Siritree Suttajit , Ruangthip Tantipidoke, Chitr Sitthi-amorn Chulalongkorn University

1. Siritree Suttajit, Ruangthip Tantipidoke, Chitr Sitthi-amornChulalongkorn University Care Seeking and Treatmentfor Adults with Upper Respiratory Infections (URIs) in Congested Communities in Bangkok: Where Problems Occur Anita Wagner, Dennis Ross-DegnanHarvard Medical School

2. Introduction • Most of URIs are caused by viruses • Antibiotic are not recommended in most cases • Widely use of antibiotics for URIs treatment • Understanding where in the care process patients receive antibiotics may help in designing interventions to reduce drug resistance in low-income & high-risk communities 1

3. Objectives • To measure patterns of antibiotic use in adults with URIs, and • To identify where inappropriate use of antibiotics occurs in the community 1

4. Methods • Cross-sectional study (Oct02) • Visit 3,973 hhs, 2 congested communities, BKK • Interview 779 adults with URIs within 2 prior wks. • Ask about URIs symptoms, health seeking behavior, drugs taken and cost, knowledge and attitudes • Identify possible viral or bacterial URIs cases with GAS score1 and signs for sinusitis2 1 McIsaac WJ, White D, Tannenbaum D, Low DE. 1998. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Canadian Medical Association Journal 158: 75-83. 2 William JW Jr, Simel DL. 1993. Does this patient have sinusitis?: Diagnosing acute sinusitis by history and physical examination. Journal of the American Medical Association 270(10):1242-1246. 2

5. 6% 4% 24% 29% 22% 21% 21% 16% 53% 50% 21% 13% 26% 26% 13% 10% Viral Bact. Viral Bact. Viral Bact. Results1 • 81.6% of URI cases were likely of viral origin • Same starting of health seeking behavior in viral and bacterial URIs, but different ending • Self-care/ self-med, then clinical settings • Bacterial URIs: more visiting and ending at clinical setting No treatment Self-med & Self-care Clinic Self-med Self-care only Hospital (p-value=0.019) Ask for advice Health center Home Drug store Clinical settings 3

6. % received antibiotic 11% Self-med @home Viral URIs 10% Bacterial URIs 21% Self-med @drugstore 36% 66% Ask for advice @drug store 65% 61% Ask for advice @Clinical settings 72% Results2 • Where did URIs cases receive antibiotics? • 44% of viral cases and 54% of bacterial cases had used an antibiotic • Antibiotic use was clearly higher among those who sought care outside their home 4

7. % correct answer Cold normally caused from bacterial 17% Antibiotic reduces sore throat 11% 42% Antibiotic reduces rhinitis Antibiotic rapids recovery of cold 43% Antibiotic reduces cough 49% Antibiotic shouldbe takenat least 5-7 days 49% I can stoptaking antibiotic when I feel better 23% Results3 • Some misconception about URIs and antibiotics use 5

8. Results4 • People agree that URIs is common, but still rely on health providers than themselves % agree Common cold is normal 97% It's better to rely on myself,if it is only a common cold 89% If it cost the same, I should see doctorrather than doing self-care 74% It's better to trustthe doctor than to question their treatment 84% Taking drug for cold is easier than doing self-care 65% Drug seller shouldgive drug info. and let me decide my treatment 38% 6

9. Results5 • Lost in viral URIs treatment from… • self-prescribing with antibiotic = 23.3 baht ($0.6) • unnecessary visiting of clinical settings = 88.7 baht ($2.3) 7

10. Discussions • Limitations • misclassification of diagnoses • problem in identifying type of drug use • Application of the results • Use in encouraging the civic group • Designing of intervention • Adding about patterns of care seeking and antibiotic use in adults of developing country 8

11. Conclusions • Antibiotics are misused for viral URIs by self-medication at home, but more frequently misused at drug stores and clinical settings • Interventions should be implemented to promote i) symptomatic self-treatment of URIs and ii) appropriate antibiotic use in drug stores and clinical settings as well. Acknowledgement: Ms. Ratana Somrongthong, Project coordinator Funding: 9