CHAPTER ONE
INTRODUCTION
 1.1 Background of Study
Antibiotics account for the most commonly prescribed drugs in the hospital setting. Inappropriate antibiotic prescribing and the increasing levels of resistance are now issues of global concern (Charani et al., 2010). According to Davy et al., (2005), a significant proportion of antibiotic prescriptions within hospitals have been described as inappropriate. Up to 50% of antibiotic use is inappropriate (Ashiru-Oredope et al., 2012).
Information about antimicrobial prescribing patterns is necessary for a constructive approach to challenges that arise from the multiple antibiotics that are available (Srishyla, et al., 1994). Excessive and inappropriate use of antibiotics in hospitals, health care facilities and the community contributes to the development of bacterial resistance (Shankar et al., 2003).
Irrational prescribing habits for antibiotics lead to ineffective and unsafe treatment of medical conditions. Moreover, irrational prescribing may worsen or prolong the illness thereby leading to distress and harm to the patient. As Sharma and Kapoor (2003) argued, not only does irrational prescribing lead to exorbitant costs of medicines, its occurrence is common in clinical practice.
The decision model of prescribing antibiotics is rather complex and multiple factors other than clinical considerations can influence the decision to prescribe. These factors include patient characteristics, physician characteristics, and medical environments such as competition for clients. Patient characteristics such as age, lower socio-economic status, and higher co-morbidity have significant effects on the antibiotic prescription rate. Physician characteristics, including gender, age, time since graduation, and volume of practice, also significantly influence antibiotic prescription (Choi et al., 2008). They also pointed out that an urban location of a medical practice and patient income level also influence antibiotic prescription rates. Other significant predictors are the physician expertise (that is specialist or generalist). Choi et al., (2008) further argued that medical environment variables such as the number of primary care clinics and number of hospital beds affect the rate of antibiotic prescription.
Sharma and Kapoor, (2003) attributed irrational prescribing to lack of knowledge about drugs, unethical drug promotions, high patient load, ineffective laboratory facilities, availability of drugs, and ineffective law enforcement by governments with subsequent failure to ensure compliance to guidelines. The irrational prescribing of antibiotics (particularly broad-spectrum antibiotics), in primary care is a major contributing factor to reduced drug efficacy, increased prevalence of resistant pathogens in the community, and the appearance of new co-infections (Sharma and Kapoor, 2003).
Antimicrobial resistance is currently the greatest challenge to the effective treatment of infections globally. Resistance adversely affects both financial and therapeutic outcomes with effects ranging from the failure of an individual patient to respond to therapy and the need for expensive or toxic alternative drugs to the social costs of higher morbidity and mortality rates, required or longer durations of hospitalisation, increased health care costs and the need for changes in empirical therapy (Essack, 2006).
Previous studies on prescribing patterns have looked at the evaluation of rational therapy, the appropriateness of prescribing antibiotics and antibiotic use, resistance development and environmental factors. These factors addressed the characteristics of individual patients and doctors, related with prescription episodes. Most studies have shown that there is inappropriate prescribing. The use of antibiotics and a large number of prescriptions did not conform to the ideal pattern (Baktygul et al., 2011).
Medicines consume a significant portion of the total health care budget. Equitable access to affordable medicines remains a challenge. The Standard Treatment Guidelines and Essential Medical List ensure the cost-effective treatment options are available to citizens of the country, and seek to build capacity in health care workers at the Primary Health Care level.
Antibiotics are among the most frequently used drugs worldwide. They are particularly utilized in developing countries, where an average of 35% of the total health budget is spent on antibiotics (Isturiz & Carbon., 2000, cited in Makhado, 2009). In Zambia for instance, the University Teaching Hospital alone spends well over 15.28 % of its medicines budget on antibiotics per quarter of the financial year (UTH Pharmacy records, 2013-unpublished data).
Monitoring of prescriptions and drug utilisation studies can identify the problems and provide feedback to prescribers and other stake holders so as to create awareness about irrational use of antibiotics. This study was undertaken to investigate the prescribing and profile of antibiotics use at the Health centre of delta state University, Abraka.
This study aimed at describing the patterns of antibiotic prescribing and to suggest modifications in practitioners prescribing habits so as to make medical care rational and cost-effective.
Rational prescribing and appropriate drug use are the keys to achieving optimum therapeutic goal. This is because inappropriate prescribing can lead to therapeutic failure, toxicity, drug interactions and even death of the patient (for which the physician and the dispensing pharmacist can be held responsible for professional misconduct), which then provides basis for a claim for compensation (Brahams, 1989). Poly-pharmacy is a recipe for adverse drug interactions (Irshaid et al, 2005); increase risk of bacterial resistance (Yousif et al., 2006; WHO, 2000); non-compliance (Pearson,1982) and increased burden/ cost to both patient and the health care delivery system (George-Kutty et al., 2002).
Inappropriate prescribing is known all over the world to be a major problem to health care delivery; and tactless prescribing is widespread (Rashid et al., 1986). It is a feature in health care settings in developing countries and is characterized by poly-pharmacy, excessive use of antibiotics, and injections (Laing, 1990; Isah et al., 2001, Ohaju-Obodo et al., 1998; Akande and Ologe, 2007).
Inappropriate prescribing will have an important economic and medical impact on health care as it makes treatment of patients more costly, more risky and less rewarding. Increased generic prescribing would rationalize drug use and reduce cost of treatment to the patient and lessen the burden on the health care delivery system (Quick et al., 2002; Hogerzveil, 1995).
Rational drug prescribing has remained a global concern such that countries have established health regulations to guard against irrational, inappropriate or negligent prescribing, which is regardless of the considerable improvements that has been made in the availability and control of drugs in hospitals over time (Laing, 1990; Hogervzeil, 1995).