Analysis of antimicrobial prescriptions in Primary Healthcare

Carvalho, Herica Emilia Félix de; Sousa, Álvaro Francisco Lopes de; Almeida, Camila Aparecida Pinheiro Landim; Moura, Maria Eliete Batista; Andrade, Denise de; Valle, Andréia Rodrigues Moura da Costa

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Revista da Escola de Enfermagem da USP

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018046903607 copy

Analysis of antimicrobial prescriptions in Primary Healthcare ^* * Extracted from the dissertation: “Prescrição de antimicrobianos na Atenção Básica”. Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí, 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate prescription receipts for antimicrobial prescriptions prescribed in primary healthcare units in a capital city in the Northeast region of Brazil.

Method

An evaluative, analytical study. Information from the central distribution of essential medicines and the receipts of antimicrobial prescriptions were used.

Results

There were 2,232 prescription receipts analyzed, in which metronidazole (250 mg) was prescribed in 28% of the evaluated prescription receipts, the “pill” pharmaceutical form in 30.7%, and the “oral” administration form in 78.2%. In the prescriptions prescribed by nurses, 80.7% were intended for users with sexually transmitted infections. With the exception of the pharmaceutical form, only 34.7% of the prescriptions were in accordance with the Nursing protocol recommendations. There is still no information on the concentration (43.7%), the dosage (39.9%) and the treatment time (36.8%).

Conclusion

The evaluated receipts of antimicrobial prescriptions do not accurately follow the guidelines of Resolution No. 20/2011, nor of the instituted Nursing protocol.

Anti-Infective Agents; Prescription Drugs; Infection Control; Primary Care Nursing

Element	M	SD	n	%
Patient name
Complete			1667	74.7
Incomplete			43	1.9
Abbreviated			513	23.0
Absent			9	0.4
Patient age*	23.4	15.1
Informed			5	0.2
Not informed			2227	98.8
Gender
Female			1547	69.3
Male			676	30.3
Absent			9	0.4
Prescription emission date
Informed			2195	98.3
Not informed			37	1.7
Prescriber
Doctor			1358	60.8
Nurse			443	19.8
Dental surgeon			292	13.1
Absent			139	6.2
Medications in the prescription	2.4	1.1
Antimicrobials in the prescription	1.1	0.3
Prescribed antimicrobial
Amoxicillin 500			471	19.3
Amoxicillin 250			195	8.0
Benzylpenicillin 1,200,000			33	1.3
Benzylpenicillin 600,000			24	1.0
Cephalexin 500			59	2.4
Cephalexin 250			19	0.8
Erythromycin 500			2	0.1
Erythromycin 250			5	0.2
Metronidazole 100			481	19.7
Metronidazole 200			385	15.7
Metronidazole 250			685	28.0
Sulfamethoxazole + Trimethoprim 200+40			23	0.9
Sulfamethoxazole + Trimethoprim 400+80			64	2.6
Quantity of antimicrobial (dose)	12.9	12.7
Mass/volume of medium (concentration)
Pill	272.1	78.5
Suspension	497.6	36.4
Capsule	255.7	492.8
Cream	80.0	34.6
Pharmaceutical form
Pill			752	30.7
Suspension			678	27.7
Capsule			534	21.8
Cream			481	19.7
Absent			1	0.1
Dose per administration (Posology)	4.7	2.7
Interval between administrations	13.6	27.5
Treatment time	7.3	2.1
Type of treatment
Short treatment (< 30 days)			2432	99.4
Longer treatment (> 30 days)			9	0.4
Absent			5	0.2
Administration form
Oral			1913	78.2
Topical			476	19.5
Injection			57	2.3
Total			2,232	100.0

Criteria	N	%
Contains all mandatory data
No	2231	99.9
Yes	1	0.1
Patient identification
Incomplete	2218	99.4
Absent	9	0.4
Present	5	0.2
Antimicrobial data
Incomplete	1153	51.7
Present	1079	48.3
Prescriber identification
Present	2093	93.8
Absent	139	6.2
Emission date
Present	2197	98.4
Absent	35	1.6
Total	2,232	100.0

Elements	n	%
Primary Healthcare Protocol Section
STI	423	80.7
Child health	74	14.1
No protocol	27	5.2
Protocols for STI*
Discharge	401	94.8
Cervicitis	22	5.2
Comparison with the protocol dose
In accordance	240	45.8
Higher	120	22.9
Lower	62	11.8
Not specified by the protocol	73	13.9
Missing data	29	5.5
Comparison with the protocol concentration
In accordance	217	41.4
Lower	5	1.0
Not specified by the protocol	73	13.9
Missing data	229	43.7
Comparison with the protocol pharmaceutical form
In accordance	492	93.9
Missing data	32	6.1
Comparison with the protocol posology
In accordance	176	33.6
Higher	65	12.4
Lower	1	0.2
Not specified by the protocol	73	13.9
Missing data	209	39.9
Comparison with the protocol interval
In accordance	130	24.8
Higher	248	47.3
Lower	9	1.7
Not specified by the protocol	73	13.9
Missing data	64	12.2
Comparison with the treatment time protocol
In accordance	147	28.1
Higher	93	17.7
Lower	18	3.4
Not specified by the protocol	73	13.9
Missing data	193	36.8
Total	524	100.0

Antimicrobial	Prescriber*
	Doctor		Nurse		Dental surgeon		P-value
	n	%	N	%	n	%
Patient identification							0.361
Absent	6	0.3	3	0.1	1	0.1
Present	1	0.1	2	0.1	0	0.0
Incomplete	1351	64.5	438	20.9	291	13.9
Antimicrobial data							<0.001
Present	755	36.1	137	6.5	133	6.4
Incomplete	603	28.8	306	14.6	159	7.6
Prescriber identification							0.763
Absent	1	0.1	0	0.0	0	0.0
Present	1357	64.8	443	21.2	292	14.0
Prescription receipt emission date							0.643
Absent	18	0.9	8	0.4	3	0.1
Present	1340	64.0	435	20.8	289	13.8
Total	1358	64.9	443	21.2	292	14.0

Zonas (UBS*)	Prescriber
	Doctor		Nurse		Dental surgeon		P-value
	n	%	N	%	N	%
East/Southeast	591	28.5	104	5.0	57	2.7	<0.001
South	558	26.9	131	6.3	70	3.4
Central/North	192	9.3	207	10.0	165	8.0
Total	1341	64.6	442	21.3	292	14.1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Herica Emilia Félix de Carvalho Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Fundamental. R. Prof. Hélio Lourenço, 3900 – Vila Monte Alegre, Ribeirão Preto – SP CEP: 14040-902 – Ribeirão Preto, SP, Brazil. herica_emilly@hotmail.com.br

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Analysis of antimicrobial prescriptions in Primary Healthcare * * Extracted from the dissertation: “Prescrição de antimicrobianos na Atenção Básica”. Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí, 2018.

ABSTRACT

Objective

Method

Results

Conclusion

Analysis of antimicrobial prescriptions in Primary Healthcare ^* * Extracted from the dissertation: “Prescrição de antimicrobianos na Atenção Básica”. Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí, 2018.