1. Care Seeking and Treatment for Adults with Upper Respiratory Infections (URIs) in Congested Communities in Bangkok: Care Seeking and Treatment for Adults with Upper Respiratory Infections (URIs) in Congested Communities in Bangkok: Where Problems Occur Where Problems Occur Siritree Suttajit, Ruangthip Tantipidoke, Chitr Sitthi-amorn Chulalongkorn University Anita Wagner, Dennis Ross-Degnan Harvard Medical School

2. Introduction  Most of URIs are caused by viruses  Antibiotic are not recommended in most cases  Widely use of antibiotics for URIs treatment  Understanding where in the care process patients receive antibiotics may help in designing interventions to reduce drug resistance in low-income & high-risk communities 1

3. Objectives 1.To measure patterns of antibiotic use in adults with URIs, and 2.To identify where inappropriate use of antibiotics occurs in the community 1

4. Methods  Cross-sectional study (Oct02)  Visit 3,973 hhs, 2 congested communities, BKK  Interview 779 adults with URIs within 2 prior wks.  Ask about URIs symptoms, health seeking behavior, drugs taken and cost, knowledge and attitudes  Identify possible viral or bacterial URIs cases with GAS score 1 and signs for sinusitis 2 2 1 McIsaac WJ, White D, Tannenbaum D, Low DE. 1998. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Canadian Medical Association Journal 158: 75-83. 2 William JW Jr, Simel DL. 1993. Does this patient have sinusitis?: Diagnosing acute sinusitis by history and physical examination. Journal of the American Medical Association 270(10):1242-1246.

5. Results 1  81.6% of URI cases were likely of viral origin  Same starting of health seeking behavior in viral and bacterial URIs, but different ending  Self-care/ self-med, then clinical settings  Bacterial URIs: more visiting and ending at clinical setting 3 Home No treatment Self-care only Self-med & Self-care 6% 4% 53% 24% ViralBact. 29% 50% Ask for advice Drug store Self-med 21% 26% ViralBact. 21% 26% Clinical settings Clinic Hospital (p-value=0.019) Health center 13% 22% ViralBact. 16% 21% 13% 10%

6. Results 2  Where did URIs cases receive antibiotics?  44% of viral cases and 54% of bacterial cases had used an antibiotic  Antibiotic use was clearly higher among those who sought care outside their home 4 11% 10% Viral URIs 36% 66% 65% 61% 72% Ask for advice @drug store Self-med @drugstore Self-med @home Ask for advice @Clinical settings % received antibiotic Bacterial URIs 21%

7. Results 3  Some misconception about URIs and antibiotics use 5 Cold normally caused from bacterial Antibiotic rapids recovery of cold Antibiotic reduces sore throat Antibiotic reduces cough Antibiotic reduces rhinitis 17% Antibiotic should be taken at least 5-7 days I can stop taking antibiotic when I feel better 49% 23% 11% 42% 43% 49% % correct answer

8. Results 4  People agree that URIs is common, but still rely on health providers than themselves 6 Common cold is normal It's better to rely on myself, if it is only a common cold If it cost the same, I should see doctor rather than doing self-care It's better to trust the doctor than to question their treatment Taking drug for cold is easier than doing self-care Drug seller should give drug info. and let me decide my treatment % agree 97% 89% 74% 84% 65% 38%

9. Results 5  Lost in viral URIs treatment from…  self-prescribing with antibiotic = 23.3 baht ($0.6)  unnecessary visiting of clinical settings = 88.7 baht ($2.3) 7

10. Discussions  Limitations  misclassification of diagnoses  problem in identifying type of drug use  Application of the results  Use in encouraging the civic group  Designing of intervention  Adding about patterns of care seeking and antibiotic use in adults of developing country 8

11. Conclusions  Antibiotics are misused for viral URIs by self- medication at home, but more frequently misused at drug stores and clinical settings  Interventions should be implemented to promote i) symptomatic self-treatment of URIs and ii) appropriate antibiotic use in drug stores and clinical settings as well. Funding: 9 Acknowledgement: Ms. Ratana Somrongthong, Project coordinator