ANTIBIOTIC NONCOMPLIANCE AND WASTE IN UPPER RESPIRATORY-INFECTIONS AND ACUTE DIARRHEA

A prospective cohort study was conducted to analyze factors associated with antibiotic noncompliance and waste among patients suffering acut e respiratory infection (ARI) and acute diarrhea (AD). The study took place in four primary health care clinics in Mexico City, two belongin g to the Ministry of Health (MoH) and two to the Mexican Social Securi ty Institute (IMSS). Two hundred twenty two patients with ARI and 155 with AD were included. Data about study variables and the assessment o f compliance were obtained through patient interviews and direct obser vation. Factors associated with noncompliance were assessed through a multiple logistic regression procedure. Noncompliance was 60% for ARI and 55.5% for AD in both health care systems. Prescription of an antib iotic was justified only in 13.5% of cases. Associated factors were: i ncreased duration of illness (OR 2.95; 95% CI, 1.17-7.41) complexity o f the treatment: 3 or more doses per day (OR 2.47; 95% CI, 1.56-3.92), and treatment for more than 7 days (OR 1.94; 95% CI, 1.16-3.26); youn ger age of patient (OR 1.89; 95% CI, 1.18-3.02); and an inadequate phy sician-patient relationship (OR 1.87; 95% CI, than in the MoH (ARI 21. 2%, AD 16.4%). Educational strategies to modify physician prescribing practices and strengthen physician-patient relationships might improve compliance and decrease drug waste. (C) 1997 Elsevier Science Inc.