Objective: The aim of this study was to estimate the direct cost per episode and the annual cost for upper respiratory tract infection (URTI) in children in Ambulatory Health Centers of the Ministry of Public Health (MSP) of Ecuador. Methods: A cost of illness study with a provider perspective was carried out through a micro-costing of health resources and valuated in international dollars. Medical visits, laboratory tests, imaging examinations, and other procedures were valued using the tariff framework of services for the National Health System, and for prescribed medication a reported cost registry of pharmacy purchases made in the year of study was used. Results: We included 380 electronic health records of children. We found a re-consultation rate of 22.89%, a medicine prescription rate of 95.52%, and an antibiotic prescription rate of 45.26%. The first medical consultation accounted for 71.9% of the total cost of URTI, the following visits accounted for 11.82%, and medication accounted for 14.68%. Antibiotics accounted for 58.92% of the total cost of medication. Conclusion: The direct medical cost to the MSP of Ecuador of 1 episode of URTI in children in primary care was around I$37.28 (2017 dollars) (95% CI: I$35.81-I$38.75). The total cost of URTI cases in children to the MSP in 2017 was at least I$50.478 million (2017 dollars) (95% CI I$48.527m-I$52.523m). Re-consultation and the prescription of medication represent an important component of the direct cost of medical care of URTI.

Clinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription. The aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n =114), and a later post-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training. The results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p<0.0001) and the appropriate antibiotic prescription rate was significantly increased by 44.2%

Background: Inappropriate prescriptions of antibiotics lead to ineffective and unsafe treatments and worsening of diseases. Medical students may have deficiencies in their prescription skills and they may need further training in the use of antibiotics for their practice. Medical skills in prescribing antibiotics can be improved through continuous medical education. The aim of this study was to assess the current levels of knowledge, attitudes, and practices (KAP) in antibiotic prescription in upper respiratory tract infections (URTI) among postgraduate family medicine students in Ecuador.Methods: A cross-sectional study with an on-line survey, based on micro-curricular contents, to evaluate KAPs regarding antibiotic prescription in URTI among postgraduate family medicine students in 5 provinces of Ecuador.Results: Two hundred and seventy-three physicians responded (94.1%). Most physicians treated between 1 and 5 URTI cases per day. The odds for inadequate knowledge and inappropriate practices in URTI among postgraduate family medicine students were 8.74 (95%CI, 4.94-15.46, P < .001) and 5.99, (IC95%, 2.66-13.50, P < .001) in physicians who were students of the first half of the stud program. Conclusion: The knowledge in URTI was limited among physicians. Nonetheless, they expressed a positive attitude toward not using antibiotics in URTI. A postgraduate program can significantly improve the knowledge and practices related to antibiotic prescriptions in URTI.