Assessment of the Prescription Patterns and Use of Antibiotics in ENT Outdoor Patients During Smog at DHQ Sahiwal
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Abstract
Background: Upper respiratory tract symptoms commonly increase during smog-season months and may clinically overlap with viral, allergic, irritant, and bacterial ENT conditions, creating diagnostic uncertainty and potentially encouraging empirical antibiotic use. Objective: To assess antibiotic prescribing patterns, WHO AWaRe classification, empirical therapy, adjuvant medicine use, polypharmacy, and prescriber-level adherence among ENT outpatients during the smog season at DHQ Hospital Sahiwal. Methods: This cross-sectional observational prescription audit reviewed 450 ENT outpatient prescriptions collected from October 2025 to January 2026. Data were extracted using a structured form and analysed in SPSS version 27. Antibiotic use was assessed through prescribing indicators and WHO AWaRe classification. Associations were examined using Chi-square, Mann–Whitney U, Jonckheere–Terpstra, and Spearman correlation tests where applicable. Results: Antibiotics were prescribed in 442 of 450 encounters (98.2%), with 437 prescriptions (97.1%) containing one antibiotic and 5 (1.1%) containing two. Watch-group antibiotics were used in 399 prescriptions (88.7%), while Access-group antibiotics were used in 43 (9.6%). All treatment was empirical, culture testing was not documented, and infection type was not specified. Macrolides were most frequent (53.1%), followed by cephalosporins (32.9%). Low adherence was observed in 402 prescriptions (89.3%) and improved significantly with prescriber seniority (p = 0.026). Polypharmacy was present in 119 prescriptions (26.4%). Conclusion: ENT outpatient antibiotic prescribing during smog-season months was predominantly empirical, Watch-group oriented, and poorly aligned with rational prescribing expectations, indicating a need for targeted antimicrobial stewardship and diagnostic guidance
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