Appropriateness of Antibiotic Prescriptions Among Non-Severe Febrile Patients in Primary Care in Rio de Janeiro, Brazil: A Prospective Observational Study

Abstract

Abstract Background: Overuse of antibiotics is a global health threat, particularly in low- and middle-income countries (LMICs). Most studies on antibiotic use in LMICs have focused on hospital settings, leaving a knowledge gap in primary care settings where a significant proportion of antibiotic use occurs. This study aimed to estimate the appropriateness of antibiotic prescriptions among acute non-severely ill febrile patients attending primary care level in urban Rio de Janeiro, Brazil. Methods: This prospective observational study was conducted on consecutive febrile patients aged 2-65 years presenting with an axillary temperature (≥ 37.5° C) for a week or less at two primary care clinics and two emergency departments (EDs) in Rio de Janeiro, Brazil. Comprehensive clinical and laboratory data were gathered to investigate the cause of fever. We reviewed each consult where antibiotic prescription occurred, including its indication and appropriateness against international guidelines. Descriptive statistics and logistical regression models were performed to identify factors associated with inappropriate prescribing. Results: 500 participants were enrolled, with antibiotic prescribed in 30.6% of visits. Antibiotic prescriptions were considered inappropriate 75% of cases, predominantly due to inappropriate indication (91.3%). The most common reason for prescribing antibiotics was acute respiratory infection (35%). Older participants, those enrolled during the summer, and those attending an EDs were more likely to receive an inappropriate prescription, while those reporting recent antibiotic use and those treated for urinary infection s were less likely to receive an inappropriate prescription. Conclusions: This study highlights the high prevalence of inappropriate antibiotic prescriptions in primary care settings in urban Rio de Janeiro, emphasizing the need for targeted antimicrobial stewardship interventions to improve prescription practices in LMIC. Clinicaltrials.gov: NCT03047642