Discussion
Prescription by a doctor may be taken as a reflection of physician’s attitude to the disease and role of the drug in treatment. It also provides an insight into the nature of health care delivery system. Little information exists about the prescriptive behaviour of physicians and the misuse of antibiotics in the management of outpatient and inpatient with ENT infections.
In general practice, the therapeutic approach for ENT infections is nearly empirical and the main aim of physicians is to treat as specifically as possible, while covering the most likely pathogens. The present descriptive study indicates general trends of prescribing in the OPD and IPD of ENT department
Demographic characteristics showed that percentage of males suffering from ENT infections was more than females. Many other studies showed that females are more sensitive to ENT infections than males; the reason might be their exposure to kitchen smoke. In our study, the observed percentage of males was predominant which might be due to the occupational reasons.
Further, it was found that a majority of the patients were in the age group of 16–25 years and the lowest percentages were in geriatric group. It indicates that ENT infections are more prevalent in young adults. Few studies have reported that majority of patients fell in different age groups like 35 - 55 years.
Patients suffering from various acute and chronic ENT infections were treated with different antibacterial agents. In our study, the number of patients with OM was maximum, however the cases of acute and chronic suppurative OM (ASOM and CSOM) observed. The cases sinusitis , DNS ( DEVIATED NASAL SPETUM) ,allergic rhinitis predominate in nose-infected patients , Thyroglossal Fistula and Chronic Rhinosinusitis Polyposis. However, sore throat, acute pharyngitis were the maximum cases of throat-infected patients. It was an interesting observation that a significant number of patients with combination of ENT patients suffered from URTIs alone or along with OM and other infections.
Most commonly prescribed categories of antibiotics were found to be β-lactam (32.05%),followed by cephalosporins (36.53%) , Aminoglycosides ( 27.56%) and macrolides (1.92%). The chloramphenicol and tetracyclines constituted only 1.28 and 0.64%, respectively. Among the individual antibiotic drugs, maximum patients received a combination of amoxicillin with clavulanic acid (25%), followed by Cefixime (28.84%), amikacin (27.56) chloramphenicol (1.28%), azithromycin (2.56%), clarithromycin (1.92%) ceftriaxone (3.84%) and doxycycline (0.64%). So, the use of azithromycin and clarithromycin should be indicated only when their broad coverage is required or when other antibiotic use is prohibited due to allergy, etc.
However, a change in the prescribing patterns from a small spectrum to penicillin to amoxicillin/clavulanate, as indicative in our study, could be due to an increase in antibiotic resistance which encourages physicians to choose a broader and safer option. Further, 7.61 %patients received antibacterial monotherapy; whereas 91.8 % patients were on multiple drug therapy.