Influence of antibiotic consumption on antibiotic resistance in outpatient settings in the private sector

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Introduction The World Health Organization recommends establishing surveillance programmes to monitor antibiotic resistance. Objectives This study aims to describe the resistance and utilization pattern of antibiotics in two private sector outpatient department (OPD) in Colombo district. Method A cross-sectional descriptive study was carried out at the OPD of two private hospitals in the Colombo District. E s c h e r ic h ia c o li (E. c o li) obtained from the urine specimens of patients who were suspected to have urinary tract infections was the indicator bacteria. The resistance pattern tested using disc diffusion method was extracted from laboratory records. Details of antibiotics dispensed in the same year at the OPD pharmacies of the said hospitals were extracted from pharmacy records and quantified using Defined Daily Doses (DDD). Results Of the 5969 urine samples, pathogenic E. c o li was isolated in 969 (16.2%) and 267 (28%) of them were Extended Spectrum Beta Lactamase producers. E. c o li was most resistant to ampicillin (80%), followed by nalidixic acid (67.8%), ciprofloxacin (59.5%) norfloxacin (59%) trimethoprim/sulphamethoxazole (52.5%), amoxicillin /clavulanic acid (43.8%), cephalothin (40.4%) and nitrofurantoin (9%). Multi-drug resistance was seen in 53%. Resistance to second level antibiotics such as cefotaxime, cefixime, aztreonam and cefepime was above 60%. Co-amoxiclav was the most frequently dispensed antibiotic (34181.8 DDDs) followed by ciprofloxacin (22153 DDDs) and amoxicillin (15738.3 DDDs) Conclusions Resistance rate > 20% was observed for all except nitrofurantoin. High use of coamoxiclav and ciprofloxacin for outpatients would have contributed to this high rate of resistance in the community.