| Ncube et al., 2017 [98]. Private health insurance (medical aid) schemes |
The objective was to analyse antibiotic prescription patterns among medical practitioners in private health insurance schemes treating patients with acute bronchitis Claims among members of 11 health insurance schemes treating these patients were analysed
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52.9% of patients with acute bronchitis were prescribed an antibiotic Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis Patients with a chronic illness were less likely to be prescribed an antibiotic than those without a chronic illness Of the antibiotics prescribed, >70% were penicillins, cephalosporins and other beta-lactams
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| Truter and Knoesen, 2018 [60]. Community pharmacists |
Determine current antibiotic prescribing habits in their locality alongside the potential rationale for prescribing practices Self-designed questionnaire among 16 community pharmacists in Nelson Mandela Bay, Eastern Cape province
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81.3% of community pharmacists felt that antibiotics were over-prescribed, including for viral infections, exacerbated by pressure from patients Amoxicillin (A)/co-amoxiclav (A) were the most dispensed antibiotics in pharmacies, followed by clarithromycin (W), ciprofloxacin (W) and azithromycin (W) The most common diagnoses for antibiotics were URTIs and sinusitis
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| Manderson 2020 [59]. Interviews with patients or guardians |
Qualitative study involving observing patient/provider consultations and 65 in-depth interviews with patients, parents or guardians presenting with children among CHCs and private GPs across South Africa Objective was to explore providers’ and patients’ expectations for treating ARIs with antibiotics to provide future guidance
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Prescribers’ treatment decisions were typically informed by a clinical assessment, concern about the risks of bacterial infection and their perceptions of the patient’s ability to seek further care Physicians in private practice often provided a prescription—sometimes post-dated to discourage antibiotic use—but with the option for antibiotics if needed Patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, which is encouraging for the future
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| Boffa et al., 2021 [99]; Salomon et al., 2022 [100]. Standardised patients |
Assessment of antibiotic prescribing as inappropriate prescribing can mask TB symptoms as well as lead to TB diagnostic delay A total of 511 standardised patients (SPs) visited 212 private GPs in Cape Town and Durban Three SP scenarios: (i) TB symptoms, HIV-positive; (ii) TB symptoms coupled with a positive molecular test for TB and HIV-negative; (iii) TB symptoms, history of incomplete TB and treatment, HIV-positive
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Antibiotics were prescribed on 76.5% of occasions (95% CI 71.7% to 80.7%), making them the most common medicines prescribed 86.1% of antibiotics prescribed belonged to the ‘Access’ group (with amoxicillin and co-amoxiclav accounting for 64%); fluoroquinolones (W) accounted for 8.8% (95% CI 6.3% to 12.3%); none in the ‘Reserve’ group Factors associated with antibiotic prescribing included whether the SP was asked to follow up if symptoms persisted and if the SP presented as HIV-positive An injection was offered in 31.9% of visits—92% with unexplained rationale 61.8% of medicines prescribed were not listed in the South African Primary Healthcare EML Overall, there were concerns about inappropriate antibiotic prescribing and costs
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| Alabi et al., 2022 [46]. Retrospective analysis of a claims database of a health insurer |
Assessment of dosing and duration of prescribed antibiotic therapy Analysis of 188,141 antibiotic prescriptions for 174,889 patients, including their appropriateness based on ICD-10 classification
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Diagnoses (Principal):
Diseases of the respiratory system (J00–J99): 46.1% of all diagnoses Unknown diagnosis: 84.0% of Z00–Z99, i.e., factors influencing health status and contact with health services (accounting for 15.8% of all diagnoses) Diseases of genitourinary system (N): 8.92%
Classes of antibiotics prescribed (Principal):
Penicillins were the most frequently prescribed antibiotic class (40.7% of all antibiotics prescribed) Macrolides (16.8%), cephalosporins (15.7%) and quinolones (13.1%) were also frequently prescribed
Individual antibiotics prescribed (Principal):
Co-amoxiclav (A): 28.6% of all antibiotics prescribed Amoxicillin (A): 9.8%; azithromycin (W): 9.3% Ciprofloxacin (W): 8.5%; cefpodoxime (W): 6.7%
Appropriateness of the prescriptions:
8.8% of all the prescriptions were appropriate 32.0% of all prescriptions were potentially appropriate, 45.4% inappropriate and 13.8% could not be assessed due to a lack of specific code, containing unlisted codes or having unclear descriptions
Appropriately and potentially appropriately prescribed antibiotics:
57.7% of antibiotic prescriptions were prescribed at the correct doses 27.4% of antibiotics were prescribed with wrong doses 14.9% of prescriptions could not be assessed
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| Guma et al., 2022 [33]. Study among private GPs using a semi-structured web-based questionnaire |
Assess current empiric prescribing of antibiotics among private GPs for patients with ARIs and associated key factors A semi-structured web-based questionnaire was used to document the findings among 209 GPs
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55.5% of surveyed private GPs prescribed antibiotics empirically for patients with ARIs more than 70% of the time The prescribing of antibiotics was primarily for symptom relief and the prevention of complications GPs between the ages of 35 and 44 years or >55 years and in practice for < 15 years were significantly more likely to prescribe antibiotics empirically Three key factors were significantly associated with empiric prescribing: workload/time pressures, diagnostic uncertainty and the use of a formulary GPs with more experience and working alone were slightly less likely to prescribe antibiotics empirically
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| Lagarde and Blaauw, 2019 and 2023 [38,62,90]. Simulated patients |
The objective was to assess prescribing practices for young and healthy simulated patients (SP) presenting with viral bronchitis in the city of Johannesburg A total of 99 SP visits in the private sector (and 102 in the public sector) One hundred twenty-five providers (across sectors) were interviewed face-to-face
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Antibiotics were recommended in 72.6% of consultations, lower in the private sector (66.7%) versus the public sector (78.4%) The high rates of antibiotic prescribing were not helped by the following:
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Significant knowledge gaps, particularly in relation to the recommended management of acute bronchitis
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Perceived patient pressure to prescribe antibiotics for this condition
30% of patients prescribed antibiotics received amoxicillin (A), 35% co-amoxiclav (A) and 14% clarithromycin (W)
Overall, in 20% of consultations in the private sector, antibiotics from the ‘Watch’ list were prescribed (versus only 5% in the public sector) 84% of providers knew that the SP case was likely a viral infection (88% in the private sector vs. 77% in the public sector) 58% of providers believed antibiotics would not hasten recovery (68% in the private sector vs. 40% in the public sector; p = 0.002) 72% of private providers believed patients would not come back if no antibiotic were prescribed (72% vs. 47% in the public sector; p = 0.008)
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