephalosporins (11.1%), and carbapenems (10.6%). Of the 6,619 antibiotics prescribed, 68.6% were used to treat infections (most commonly respiratory tract infections), 26.7% were used for surgical prophylaxis (infection prevention), and 4.7% for other or unknown indications. Of the patients who received antibiotics for prophylaxis, 70.3% received them for more than 1 day after surgery, which is considered inappropriate.
"In the context of uncertainties, evidence and practice guidelines can improve such inappropriate practices," the study authors wrote. "Prolonged surgical prophylaxis is not only ineffective for postoperative infections but it increases the risk of side effects and AMR [antimicrobial resistance]."
Prolonged surgical prophylaxis is not only ineffective for postoperative infections but it increases the risk of side effects and AMR.
The study authors note that the 53% prevalence rate is slightly higher than that found in a prior study conducted in Thailand in 2018 (51.5) and significantly higher than recent PPS studies reported in Eastern Europe (28%), North America (39%), and East and South Asia (39%).
"The findings from the study could be used as benchmarks for improving antibiotic prescription in the future," they concluded.