Estudo da prescrição de antibacterianos de uso sistêmico em unidades da Gerência de Saúde Centro Sul (GERSA CS) - Belo Horizonte MG

Abstract

The antimicrobial use has been raising discussions concerning the rationality of its use, in order to prevent the appearance of strains of resistant microorganisms. This work aim to investigate the use of antibacterial of systemic use in health centers of the Municipal Health Department in Belo Horizonte. It is a cross-sectional study, with two stages. In the first one, it has been made an evaluation of the prescriptions dispensed during March 2002, using the indicators of the World Health Organization. On the second one, it was made an evaluation of medical records related to a sample of the prescriptions. It has been verified that in average 20.0% of the prescriptions dispensed had at least one antibacterial of systemic use and among them, approximately 46.0% originated from non-municipal health centers. The pediatrics presented the largest rate of antimicrobial prescription. Amoxicillin was the more often antibacterial prescript, followed by benzylpenicillin benzathine, the association of sulfamethoxazole+trimethoprim and the erythromycin. It was observed, in the prescriptions, rates of record of technical data (dose, intervals between doses, administration and period of treatment) varying from 23.6 to 99.6%. In about 10.0% of the prescriptions, there was no definition of the period of treatment for the antimicrobial agent. Amoxicillin was the antibacterial that presented the best results related to the indicators used to assess quality of prescriptions and the erythromycin the worst ones. Related to the medical records, the diagnostics hypothesis registered with larger frequency was tonsillitis, medium otitis and upper respiratory tract infection. The proportion of inadequacy, comparing the diagnostic hypothesis registered and the used antimicrobial, was higher than 25%. The inadequacy of the dose was more frequent in the pediatric. It has been found hard difficulties to find the medical records selected from the prescriptions, what required replacement of 73,3% of the sample. It has been also observed a systematic absence of general information as age, weight, presence of co-morbidity and reports of adverse reactions. Data analysis showed the need for review some stages of the work process and take measures that allow an appropriate accompaniment of the patients by the health team. It was also possible to verify, the need of implementation of rules that makes possible controlling the prescription and the use of antimicrobial agent, assuring the rational use of this specific medication by the municipal health services. Key words: antimicrobial, prescription, medical records, and primary health care.