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Torres, `Neusa, Vernon Solomon, and Lyn Middleton. "Pharmacists’ practices for non-prescribed antibiotic dispensing in Mozambique." Pharmacy Practice 18, no. 3 (August 18, 2020): 1965. http://dx.doi.org/10.18549/pharmpract.2020.3.1965.
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Background: Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance.
Objective: We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique.
Methods: A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed.
Results: Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients’ behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians’ prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms.
Conclusions: The practices of non-prescribed antibiotic dispensing characterize the ‘daily life’ of the pharmacists. On the one hand, the patient’s demand for antibiotics without valid prescriptions, and pharmacist’s wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.
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Hu, Jie, and Zhiqiang Wang. "Non-prescribed antibiotic use and general practitioner service utilisation among Chinese migrants in Australia." Australian Journal of Primary Health 22, no. 5 (2016): 434. http://dx.doi.org/10.1071/py15076.
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Non-prescribed antibiotic use occurs worldwide and is an important contributor to antibiotic resistance. Social and health system factors were related to the practice of self-medication with antibiotics. This study aims to investigate the practice of non-prescribed antibiotic use, and to assess the impact of primary health service access and use on this practice among Australian Chinese migrants. Four-hundred and twenty-six participants, who self-identified as Chinese and who had been residing in Australia for at least 12 months, were recruited through several Australian Chinese social websites to participate in an online health survey about antibiotic use and health services use from July to October 2013. Logistic regression analyses were conducted to assess the associations between health services utilisation factors and the use of non-prescribed antibiotics. In total, 20.2% (86/426) participants reported having used antibiotics without medical consultation in the last 12 months. Of 170 antibiotic users, 50.6% (86/170) used antibiotics without medical consultation. Chinese migrants who self-evaluated as ‘satisfied’ with the experiences of GP services were less likely to self-medicate with antibiotics. In addition, Chinese migrants without any perceived barriers to using primary health services in Australia were less likely to use non-prescribed antibiotics. Among Australian Chinese migrants, over half of antibiotic users admitted that they had used antibiotics without medical consultation. Participants with positive experience and perception of primary health services, primarily GP services, had a lower risk of using non-prescribed antibiotics.
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Wang, Nan Christine. "Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians’ Prescribing of Antibiotics at Medical Visits." Antibiotics 11, no. 11 (November 4, 2022): 1553. http://dx.doi.org/10.3390/antibiotics11111553.
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Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children’s acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians’ prescribing of antibiotics was significantly associated with caregivers’ self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations.
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Machowska, Anna, Kristoffer Landstedt, Cecilia Stålsby Lundborg, and Megha Sharma. "Antibiotic Prescribing to Patients with Infectious and Non-Infectious Indications Admitted to Obstetrics and Gynaecology Departments in Two Tertiary Care Hospitals in Central India." Antibiotics 9, no. 8 (July 30, 2020): 464. http://dx.doi.org/10.3390/antibiotics9080464.
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Background: Patients admitted to obstetrics and gynaecology (OBGY) departments are at high risk of infections and subsequent antibiotic prescribing, which may contribute to antibiotic resistance (ABR). Although antibiotic surveillance is one of the cornerstones to combat ABR, it is rarely performed in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients in OBGY departments of two tertiary care hospitals, one teaching (TH) and one nonteaching (NTH), in Central India. Methods: Data on patients’ demographics, diagnoses and prescribed antibiotics were collected prospectively for three years. Patients were divided into two categories- infectious and non-infectious diagnosis and were further divided into three groups: surgical, nonsurgical and possible-surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system, and the International Classification of Disease system version-10 and Defined Daily Doses (DDDs) were calculated per 1000 patients. Results: In total, 5558 patients were included in the study, of those, 81% in the TH and 85% in the NTH received antibiotics (p < 0.001). Antibiotics were prescribed frequently to the inpatients in the nonsurgical group without any documented bacterial infection (TH-71%; NTH-75%). Prescribing of broad-spectrum, fixed-dose combinations (FDCs) of antibiotics was more common in both categories in the NTH than in the TH. Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: Antibiotics were frequently prescribed to the patients with no documented infectious indications. Misprescribing of the broad-spectrum FDCs of antibiotics and unindicated prescribing of antibiotics point towards threat of ABR and needs urgent action. Antibiotics prescribed to the inpatients having nonbacterial infection indications is another point of concern that requires action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve antibiotic prescribing practice.
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Silfwerbrand, Elisabeth, Sumeer Verma, Cora Sjökvist, Cecilia Stålsby Lundborg, and Megha Sharma. "Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study." International Journal of Environmental Research and Public Health 16, no. 21 (October 23, 2019): 4074. http://dx.doi.org/10.3390/ijerph16214074.
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Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient departments of two private-sector Indian hospitals. Data of all consecutive inpatients (n = 3527) were collected but analyzed for the inpatients aged >15 years (n = 2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses groups: surgical, non-surgical, chronic suppurative otitis media (CSOM), and others. Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% of patients in the clean surgery group and more than 75% in the viral and non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis (31%), where 90% of inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. This study highlights the inappropriate prescribing of antibiotics to patients of clean surgeries, viral infections, and non-infectious groups. The single-prophylactic dose of antibiotic for clean-contaminated surgeries was replaced by the prolonged empirical prescribing. The use of microbiology investigations was insignificant.
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Linder, Jeffrey A., Tiffany Brown, Ji Young Lee, Kao-Ping Chua, and Michael A. Fischer. "1632. Non-Visit-Based and Non-Infection-Related Ambulatory Antibiotic Prescribing." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S43. http://dx.doi.org/10.1093/ofid/ofy209.102.
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Abstract Background Many studies have examined or intervened on ambulatory antibiotic prescribing based on infection-related diagnosis codes. However, clinicians may prescribe antibiotics without seeing patients face-to-face or without documenting an infection-related diagnosis. Methods We measured the prevalence of non-visit-based and non-infection-related oral, antibacterial–antibiotic prescribing between November 2015 and October 2017 using the EHR of an integrated health delivery system. We examined the visit type (in-person vs. other) and classified prescriptions into 3 mutually exclusive groups based on same-day diagnosis codes: (1) infection-related for prescriptions associated with at least one of 21,730 ICD-10 codes that may signify infection; (2) non-infection-related for prescriptions only associated with the 72,519 ICD-10 codes that do not signify infections; and (3) associated with no diagnosis. Results There were 509,534 antibiotic prescriptions made to 279,169 unique patients by 2,413 clinicians in 514 clinics. Patients had a mean age of 43 years old, were 60% women, and 75% white. Clinicians were 54% women; were 63% attending physicians, 18% residents/fellows, 10% nurse practitioners, and 7% physician assistants; and were 41% medical specialists, 21% primary care clinicians, and 7% surgical specialists. The most common antibiotic classes were penicillins (30%), macrolides (23%), cephalosporins (14%), fluoroquinolones (11%), tetracyclines (10%), and sulfonamides (6%). Clinicians prescribed 20% of antibiotics outside of an in-person visit; prescription encounters were in-person (80%), telephone (10%), order-only (4%), refill (4%), and online portal (1%). Clinicians prescribed 46% of antibiotics without an infection-related diagnosis: 54% of antibiotic prescriptions were infection-related, 29% were non-infection-related, and 17% were associated with no diagnosis. Various look-back and look-forward durations for diagnosis codes changed the results only slightly. Conclusion Clinicians prescribed 20% of antibiotics outside of in-person visits and 46% of antibiotics without an infection-related diagnosis. Interventions that target visit-based, diagnosis-specific prescriptions miss a large share of antibiotic prescribing. Disclosures All authors: No reported disclosures.
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Ajie, Anita Ayu Dwi, Retnosari Andrajati, and Maksum Radji. "FACTORS AFFECTING THE SALE OF NON-PRESCRIBED ANTIBIOTICS IN JAKARTA, INDONESIA: A CROSS-SECTIONAL STUDY." International Journal of Applied Pharmaceutics 10, no. 1 (December 20, 2018): 243. http://dx.doi.org/10.22159/ijap.2018.v10s1.54.
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Objective: This study aimed to investigate the factors affecting the sale of non-prescribed antibiotics in Jakarta, Indonesia.Methods: A cross-sectional, observational study was conducted across 190 randomly selected pharmacies in five administrative districts of Jakarta,Indonesia. Data regarding pharmacies were obtained from the Facility of Pharmaceutical Services Ministry of Health Data, in 2014, which includes allpharmacies in Jakarta. Further data were obtained using structured questionnaires.Results: Among the 190 respondents, 15 pharmacies (9.7%) never provided antibiotics without prescription, whereas 44 (23.6%), 60 (31.6%), and71 pharmacies (36.3%) provided antibiotic services without prescription rarely, sometimes, and always, respectively. Factors considerably associatedwith the increased sale of antibiotics without a prescription included the attitude and age of pharmacists, the type of pharmacy (independent or chainstore), and the presence of pharmacist assistants. Attitude was the most common variable related to providing antibiotics without a prescription.Conclusion: Antibiotics are frequently dispensed by community pharmacies in Jakarta without an appropriate prescription. These findings supportthe need for strict enforcement of pharmacy laws through improved inspections, and they highlight the need for evidence-based guidelines andeducational interventions to improve practices regarding antibiotic provision.
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Ishibashi, Noriomi, Ines Pauwels, Yuki Tomori, Yoshiaki Gu, Takefumi Yamaguchi, Takahiro Handa, Minoru Yamaoka, et al. "Point Prevalence Surveys of Antimicrobial Prescribing in a Non-Acute Care Hospital in Saitama Prefecture, Japan." Canadian Journal of Infectious Diseases and Medical Microbiology 2022 (March 25, 2022): 1–7. http://dx.doi.org/10.1155/2022/2497869.
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Background. The global point prevalence survey (Global-PPS) is the standard for the surveillance of prescribed antimicrobials among inpatients and provides data for the development of hospital antimicrobial stewardship programs. Aim. To evaluate the prevalence and quality of antimicrobial prescriptions using the universally standardized Global-PPS protocol in a non-acute care hospital in Saitama Prefecture, Japan. Methods. Antimicrobial prescriptions for inpatients, staying at the hospital overnight, were surveyed on three separate week days in November 2018, January 2019, and May 2019. Information on the prescribed antimicrobials on the survey target day was obtained from the in-hospital pharmacy. Survey data were collected by physicians, based on the extracted information. Patient information was anonymized and entered in the Global-PPS Web application by physicians. We report the antimicrobial use prevalence, the indication for prescription, diagnosis, the most prescribed antimicrobials, and a set of quality indicators related to antimicrobial prescribing. Results. In total, 6.7% of the surveyed inpatients (120/1796) were prescribed antimicrobials on the survey day. Sulfamethoxazole/trimethoprim was the most commonly prescribed, with 20.0% of systemic antibiotic prescriptions (ATC J01). Of all antibiotics for systemic use, up to 58.4% were Watch antibiotics, as defined by the World Health Organization AWaRe classification. The most prescribed group of systemic antibiotics was non-penicillin beta-lactam antibiotics (34.4%), followed by penicillin antibiotics in combination with beta-lactamase inhibitors (25.6%), and sulfonamides with trimethoprim (20.8%). Healthcare-associated infections and medical prophylaxis were the most common indications reported in 69.3% and 26.3% of prescriptions, respectively. The most common diagnosis for systemic antibiotic prescriptions was pneumonia (49.6%). Reasons for antimicrobial prescriptions were indicated in the medical records for 67.1% of prescriptions, and the stop/review date was documented to be 50.3%. Compliance with local guidelines reached 66.7%. Conclusions. This study highlights important challenges related to antimicrobial prescription in a highly specific, non-acute care patient population.
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Majid Aziz, Muhammad, Fatima Haider, Muhammad Fawad Rasool, Furqan Khurshid Hashmi, Sadia Bahsir, Pengchao Li, Mingyue Zhao, Thamir M. Alshammary, and Yu Fang. "Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff’s Opinion." Antibiotics 10, no. 5 (April 22, 2021): 482. http://dx.doi.org/10.3390/antibiotics10050482.
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Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31–40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients’ economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.
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Okoro, Roland Nnaemeka, Chijioke Nmeka, and Patrick O. Erah. "Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria." African Health Sciences 19, no. 3 (November 4, 2019): 2356–64. http://dx.doi.org/10.4314/ahs.v19i3.8.
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Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS).Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions.Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure.Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.Keywords: Antibiotics; national health insurance scheme; Nigeria; poly-pharmacy; prescription.
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Zulqarnain, Md, Sanjit Singh, Abhishek Prasad, ,. Abdullah, and Tanaya Palit. "Use of Antibiotics in Upper Respiratory Tract Infections in Tertiary Care Teaching Hospital of Delhi." Journal of Drug Delivery and Therapeutics 11, no. 2-S (April 15, 2021): 36–40. http://dx.doi.org/10.22270/jddt.v11i2-s.4793.
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The aim of this study was to evaluate the prescribing pattern of antibiotics in URTI patients attending the OPD and IPD of HAHC Hospital, a tertiary care teaching hospital of Jamia Hamdard, associated with HIMSR, New Delhi.
URTI account for millions of visits to family physicians each year. Although warranted in some cases, antibiotics are greatly overused. In the present study, an overall antibiotic prescription rate for adult patients with URTI was 45.6% whereas 54.4% patients were on non-antibiotic treatment. In our study the antibiotics were prescribed in 10.5% cases of common cold, 76.47% cases of pharyngitis, 63.15% cases of laryngitis, 100% cases of otitis media and 52.38% cases of sinusitis. The most commonly prescribed antibiotic was azithromycin which was prescribed collectively in 70.3% cases of common cold, pharyngitis, laryngitis, and sinusitis. The combination of amoxicillin and clavulanic acid was prescribed in remaining 29.7% cases suffering from pharyngitis. sinusitis, and otitis media. The antibiotic prescription at Hospital is in line with the ICMR guidelines for URTIs.
We found adverse drug reactions in only 9% cases receiving azithromycin and combination of amoxicillin and clavulanic acid. The adverse drug reaction reported with azithromycin was diarrhoea, stomach pain, nausea and vomiting whereas only diarrhoea was reported with amoxicillin and clavulanic acid combination. No other unexpected adverse drug reaction was observed in this study.
Keywords: URTI, Antibiotics, Azithromycin and co-morbidities.
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Naz, Misbah, Ali Hassan Gillani, Muhammad Arsalan Amjad, Muhammad Qamar uz zaman, Muhammad Hassan Akbar, Sharjeel Ahmed, Jamshaid Akbar, and Sameer Ali. "DRUG UTILIZATION EVALUATION OF MACROLIDES IN ENT OUTPATIENT DEPARTMENT IN TEACHING HOSPITAL PUNJAB, PAKISTAN." International Journal of Pharmacy & Integrated Health Sciences 3, no. 2 (October 24, 2022): 60–74. http://dx.doi.org/10.56536/ijpihs.v3i2.50.
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Background: A major danger to the health care system is the rise in antibiotic resistance. The aim of current Study is to evaluate the comparison defined daily dose (DDD) and prescribed daily dose (PDD) of macrolide and to evaluate the prescribing pattern of the drug, either it met the standards or not. Methodology: Quantitative, retrospective study was carried out to measure the use of antibiotics specifically macrolide antibiotics in ENT outdoor department of teaching hospital Punjab, Pakistan. Study research from August 2021 to October 2021, the patient who was reported in OPD of ENT department during study period of 3 month retrospectively. Results: Total 438 prescriptions were collected and reviewed to evaluate the prescribing pattern of macrolides in outdoor patients of ENT department. Out of 438 prescriptions only in one prescription 10 antibiotics was prescribe (polypharmacy) and in 19(4.3%) prescriptions only one antibiotic is prescribed. Drug prescribed by their generic were 438(100). Encounter with antibiotics 95%. All drug were prescribed from essential drug list (EDL). Azithromycin was the most commonly prescribed drug in ENT department, followed by clarithromycin. Conclusion: Control bacterial resistance is become challenge to our health care system, major portion of our population is become resistance to majority classes of antibiotic if this practice will continue in future, it became difficult to control or treat infectious diseases. Irrational use of drugs, over prescribing of antibiotics and brand prescribing were observing during the study. Lack of knowledge and non-adherence to the prescribing indicators are the major factors that contribute towards the irrational drug prescribing that ultimately leads towards the antibiotics resistance.
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Skender, Kristina, Vivek Singh, Cecilia Stalsby-Lundborg, and Megha Sharma. "Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study." PLOS ONE 16, no. 1 (January 27, 2021): e0245902. http://dx.doi.org/10.1371/journal.pone.0245902.
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Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.
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Kilgore, Jacob T., Mariana M. Lanata Piazzon, Jonathan M. Willis, Joseph Evans, and Michael J. Smith. "1359. Utilization of West Virginia Pediatric Medicaid Claims Data to Guide Outpatient Antimicrobial Stewardship Interventions." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S691. http://dx.doi.org/10.1093/ofid/ofaa439.1541.
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Abstract Background Antimicrobial resistance is a significant public health risk with overuse and misuse of antibiotics as primary drivers. West Virginia (WV) leads the nation in per capita prescribing in the outpatient setting, where the majority of antibiotic use occurs. Methods We analyzed outpatient pharmacy and medical claims for WV Medicaid recipients age < 20 years from 1/1/2018 – 12/31/2019. Dental claims were excluded. Oral antibiotics were identified using National Drug Codes (NDCs). Key demographic variables extracted from the claims include patient age (as of December 31st of that calendar year [CY]), sex, race, ethnicity, Medicaid region, place of medical service, provider, and cost. Rates of prescribing were calculated as the number of prescriptions per 1,000 children and stratified by age, race/ethnicity, sex, and WV Medicaid region. We used geographic information system (GIS) mapping to depict geographic variation in prescribing by county. Oral antibiotic prescriptions were compared across CY 2018 and 2019 including spectrum of antibiotic coverage. Results In CY 2018, 204,576 pediatric patients received 237,759 antibiotics (1,162 prescriptions/1,000 children). In 2019, 201,520 pediatric patients received 227,440 antibiotics (1,129 prescriptions/1,000 children). Prescription rates were higher among females, Caucasians and a younger (0-2) age group (Table 1). Antibiotics were more commonly prescribed by non-physician (e.g. nurse practitioner, etc.), non-pediatric specialty providers. Amoxicillin, cefdinir, and azithromycin were the most commonly prescribed antibiotics across CYs. Table 2 summarizes commonly prescribed antibiotics and their associated cost. Medicaid region 4 encompassed the highest prescription rates. Figure 1 is a GIS map of prescription rates by WV county. Table 1. West Virginia pediatric (0 – 19 years*) Medicaid patient population demographic summary by calendar year (CY). Table 2. Oral antibiotic prescription review including cost, CY 2018-2019. Figure 1. Geographic information system (GIS) mapping of prescriptions per 1,000 children by WV county. Conclusion There is significant variation in antibiotic prescribing across WV. Potential areas of stewardship intervention should focus on non-physician, non-pediatric providers in Medicaid Region 4, the southern and arguably most rural portion of the state. Secondary analysis revealed an alarmingly high total number of broad-spectrum antibiotic use compared to narrow-spectrum. Further data analysis will examine diagnosis-specific prescription practices within this population. Disclosures Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support)
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Teratani, Yusuke, Hideharu Hagiya, Toshihiro Koyama, Mayu Adachi, Ayako Ohshima, Yoshito Zamami, Hiroyoshi Y. Tanaka, et al. "Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013–15: a retrospective observational study." Family Practice 36, no. 4 (September 29, 2018): 402–9. http://dx.doi.org/10.1093/fampra/cmy094.
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Abstract Background In this age of antimicrobial resistance, unnecessary use of antibiotics to treat non-bacterial acute respiratory tract infections (ARTIs) and inappropriate use of antibiotics in treating bacterial ARTIs are public health concerns. Purpose Our aim is to identify the pattern of oral antibiotic prescriptions for outpatients with ARTIs in Japan. Methods We analysed health insurance claims data of patients (aged ≤74 years) from 2013 to 2015, to determine the pattern of antibiotic prescriptions for outpatient ARTIs and calculated the proportion of each antibiotic. Results Data on 4.6 million antibiotic prescriptions among 1559394 outpatients with ARTIs were analysed. The most commonly prescribed classes of antibiotics included cephalosporins (41.9%), macrolides (32.8%) and fluoroquinolones (14.7%). The proportion of first-, second- and third-generation cephalosporins was 1.0%, 1.7% and 97.3%, respectively. Fluoroquinolones accounted for a quarter of the prescriptions for ARTIs in patients aged >20 years. In contrast, penicillins accounted for just 8.0% of the total number of antibiotic prescriptions for ARTIs. Conclusions According to clinical guidelines, penicillins are first-line antibiotics against ARTIs. However, third-generation cephalosporins, macrolides and fluoroquinolones are more frequently prescribed in Japan. Although we could not assess the extent to which appropriate antibiotics are selected, our results support the necessity of improving antibiotic choices in the treatment of ARTIs.
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Glass, Nina E., Jay Schulkin, Shadi Chamany, Laura E. Riley, Anne Schuchat, and Stephanie Schrag. "Opportunities to Reduce Overuse of Antibiotics for Perinatal Group B Streptococcal Disease Prevention and Management of Preterm Premature Rupture of Membranes." Infectious Diseases in Obstetrics and Gynecology 13, no. 1 (2005): 5–10. http://dx.doi.org/10.1155/2005/982060.
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Objective:To identify opportunities to reduce overuse of antibiotics for prevention of perinatal group B streptococcal (GBS) disease and management of preterm premature rupture of membranes (pPROM).Methods:An anonymous written questionnaire was sent to each of 1031 Fellows of the American College of Obstetricians and Gynecologists, and the responses were subjected to statistical analysis.Results:Among those of the 404 respondents who saw obstetric patients in 2001, most (84%) screened for GBS colonization, and 22% of these prescribed prenatal antibiotics to try to eradicate GBS colonization. Of the 382 respondents (95%) who prescribed antibiotics for pPROM, 36% continued antibiotics for more than 7 days despite negative results from GBS cultures collected before initiation of treatment. Having more years of clinical experience (adjusted odds ratio (OR) 3.0, 95% confidence interval (CI) 1.5 to 6.2), working in a non-academic setting (adjusted OR 2.7, 95% CI 1.0 to 6.9), and prescribing antibiotics prenatally for GBS colonization (adjusted OR 2.0, 95% CI 1.1 to 3.4) were associated with prescribing prolonged antibiotics for pPROM.Conclusion:Prenatal antibiotic treatment for GBS colonization and prolonged antibiotic treatment for pPROM contribute to overuse of antibiotics in obstetrics.
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Heal, Clare, Hilary Gorges, Mieke L. van Driel, Amanda Tapley, Josh Davis, Andrew Davey, L. Holliday, et al. "Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo." BMJ Open 9, no. 10 (October 2019): e031527. http://dx.doi.org/10.1136/bmjopen-2019-031527.
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ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.SettingReCEnT is an ongoing multisite cohort study of Australian registrars’ in-consultation clinical practice across five Australian states.ParticipantsRegistrars participating in ReCEnT from 2010 to 2017.Outcome measuresManagement of impetigo with systemic antibiotics.Results1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01).ConclusionsAustralian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
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Pudak Wangi, Putu Ary, and Made Krisna Adi Jaya. "ANTIBIOTICS USAGE OVERVIEW IN ORTHOPEDIC SURGERY PATIENTS AT A HOSPITAL IN BALI." Journal of Pharmaceutical Science and Application 4, no. 2 (December 1, 2022): 76. http://dx.doi.org/10.24843/jpsa.2022.v04.i02.p05.
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Backgrounds: Antibiotic resistance can be prevented by controlling the use of antibiotics wisely. Based on WHO recommendations, controlling the use of antibiotics is done by grouping antibiotics with the AWaRe category. Objective: This work aims to present an overview of the use of antibiotics in orthopaedic surgery patients as an effort to monitor the use of antibiotics in a hospital in Bali. Methods: Based on the patient's medical record data, the antibiotics used for orthopaedic surgery were calculated and grouped with the AWaRe classification. Result: Results showed that the most prescribed antibiotic was ceftriaxone (84.74%). There were no antibiotics in the reserve category, but the highest percentage was 94.92% in the watch category, and the access category was 5.08%. Conclusion: There is still non-selective use of antibiotics in this hospital, so in the future, it is necessary to evaluate qualitatively and quantitatively to ensure rational use as well as efforts to prevent the occurrence of antibiotic resistance.
Keywords: Antibiotics; Resistance; AwaRe; Hospital; Bali
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Moghadamnia, A. A., M. R. Mirbolooki, and M. B. Aghili. "General practitioner prescribing patterns in Babol city, Islamic Republic of Iran." Eastern Mediterranean Health Journal 8, no. 4-5 (June 15, 2002): 550–55. http://dx.doi.org/10.26719/2002.8.4-5.550.
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To determine patterns of prescribing in Iranian primary care, we analysed 4000 randomly selected prescriptions from 52 general practitioners [GPs] in Babol city during 1999-2000. The mean number of drugs prescribed per encounter was 4.4 +/- 1.7, with 98% prescribed by generic name. The most commonly prescribed items were non-steroidal anti-inflammatory drugs [62.9% of encounters] and antibiotics [61.9%], followed by central nervous system drugs, gastrointestinal tract drugs, corticosteroids, vitamins and cardiovascular system drugs respectively. Injections were prescribed in 58.0% of encounters. Female and male doctors had significantly different antibiotic prescribing patterns. Our study confirms the tendency of GPs to overprescribe.
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Belkina, Tatyana, Abdullah Al Warafi, Elhassan Hussein Eltom, Nigora Tadjieva, Ales Kubena, and Jiri Vlcek. "Antibiotic use and knowledge in the community of Yemen, Saudi Arabia, and Uzbekistan." Journal of Infection in Developing Countries 8, no. 04 (April 15, 2014): 424–29. http://dx.doi.org/10.3855/jidc.3866.
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Introduction: Inappropriate use of antibiotics has resulted in a dramatic increase of antimicrobial resistance in developing countries. We examined knowledge, attitudes, and practices of antibiotic use in three Asian countries. Methodology: A nationwide cross-sectional study of teachers in large cities of Yemen, Saudi Arabia, and Uzbekistan was conducted. A random sample of 1,200 teachers was selected in each country. Data were collected through a questionnaire-based survey and then analyzed using descriptive and multivariate statistical methods. Results: The prevalence of non-prescription antibiotic use ranged from 48% in Saudi Arabia to 78% in Yemen and Uzbekistan. Pharmacies were the main source of non-prescribed antibiotics. The most common reasons for antibiotic use were cough (40%) and influenza (34%). Forty-nine percent of respondents discontinued antibiotics when they felt better. Although awareness of the dangers of antibiotic use correlated inversely with self-medication, understanding of the appropriate use of antibiotics was limited. Conclusions: The prevalence of antibiotic self-medication in the educated adult population in the studied countries was found to be alarmingly high. Effective strategies involving regulatory enforcement prohibiting sales of antibiotics without prescription should be implemented along with educational interventions for health professionals and the public.
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Brett, Elizabeth Ann, and Marion Palmer. "The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the impact of the COVID-19 pandemic on the prescribing of antibiotics by non-medical prescribers in England in 2020 (part 2)." Journal of Prescribing Practice 4, no. 11 (November 2, 2022): 490–97. http://dx.doi.org/10.12968/jprp.2022.4.11.490.
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Background Part one of this study identified that prescribing behaviours during 2020 differed significantly from 2016-2021. Part 2, presented here, covers a more detailed analysis of the impact of the early part of the COVID-19 pandemic is presented here. Aims To describe patterns in community prescribed and dispensed antibiotic volumes attributable to non-medical prescribers during 2020 compared to the previous 4 years and identify any changes of behaviour during this period and their impact on antimicrobial stewardship. Methods An analysis of retrospective non-medical prescribers' prescribing data was performed to determine the numbers of independent non-medical prescribers and the patterns of prescribed community dispensed antibiotic volumes between 2016-2021. The 2020 data were then compared to the data from previous years. Findings The total amount of dispensed non-medical prescribers antibiotic prescription items per 100000 population dropped by 12% in 2020 compared to 2019, driven predominantly by reductions in nurse prescribing. However, high-risk antibiotic prescribing rose from 5.3% of antibiotics prescribed in 2019 to 6.4% in 2020. Seasonal patterns of antibiotic prescribing differed in 2020, with significant reductions in prescribing of antibiotics normally associated with treating LRTI from the first lockdown in March 2020. Conclusions The COVID-19 pandemic forced rapid changes in practice, including increased remote working, which created a challenging prescribing environment that adversely affected the high-risk antibiotic prescribing behaviour of non-medical prescribers more than it affected their medical colleagues. There were unusually low levels of prescribing for respiratory tract infections over the last quarter of 2020 which, although likely multifactorial, may indicate over-prescribing for self-limiting viral infections in previous years. More research is needed to establish ongoing prescribing trends and patient outcomes, and how antimicrobial stewardship programmes and training can be better targeted to support prescribers to address quality and safety issues arising from changing modes of practice.
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Li, Yan, Anna Mölter, Andrew White, William Welfare, Victoria Palin, Miguel Belmonte, Darren M. Ashcroft, Matthew Sperrin, and Tjeerd Pieter van Staa. "Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study." British Journal of General Practice 69, no. 678 (December 17, 2018): e42-e51. http://dx.doi.org/10.3399/bjgp18x700457.
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BackgroundHigh levels of antibiotic prescribing are a major concern as they drive antimicrobial resistance. It is currently unknown whether practices that prescribe higher levels of antibiotics also prescribe more medicines in general.AimTo evaluate the relationship between antibiotic and general prescribing levels in primary care.Design and settingCross-sectional study in 2014–2015 of 6517 general practices in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink for a replication study.MethodLinear regression to assess determinants of antibiotic prescribing.ResultsNHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients per year (329.9 at the 5th percentile and 808.7 at the 95th percentile). The levels of prescribing of antibiotics and other medicines were strongly correlated. Practices with high levels of prescribing of other medicines (a rate of 27 159.8 at the 95th percentile) prescribed 80% more antibiotics than low-prescribing practices (rate of 8815.9 at the 5th percentile). After adjustment, NHS-DPPD practices with high prescribing of other medicines gave 60% more antibiotic prescriptions than low-prescribing practices (corresponding to higher prescribing of 276.3 antibiotics per 1000 patients per year). Prescribing of non-opioid painkillers and benzodiazepines were also strong indicators of the level of antibiotic prescribing. General prescribing levels were a much stronger driver for antibiotic prescribing than other risk factors, such as deprivation.ConclusionThe propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to target general prescribing behaviours, in addition to specifically targeting antibiotics.
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Brett, Elizabeth Ann, and Marion Palmer. "The influence of non-medical prescribers on antimicrobial stewardship: a national evaluation of the prescribing of antibiotics by non-medical prescribers in England from 2016 to 2021 (part 1)." Journal of Prescribing Practice 4, no. 10 (October 2, 2022): 452–62. http://dx.doi.org/10.12968/jprp.2022.4.10.452.
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Background Non-medical prescriber numbers have increased rapidly over the last 10 years, with increasingly diverse roles and backgrounds. Previous evaluations of their antibiotic prescribing demonstrated it was generally of a high quality and guideline-driven, but recent evidence is lacking and the data are not easily accessible. Aims To describe changes in the non-medical prescriber population and patterns in dispensed antibiotic volumes between 2016–2021, highlighting evidence of good antimicrobial stewardship and where further interventions may be required. Methods An analysis of retrospective non-medical prescriber prescribing data was performed, to determine the numbers of independent non-medical prescribers and the patterns of prescribed community-dispensed antibiotics in England between 2016–2021. Findings Between 2016–2021, it was found that independent non-medical prescriber numbers in England rose by 54%. Whilst they remain predominantly nurses (76%), the numbers of pharmacists and allied health professionals have increased. Non-medical prescribers were responsible for 10.6% of all dispensed antibiotic items prescribed in primary care in England. However, the proportion of dispensed antibiotic items prescribed by these non-medical prescribers reduced by over 50%. Prescribing in 2020 differed from previous years, with increased high-risk antibiotic prescribing. Conclusion The quality of prescribing generally appears good and in accordance with national guidelines and principles of good antimicrobial stewardship. The 2020 COVID-19 pandemic prompted changes in antibiotic prescribing behaviour.
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Hood, Kerenza, Jacqui Nuttall, David Gillespie, Victoria Shepherd, Fiona Wood, Donna Duncan, Helen Stanton, et al. "Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes." Health Technology Assessment 18, no. 63 (October 2014): 1–84. http://dx.doi.org/10.3310/hta18630.
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BackgroundAntibiotic prescribing rates in care homes are higher than in the general population. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic-associated diarrhoea (AAD).Clostridium difficile(Hall and O’Toole 1935) Prévot 1938 is the most commonly identified cause of AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting.ObjectivesThe Probiotics for Antibiotic-Associated Diarrhoea (PAAD) study was designed as a two-stage study. PAAD stage 1 aimed to (1) prospectively describe antibiotic prescribing in care homes; (2) determine the incidence ofC. difficilecarriage and AAD (includingC. difficile-associated diarrhoea); and (3) to consider implementation challenges and establish the basis for a sample size estimation for a randomised controlled trial (RCT) of probiotic administration with antibiotics to prevent AAD in care homes. If justified by PAAD stage 1, the RCT would be implemented in PAAD stage 2. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2.DesignPAAD stage 1 was a prospective observational cohort study in care homes in South Wales with up to 12 months’ follow-up for each resident.SettingRecruited care homes had management and owner’s agreement to participate and three or more staff willing to take responsibility for implementing the study.ParticipantsEleven care homes were recruited, but one withdrew before any residents were recruited. A total of 279 care home residents were recruited to the observational study and 19 withdrew, 16 (84%) because of moving to a non-participating care home.Main outcome measuresThe primary outcomes were the rate of antibiotic prescribing, incidence of AAD, defined as three or more loose stools (type 5–7 on the Bristol Stool Chart) in a 24-hour period, andC. difficilecarriage confirmed on stool culture.ResultsStool samples were obtained at study entry from 81% of participating residents. Over half of the samples contained antibiotic-resistant isolates, with Enterobacteriaceae resistant to ciprofloxacin in 47%. Residents were prescribed an average of 2.16 antibiotic prescriptions per year [95% confidence interval (CI) 1.90 to 2.46]. Antibiotics were less likely to be prescribed to residents from dual-registered homes. The incidence of AAD was 0.57 (95% CI 0.41 to 0.81) episodes per year among those residents who were prescribed antibiotics. AAD was more likely in residents who were prescribed co-amoxiclav than other antibiotics and in those residents who routinely used incontinence pads. AAD was less common in residents from residential homes.ConclusionsCare home residents, particularly in nursing homes, are frequently prescribed antibiotics and often experience AAD. Antibiotic resistance, including ciprofloxacin resistance, is common in Enterobacteriaceae isolated from the stool of care home residents. Co-amoxiclav is associated with greater risk of AAD than other commonly prescribed antibiotics.Trial registrationCurrent Controlled Trials ISRCTN 7954844.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 63. See the NIHR Journals Library website for further project information.
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Dehn Lunn, Amy. "Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India." BMJ Open Quality 7, no. 4 (November 2018): e000217. http://dx.doi.org/10.1136/bmjoq-2017-000217.
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Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.
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Maffucci, Fenizia, Chrystal Chang, Jay Simhan, and Joshua A. Cohn. "Is There Any Benefit to the Use of Antibiotics with Indwelling Catheters after Urologic Surgery in Adults." Antibiotics 12, no. 1 (January 12, 2023): 156. http://dx.doi.org/10.3390/antibiotics12010156.
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Antibiotic stewardship in urologic reconstruction is critically important, as many patients will require indwelling catheters for days to weeks following surgery and thus are at risk of both developing catheter-associated urinary tract infections (CAUTI) as well as multi-drug resistant (MDR) uropathogens. Accordingly, limiting antibiotic use, when safe, should help reduce antibiotic resistance and the prevalence of MDR organisms. However, there is significant heterogeneity in how antibiotics are prescribed to patients who need indwelling urethral catheters post-operatively. We performed a literature review to determine if there are benefits in the use of antibiotics for various clinical scenarios that require post-operative indwelling catheters for greater than 24 h. In general, for patients undergoing prostatectomy, transurethral resection of the prostate, and/or urethroplasty, antibiotic administration may be limited without increased risk of CAUTI. However, more work is needed to identify optimal antibiotic regimens for these and alternative urologic procedures, whether certain sub-populations benefit from longer courses of antibiotics, and effective non-antibiotic or non-systemic therapies.
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Flood, Shannon M., Neil M. Desai, Jan E. Leonard, and Rakesh D. Mistry. "Emergency Department Prescribing Patterns for Pharyngitis in Children." Clinical Pediatrics 59, no. 11 (June 5, 2020): 995–1003. http://dx.doi.org/10.1177/0009922820927042.
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Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of group A streptococcal (GAS) pharyngitis diagnosis and antibiotic prescribing patterns. This was a secondary data analysis of the National Hospital Ambulatory Medical Care Survey. Diagnosis and antibiotic treatment for GAS and non-GAS (viral) pharyngitis were reported in all ages and specifically examined in children <3 years of age from 2010 to 2015. GAS pharyngitis was diagnosed in 29% of visits for children with pharyngitis; however, 60% of patients with any pharyngitis received antibiotics. Twenty percent of children <3 years were diagnosed with GAS pharyngitis, yet over half were given antibiotics. Broad-spectrum antibiotics were commonly prescribed. Antibiotic treatment of pharyngitis, including broad-spectrum antibiotics, remains high when compared with the known prevalence of GAS pharyngitis. Diagnosis and treatment of GAS pharyngitis in patients <3 years persists despite recommendations against testing.
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Adamu, Abdu A., Muktar A. Gadanya, Rabiu I. Jalo, Olalekan A. Uthman, and Charles S. Wiysonge. "Factors influencing non-prescription sales of antibiotics among patent and proprietary medicine vendors in Kano, Nigeria: a cross-sectional study." Health Policy and Planning 35, no. 7 (June 12, 2020): 819–28. http://dx.doi.org/10.1093/heapol/czaa052.
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Abstract Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It’s unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27–3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.
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Cioca, Gabriela, and Florentina-Daniela Munteanu. "Estimation of the Amount of Disposed Antibiotics." Sustainability 11, no. 6 (March 25, 2019): 1800. http://dx.doi.org/10.3390/su11061800.
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The impact of the antibiotics in the environment is not well understood yet. Moreover, the total amount of antibiotics that are ending up in the environment as solid waste is not known and cannot be rigorously determined as many variables are influencing the determination of their concentration. The present article is focused on the estimation of the amount of non-prescribed antibiotics that are used in different European countries. Particular attention is paid to the class of beta-lactams, as they are responsible for a considerate share of the antimicrobial resistance. The primary purpose was the estimation of the quantity of non-prescribed antibiotics that might reach the environment as solid waste. For the present study, we used the ECDC and EUROSTAT reported data.
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Diaz, Maria Carmen G., Lori K. Handy, James H. Crutchfield, Adriana Cadilla, Jobayer Hossain, and Lloyd N. Werk. "Impact of a Personalized Audit and Feedback Intervention on Antibiotic Prescribing Practices for Outpatient Pediatric Community-Acquired Pneumonia." Clinical Pediatrics 59, no. 11 (June 2, 2020): 988–94. http://dx.doi.org/10.1177/0009922820928054.
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Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers’ antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers’ CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non–guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, P < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician’s selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.
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Kandla Sharma and Ankit Mangla. "Managing Antibiotic Associated Diarrhea With Pseudomembranous Colitis: A Case Report." International Healthcare Research Journal 2, no. 2 (May 10, 2018): 35–37. http://dx.doi.org/10.26440/ihrj/02_02/165.
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Antiobiotic associated diarrhea is a usual adverse event during antibiotic therapy. We present the case of a 32-year-old female diagnosed with diarrhea induced by antibiotics. After eradication of Helicobacter pylori by using antibiotics, she presented with hemorrhagic stools. The faecal examination was positive for, Clostridium difficile infection (CDI) although no toxins were detectable. Vancomycin was initiated for the C. difficile infection but the condition worsened due to treatment non-compliance. Finally oral metronidazole was prescribed. Stool abnormality improved and faecal test became negative after metronidazole treatment.
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Domínguez-Domínguez, Laura, Alfonso López-Marrufo-Medina, Daniel Cabanillas-Balsera, María Carmen Jiménez-Sánchez, Victoria Areal-Quecuty, José López-López, Juan J. Segura-Egea, and Jenifer Martin-González. "Antibiotics Prescription by Spanish General Practitioners in Primary Dental Care." Antibiotics 10, no. 6 (June 11, 2021): 703. http://dx.doi.org/10.3390/antibiotics10060703.
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The aim of this study was to analyze the antibiotics prescription habits, both prophylactically and therapeutically, of Spanish general dental practitioners in the management of endodontic infections in primary care. Two hundred Spanish general dental practitioners were asked to respond to a survey on indications for antibiotics prescription in the treatment of endodontic infections, being 190 general dentists (95%) included in the study. Data were analyzed using descriptive statistics and the chi-square test. The average duration of antibiotics therapy was 6.5 ± 1.0 days. In patients without medical allergies, most of them (97%) selected amoxicillin as the antibiotic of the first choice, alone (51.1%) or associated with clavulanic acid (45.8%); in patients with penicillin allergies, the drug of choice was clindamycin 300 mg (70%). For cases of symptomatic irreversible pulpitis, 44% of the respondents prescribed antibiotics, in the scenario of prophylactic antibiotic prescription, up to 27% of the general dentists prescribe according to non-current guidelines (1 g 1 h before or 1 g 1 h before and 1 g 1 h after) in non-indicated cases (16% in patients taking oral bisphosphonates). It is necessary to improve the antibiotic prescription habits of Spanish general dentists in endodontics.
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Diop, Boubacar BF, Amine Cheikh, Houda Attjioui, Mohamed R. Ajaja, Hafid Mefetah, and Mustapha Bouatia. "Evaluation of anti-infectives prescriptions in a pediatric hemato-oncological center: A retrospective study." Journal of Oncology Pharmacy Practice 25, no. 8 (December 5, 2018): 1811–16. http://dx.doi.org/10.1177/1078155218816779.
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Introduction A few years after the discovery and development of anti-infectives, this therapeutic feat gave way to bacterial resistance because of the overconsumption of antibiotics, most often with unjustified prescriptions. The objective was to evaluate the compliance of the prescription of antibiotherapy in the pediatric onco-hematology unit of Rabat Children's Hospital and to determine the drug interactions. Material and methods This is a retrospective study of anti-infectives prescriptions in pediatric onco-hematology. All prescriptions containing an antibiotic or antimycotic were isolated at the end of each month for analysis according to the ANSM standard. The variables of compliance analyzed in the prescriptions were: form, indication, posology, duration of the treatment, drug interactions and number of antibiotics which were prescribed. Results The prescriptions containing at least one anti-infective were 195. All the prescriptions were in conformity with their indications; 111 (57%) of the cases were conform with respect to all criteria; 20 (12%) prescriptions were not conform in their form, 12 (6.6%) contained at least one over-dosed drug and 52 (26.7%) contained at least one under-dosed drug. A drug interaction was found in 15 (7.7%) of cases, of which 12 (6.2%) are precautions for use. A drug interaction is present in 1(6,7%) cases when a single antibiotic is prescribed against 3 (20%) cases when 4 antibiotics are prescribed. ( p = 0.007). Conclusion The number of non-compliances in our study was high. It would therefore be advisable to recommend the establishment of an information system to minimize the non-compliances and to ensure a training program for young doctors on international recommendations.
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Pinte, Larisa, Alexandr Ceasovschih, Cristian-Mihail Niculae, Laura Elena Stoichitoiu, Razvan Adrian Ionescu, Marius Ioan Balea, Roxana Carmen Cernat, et al. "Antibiotic Prescription and in-Hospital Mortality in COVID-19: A Prospective Multicentre Cohort Study." Journal of Personalized Medicine 12, no. 6 (May 26, 2022): 877. http://dx.doi.org/10.3390/jpm12060877.
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Background: Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus disease 2019 (COVID-19). Methods: We conducted a prospective multicentre cohort study in six clinical hospitals, between January 2021 and May 2021. Results: We included 553 hospitalised COVID-19 patients, of whom 58% (311/553) were prescribed antibiotics, while bacteriological tests were performed in 57% (178/311) of them. Death was the outcome in 48 patients—39 from the ATBs group and 9 from the non-ATBs group. The patients who received antibiotics during hospitalisation had a higher mortality (RR = 3.37, CI 95%: 1.7–6.8), and this association was stronger in the subgroup of patients without reasons for antimicrobial treatment (RR = 6.1, CI 95%: 1.9–19.1), while in the subgroup with reasons for antimicrobial therapy the association was not statistically significant (OR = 2.33, CI 95%: 0.76–7.17). After adjusting for the confounders, receiving antibiotics remained associated with a higher mortality only in the subgroup of patients without criteria for antibiotic prescription (OR = 10.3, CI 95%: 2–52). Conclusions: In our study, antibiotic treatment did not decrease the risk of death in the patients with mild and severe COVID-19, but was associated with a higher risk of death in the subgroup of patients without reasons for it.
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Debets, Vera EC, Theo JM Verheij, and Alike W. van der Velden. "Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands." British Journal of General Practice 67, no. 656 (February 23, 2017): e178-e186. http://dx.doi.org/10.3399/bjgp17x689641.
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BackgroundUnnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations.AimTo obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases.Design and settingTwo two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden.MethodFrom the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients’ age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations.ResultsOnly 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice.ConclusionThe suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality.
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Chakraborty, Madhurima, Taniya Bardhan, Manjari Basu, and Bornali Bhattacharjee. "Influence of Sub-Inhibitory Dosage of Cefotaxime on Multidrug Resistant Staphylococcus haemolyticus Isolated from Sick Neonatal Care Unit." Antibiotics 11, no. 3 (March 8, 2022): 360. http://dx.doi.org/10.3390/antibiotics11030360.
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Staphylococcus haemolyticus has emerged to be a frequently encountered late-onset sepsis pathogen among newborn infants. Critical care of neonates involves substantial usage of antibiotics and these pathogens are often exposed to sub-optimal doses of antibiotics which can augment maintenance of selection determinants and a range of physiological effects, prime among them being biofilm formation. Therefore, in this study, the outcome of a sub-inhibitory dosage of a commonly prescribed third-generation antibiotic, cefotaxime (CTX), on multidrug resistant (MDR) S. haemolyticus, was investigated. A total of 19 CTX-resistant, MDR and 5 CTX-susceptible strains isolated from neonates were included. Biofilm-forming abilities of S. haemolyticus isolates in the presence of sub-optimal CTX (30 μg/mL) were determined by crystal violet assays and extracellular DNA (eDNA) quantitation. CTX was found to significantly enhance biofilm production among the non-susceptible isolates (p-valueWilcoxintest—0.000008) with an increase in eDNA levels (p-valueWilcoxintest—0.000004). Further, in the absence of antibiotic selection in vitro, populations of MDR isolates, JNM56C1 and JNM60C2 remained antibiotic non-susceptible after >500 generations of growth. These findings demonstrate that sub-optimal concentration of CTX induces biofilm formation and short-term non-exposure to antibiotics does not alter non-susceptibility among S. haemolyticus isolates under the tested conditions.
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Witt, Anna, Mason G. Harper, Juan Carlos Rico Crescencio, Ryan K. Dare, and Mary Burgess. "46. Antimicrobial Stewardship’s Selective Antibiotic Suppression Does Not Lead to Adverse Outcomes in Neutropenic Patients with Gram-Negative Bacteremia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S46. http://dx.doi.org/10.1093/ofid/ofaa439.091.
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Abstract Background An antimicrobial stewardship program (ASP) strategy to minimize the use of overly broad antimicrobials is to suppress specific antimicrobial susceptibility results when isolates are sensitive to narrow antibiotics. There is limited data on possible adverse outcomes of this method. Patients with febrile neutropenia (FN) and gram-negative bacteremia (GNB) whose culture is sensitive to non-pseudomonal antibiotics still require broader pseudomonal coverage to treat the syndrome of FN. We evaluated if ASP suppression of anti-pseudomonal antibiotics adversely affects patients with FN and GNB. Methods In February 2018, our institution’s ASP began suppressing cefepime and meropenem susceptibility results from E. coli, Klebsiella spp, and Proteus spp when sensitive to cefepime (MIC ≤ 2), ceftriaxone and ceftazidime. We performed a retrospective analysis of patients with FN and GNB from 2016 – 2020 to evaluate the appropriateness of antibiotic regimens before and after the ASP intervention. Antibiotic regimens were deemed inappropriate if the patient was de-escalated to a narrow-spectrum, non-pseudomonal agent while neutropenic. Of 338 inpatient encounters identified with any bacteremia and FN, 49 were due to non-Pseudomonas, non-ESBL GNB, 20 before and 29 after the intervention. Sixteen of the 29 post-intervention patients were excluded, as their isolates did not meet suppression criteria. This resulted in a total of 13 patients in the post-intervention group. Results After culture susceptibility reports were released, 3 out of 20 patients in the pre-intervention group (15%) and 4 out of 13 patients in the post-intervention group (30.8%) were inappropriately tailored to narrow-spectrum antibiotics (p=0.39). There was no significant difference in 30-day mortality, 10.0% pre- and 0% post-intervention (p=0.50), or amount of meropenem prescribed, 45% pre- and 38.5% post-intervention (p=0.74). Conclusion These data show no significant difference in inappropriate antibiotic regimens prescribed for patients with FN and GNB after ASP antibiotic suppression was implemented. 30-day mortality was also not affected. The ASP intervention did not decrease meropenem prescriptions in this patient group, which may be appropriate. Larger studies are needed to verify these findings. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support) Mary Burgess, MD, Pfizer Inc (Grant/Research Support)
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Fentie, Atalay Mulu, Yidnekachew Degefaw, Getachew Asfaw, Wendosen Shewarega, Mengistab Woldearegay, Ephrem Abebe, and Gebremedhin Beedemariam Gebretekle. "Multicentre point-prevalence survey of antibiotic use and healthcare-associated infections in Ethiopian hospitals." BMJ Open 12, no. 2 (February 2022): e054541. http://dx.doi.org/10.1136/bmjopen-2021-054541.
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ObjectiveEffective antimicrobial containment strategies such as Antimicrobial Stewardship Programs (ASPs) require comprehensive data on antibiotics use which are scarce in Ethiopia. This study sought to assess antibiotics use and healthcare-associated infections (HCAIs) in Ethiopian public hospitals.DesignWe conducted a cross-sectional study using the WHO point-prevalence survey protocol for systemic antibiotics use and HCAIs for low/middle-income countries.SettingThe study was conducted among 10 public hospitals in 2021.ParticipantsAll patients admitted to adult and paediatric inpatient and emergency wards before or at 08:00 on the survey date were enrolled.Outcome measureThe primary outcome measures were the prevalence of antibiotic use, HCAIs and the hospitals’ readiness to implement ASP.ResultsData were collected from 1820 patient records. None of the surveyed hospitals had functional ASP. The common indication for antibiotics was for HCAIs (40.3%). Pneumonia was the most common bacterial infection (28.6%) followed by clinical sepsis (17.8%). Most treatments were empiric (96.7%) and the overall prevalence of antibiotic use was 63.8% with antibiotics prescription per patient ratio of 1.77. Ceftriaxone was the most commonly prescribed antibiotic (30.4%) followed by metronidazole (15.4%). Age, having HIV infection, ward type, type of hospital, catheterisation and intubation history had significant association with antibiotic use. Patients who were treated in paediatric surgical wards were about four times more likely to be on antibiotics compared with patients treated at an adult emergency ward. Patients on urinary catheter (adjusted OR (AOR)=2.74, 95% CI: 2.04 to 3.68) and intubation device (AOR=2.62, 95% CI: 1.02 to 6.76) were more likely to be on antibiotics than their non-intubated/non-catheterised counterparts. Patients treated at secondary-level hospitals had 0.34 times lower odds of being on antibiotics compared with those in tertiary hospitals.ConclusionsAntibiotic use across the surveyed hospitals was common and most were empiric which has both practical and policy implications for strengthening ASP and promoting rational antibiotics use.
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Murphy, Marion. "Does cash payment influence a GP’s decision to prescribe antibiotics?" Boolean: Snapshots of Doctoral Research at University College Cork, no. 2010 (January 1, 2010): 125–32. http://dx.doi.org/10.33178/boolean.2010.28.
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Antimicrobial resistance is a major public health concern and one of the primary factors contributing to resistance is the unnecessary use of antimicrobials. Many countries have developed strategies in order to promote the rational use of antibiotics. Ireland is only one of three European countries where outpatient antibiotic use is increasing, at a rate of 3% per year since 2000. The majority of antibiotic prescribing is conducted by General Practitioners (GPs) in the community, and wide variation is known to exist. The volume of antibiotics prescribed that are unnecessary in the community is unknown but it is believed that a number are used to treat minor respiratory tract infections. These conditions such as the common cold, sore throat, acute otitis media and acute bronchitis have no compelling evidence to support the use of antibiotics in their treatment. There are many external (non-clinical) factors that influence a GP’s decision to prescribe, ...
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Xu, Yannan, Jingjing Lu, Chenhui Sun, Xiaomin Wang, Yanhong Jessika Hu, and Xudong Zhou. "A cross-sectional study of antibiotic misuse among Chinese children in developed and less developed provinces." Journal of Infection in Developing Countries 14, no. 02 (February 29, 2020): 129–37. http://dx.doi.org/10.3855/jidc.11938.
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Introduction: Antimicrobial resistance is a global health crisis and primarily caused by antibiotic misuse. Antibiotic misuse among children is particularly concerning, and its prevalence may vary from region to region in China with different development levels.
Methodology: Zhejiang and Shaanxi were selected to represent developed and less developed provinces in China, respectively. Data of 2924 parents in Zhejiang and 3355 parents in Shaanxi whose children were 0-13 years old were collected through multi-stage stratified cluster random sampling and a self-administrated questionnaire. Chi-square tests and logistic regression models were used for statistical analysis.
Results: Compared to parents in Zhejiang, those in Shaanxi were more likely to keep antibiotics for children at home, to engage in self-medication with antibiotics for children, and to make their children take antibiotics prophylactically. While there were no significant provincial differences between parents’ requests for antibiotics during pediatric consultations, parents in Shaanxi province were more likely to receive prescribed antibiotics.
Conclusions: Children in less developed provinces face higher risks of antibiotic misuse at home as well as when attending medical practitioners. Comprehensive educational interventions are required to improve antibiotic use for children all over China but particularly in less developed provinces such as Shaanxi. Furthermore, non-prescription sales and over-prescribing of antibiotics should be reduced by targeted strategies.
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Rodríguez-Fernández, Almudena, Olalla Vázquez-Cancela, María Piñeiro-Lamas, Adolfo Figueiras, and Maruxa Zapata-Cachafeiro. "Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dentists in Galicia, Spain: A Quasi-Experimental Approach." Antibiotics 11, no. 8 (July 29, 2022): 1018. http://dx.doi.org/10.3390/antibiotics11081018.
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Background: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim of this study was to assess the impact of the COVID-19 pandemic on antibiotic prescribing by dentists, and to review antibiotic consumption according to the WHO Access, Watch, Reserve classification. We conducted a natural, before-and-after, quasi-experimental study, using antibiotic prescription data covering the period from January 2017 to May 2021. A segmented regression analysis with interrupted time series data was used to analyse the differences between the numbers of defined daily doses (DDD) of antibiotics prescribed monthly. The outcomes showed an immediate significant decrease in overall antibiotic prescribing by primary-care dentists during lockdown, followed by a non-significant upward trend for the next year. This same pattern was, likewise, observed for Access and Watch antibiotics. COVID-19 pandemic restrictions on dental care influenced the prescription of antibiotics. During confinement, an initial decrease was observed, this trend changed when in person consultations were recovered. It might be beneficial to analyse the prescription of antibiotics using the WHO AWaRe classification, in order to monitor their appropriate use.
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Seol, Sung Yong, Yong Tae Kim, Young Sook Jeong, Jae Young Oh, Hee Young Kang, Dong Chan Moon, Jungmin Kim, Yoo Chul Lee, Dong Taek Cho, and Je Chul Lee. "Molecular characterization of antimicrobial resistance in Shigella sonnei isolates in Korea." Journal of Medical Microbiology 55, no. 7 (July 1, 2006): 871–77. http://dx.doi.org/10.1099/jmm.0.46441-0.
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The antimicrobial resistance of 122 Shigella sonnei isolates obtained in Korea during the period 1991–2000 was characterized. These isolates were highly resistant to traditional antibiotics such as trimethoprim (100 %), streptomycin (100 %), sulfamethoxazole (94 %), tetracycline (93 %) and nalidixic acid (90 %). All S. sonnei isolates carried Tn7 in their chromosomes. The 8.4 kb non-transferable resistance (R) plasmid carrying tetA, strA-strB and sul1 was found in 93 % of the S. sonnei isolates. Resistance to nalidixic acid first appeared in a S. sonnei isolate in 1997, and then in all S. sonnei isolates from 1998 and 1999. Resistance to commonly prescribed antibiotics such as ampicillin was increased in S. sonnei isolates during the outbreak period 1998–2000. Resistance to ampicillin was mediated by the conjugative R plasmids carrying bla TEM-1. In conclusion, S. sonnei acquired antimicrobial resistance to commonly prescribed antibiotics through the horizontal transfer of conjugative R plasmids, while the genetic stability of transposon and non-transferable R plasmids was responsible for resistance to traditional antibiotics.
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Suda, Katie J., Margaret A. Fitzpatrick, Linda Poggensee, Kelly Echevarria, Colin Hubbard, Jessina C. McGregor, and Charlesnika T. Evans. "128. Antibiotic Prophylaxis Prior to Dental Visits in the Veterans Health Administration (VHA), 2015–2018." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S76—S77. http://dx.doi.org/10.1093/ofid/ofaa439.173.
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Abstract Background Antibiotic prophylaxis (AP) is recommended prior to invasive dental visits in patients with certain cardiac conditions but is not recommended in patients with prosthetic joints. Meta-analyses indicate benefit of AP prior to dental implants and tooth extractions. Within dentistry, it is also common to prescribe AP in patients with immunocompromising conditions. Our objective was to determine appropriateness of AP by VHA dentists. Methods A national cross-sectional study of dental visits was conducted in VHA, 2015–2018. Antibiotics prescribed 7 days before a visit were included. Antibiotics prescribed for an oral infection were excluded (15%). Appropriate AP was defined as visits with gingival manipulation and was further delineated into narrow and broad definitions by medical comorbidities. The narrow definition (primary analysis) only included cardiac conditions at risk of infective endocarditis. The broad definition included these cardiac conditions, tooth extractions/implants or immunocompromising conditions. The association of covariates with unnecessary AP was modeled using GEE for logistic regression. Results Out of 367,872 patient-visit dates associated with an antibiotic, 85% were prescribed for AP (N=313,886 prescriptions; median=7 days). AP (74% amoxicillin, 18% clindamycin) was prescribed to 198,314 patients (91% male; mean age=62 years). 87% of dental visits were categorized as gingival manipulation. With the narrow definition (cardiac only), 15% of AP were guideline concordant, increasing to 73% with the broader definition (cardiac or implant/extractions or immunocompromised). For the narrow definition, Black or other non-white race, current smoking, penicillin allergy and visits located in the West or South were associated with unnecessary AP. Protective factors were older age, prosthetic joints, immunocompromised, dental implants, extractions and visits in the Midwest. Unnecessary AP increased over time. Conclusion Few antibiotics prescribed before dental visits were for oral infections. Focusing on improving AP duration and appropriateness may have large implications for stewardship. Guidelines should inform if AP is indicated for extractions, implants, and immunocompromised patients. Disclosures All Authors: No reported disclosures
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Veillette, John J., Stephanie C. Shealy, Stephanie Gelman, Edward A. Stenehjem, Steven K. Throneberry, Michael Pirozzi, Brandon J. Webb, et al. "138. Tele-COVID Rounds and Tele-Stewardship Surveillance Reduces Antibiotic Use in COVID-19 Patients Admitted to 17 Small Community Hospitals." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S84. http://dx.doi.org/10.1093/ofid/ofab466.138.
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Abstract Background Early bacterial co-infection is rare in hospitalized COVID-19 patients, yet antibiotics are commonly prescribed. Antibiotic stewardship (AS) intervention is needed, especially in small community hospitals (SCHs), which often lack access to AS expertise. Methods We implemented daily remote multidisciplinary tele-COVID rounds (synchronous case review between SCH providers and ID clinicians) and tele-stewardship surveillance (ID pharmacist review of COVID patients on antibiotics) on 6/24/2020 in 17 SCHs. We retrospectively included adult symptomatic COVID-19 admissions between 3/2020 and 4/2021. The primary outcome was early use of antibiotics for pneumonia (started within 48 hours of admission); mean monthly days of therapy per 1,000 patient days (DOT) were compared pre- (3/2020-6/2020) and post-intervention (7/2020-4/2021). Secondary outcomes were early use of antibiotics for any indication, estimated days of antibiotics avoided (comparing pre- and post-intervention DOT), and in-hospital mortality. Analyses were conducted using a two-tailed unpaired t-test (antibiotic use) or Fisher’s exact test (mortality). Results Of the 1,976 patients included (124 pre- vs. 1852 post-intervention), 55.4% were male and 85.5% were white. Patients in the pre-intervention group were more likely to require hospital transfer [21.8% vs 8.8% (p< 0.001)] and ICU admission [18.5% vs. 9.7% (p=0.003)]. We observed a significant decrease in mean use of early antibiotics for pneumonia [656.9 vs. 240.1 DOT (p< 0.001)], including among non-ICU patients only [603.6 vs 240.2 DOT (p< 0.001)]. Early antibiotic use for any indication also decreased [686.2 vs. 359.3 DOT (p< 0.001)]. An estimated 3,697 days of unnecessary antibiotics for pneumonia were avoided in the 10-months post-intervention [370 days per month (95% CI 304 – 435)]. Unadjusted in-hospital mortality was not different pre- vs post-intervention (0.8% vs. 2.0%, p=0.511), but was higher among those prescribed early antibiotics (4.4% vs 0.5%, p< 0.001). Conclusion A significant, sustained reduction in antibiotic use among COVID-19 patients at 17 SCHs was observed after implementation of tele-COVID rounds and tele-stewardship surveillance without an observed difference in mortality. Disclosures All Authors: No reported disclosures
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Vazin, Afsaneh, Nazafarin Hatami-Mazinani, Effat Alemzadeh, Fatemeh Dehghani, and Motahareh Mahi-Birjand. "Compliance with Antibiotics Prophylaxis Guideline in Surgical Patients in ICUs of a Teaching Referral Hospital." Health Services Insights 15 (January 2022): 117863292211364. http://dx.doi.org/10.1177/11786329221136437.
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Antimicrobial prophylaxis used for surgical procedures remains one of the measures for the prevention of surgical site infections (SSIs). The present study was designed to assess the compliance with clinical practice guideline for antimicrobial prophylaxis in variable surgeries conducted in the intensive care units (ICUs) of a major referral hospital. This cross-sectional investigation was carried out by prospective data collected from October 2017 to March 2018 in the intensive care unit (ICU) of Nemazi hospital in Shiraz. Demographic characteristics, surgery type as well as antibiotic treatment were gathered from medical records and entered in data collection forms. We reviewed compliance and adherence of prophylactic antibiotic administration to the Infectious Diseases Society of America (IDSA) guideline and evaluated the courses of antimicrobial drugs. If an antibiotic administrated for surgical prophylaxis was different from the guideline, the antibiotic was classified as non-guideline-based antibiotics. Most patients participated in this study were male (64.5%). Only 8.75% of the administrated antibiotics chosen for surgical prophylaxis were found to be appropriate antibiotic prescriptions; however, those patients receiving appropriate antibiotics prescribed an inappropriate dosage. In addition, the antibiotics were administrated with inappropriate durations in all cases. Our findings indicated that adherence to the IDSA international guideline seems to be far from ideal in Namazi hospital for antimicrobial prophylaxis, resulting in the unsuitable administration of a wide variety of antibiotics.
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Bhagwat, Bhanuja, and Anuradha H. V. "Evaluation of immediate reactions to β lactam antibiotics using a comprehensive diagnostic protocol." International Journal of Basic & Clinical Pharmacology 6, no. 10 (September 23, 2017): 2366. http://dx.doi.org/10.18203/2319-2003.ijbcp20174360.
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Background: β lactam antibiotics are commonly prescribed groups of antibacterial drugs for various infections however the prevalence of its allergic effects is not clear in our country, hence the need for an effective diagnostic protocol to determine immediate hypersensitivity reactions. The objective was to formulate a diagnostic protocol for evaluating immediate drug hypersensitivity to β lactam antibiotics.Methods: A prospective study was conducted at a tertiary care hospital. Adults who were prescribed any class of β lactam antibiotic were included. Non irritating concentrations of the antibiotic as per The European Network on drug Allergy were used. A strict three step diagnostic algorithm with skin prick test followed by intradermal test and drug provocation test, with 20 minutes observation period between each step, to determine cutaneous allergic reactions was followed.Results: The most commonly prescribed drug was cefazolin, followed by ceftriaxone, and cefoperazone + sulbactam combination. The culprit drugs were ceftriaxone in 4 (4.7%) patients, followed by piperacillin + tazobactam combination in 3 (3.5%), amoxicillin + clavulanic acid in 2 (2.3%) and 1 (1.1%) each for cefotaxime and cefepime + tazobactam combination. No patients were positive for skin prick test; 2.4% were positive for intradermal test and 10.6% were positive for drug provocation test.Conclusions: This diagnostic protocol is apt to adequately diagnose immediate reactions to β lactam antibiotics and henceforth can be used effectively in India. However, the skin prick test may be excluded but the intradermal test and drug provocation test is crucial to identify these immediate reactions.
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Javed, Danish, Sana Zafar, Shakeel Ahmad, Khurram Anwar, Mudassar Iqbal Arain, and Saira Shahnaz. "Trends of prescribing antibiotics in various dental diseases at different private clinical setups of Sialkot, Pakistan." Professional Medical Journal 26, no. 10 (October 10, 2019): 1618–24. http://dx.doi.org/10.29309/tpmj/2019.26.10.1625.
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Objectives: Antibiotics widely used now a day in dental practice for treatment of acute odontogenic, non-odontogenic infections and as a prophylactic purpose for focal infections in patients at possibility for infective endocarditis development as well as prevention of surgical infection of wound and controlling of orofacial infections. Studies of prescribing trends provide information about the quality & pattern of use causes of drug use, and their outcomes. The main objective of this study was to assist trends and the rational utilization of antibiotics in dental practice. Study Design: Descriptive study. Settings: The current study was conducted among the different private dental clinical settings of Sialkot. Period: Eight months study (Jan-Aug 2018). Material and Methods: Sample size was 700 prescriptions which were gathered during. A purposive sampling was used for collection of prescription. A proforma was used for recording all required demographic & prescribing data was designed to collect all information associated to antibiotic prescribing trend. The data was collected, compiled, & analysed on MS Excel and descriptive statistics was used for analysing the result of the study. Results: A total of 700 prescriptions were collected from various Dental clinics. Among the study, 58.7% patients were male and 41.3 % females and more frequent age group was 51-68 (37%). Mostly patients have pervious medication history (38.8%) and most common diagnosis was periodontal abscess (16.6%) observed during our study followed by pulpitis (15.9%). The trend observed was that majority 35.3% would prescribe antibiotics for patients who presented with elevated body temperature. Commonly 5 drugs per prescription prescribed (26.7%) least numbers of drugs prescribed per prescription is 2(5.9%). Total 3445 drugs were prescribed in 700 prescriptions. Analgesics are frequently prescribed drug category (22.3%) followed by antibiotics (21.8%) Amoxicillin and clavulanic acid was mostly used (31.9%) in these dental centres. Conclusion: This study show that most prevalent dental disease for which doctors prescribed antibacterial was periapical or periodontal abscess and Amoxicillin and clavulanic acid used as a 1st choice for oral infections.
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Hanson, Amy P., Massimo Pacilli, Shannon N. Xydis, Kelly Walblay, and Stephanie R. Black. "2047. GAIN (Generating Antimicrobial Stewardship Initiatives in Chicago Skilled Nursing Facilities) Collaborative: Cumulative Results of Point Prevalence Surveys Assessing Antibiotic Appropriateness in Four Chicago Skilled Nursing Facilities." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S689—S690. http://dx.doi.org/10.1093/ofid/ofz360.1727.
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Abstract Background Antimicrobial Stewardship Programs (ASPs) in long-term care facilities are a Center for Medicare and Medicaid Services requirement as of 2017. The CDC estimates 40–75% of antibiotic prescribing in skilled nursing facilities (SNFs) is inappropriate. Overuse of antibiotics can cause harm by increasing the risk of adverse drug events (including C. difficile infections) and antimicrobial resistance. Methods The GAIN Collaborative was launched to assist SNFs in improving antibiotic prescribing. A list of antibiotics prescribed was generated from the electronic health records, and a chart review was performed. Results Antibiotic orders from September 2018 to March 2019 were randomly selected at 4 SNFs, and 120 antibiotic courses were reviewed (23, 40, 25, and 32 at SNFs A-D). Bed size ranged from 72 to 156 (median 88). Inappropriate antibiotic prescribing ranged from 60 to 78% (median 71%) among facilities. Urinary tract infections (UTIs) were the most frequent indication (40%), followed by lower respiratory tract infections (LRTIs), and skin and soft-tissue infections (SSTIs), accounting for 26% and 19% of indications, respectively. Inappropriate prescribing rates by indication were 90% for UTIs, 78% for SSTIs, and 47% for LRTIs. The most common reasons for inappropriate antibiotic prescribing were: insufficient signs and symptoms based on the Loeb minimum criteria for starting antibiotics (43%), inappropriate agent selection (30%), and lengthy treatment durations (29%). The majority of antibiotics prescribed were β-lactams (42%) or fluoroquinolones (29%). The median antibiotic prescription duration for non-catheter-associated UTIs was 5 days, LRTIs was 7 days, catheter-associated UTIs was 10 days, prophylaxis was 10 days, and SSTIs was 13 days. Conclusion Inappropriate antibiotic use was common in the four Chicago SNFs assessed. Results were presented at each facility’s Quality Assurance meeting to deliver provider-focused feedback. Additionally, provider and nursing education has been conducted at the four SNFs aimed at reducing unnecessary treatment of asymptomatic bacteriuria. Any improvements in antibiotic use will be captured through repeat point prevalence surveys post-implementation of a UTI SBAR communication tool and common infection treatment guidelines. Disclosures All authors: No reported disclosures.
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McGuinness, Matthew J., Jonathan Mccoy, and Tanaya Bhowmick. "1531. Antibiotic Selection for Neisseria gonorrhoeae among Penicillin Allergic Patients in the Emergency Department." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S766. http://dx.doi.org/10.1093/ofid/ofaa439.1711.
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Abstract Background While penicillin (PCN) allergies are commonly reported, their cross-reactivity with beta-lactam antibiotics is minimal. First line treatment of gonorrheal infections includes a cephalosporin (CPH). In an emergency department (ED) environment, physicians must consider potential allergies when selecting antibiotics for a patient with symptoms concerning for sexually transmitted infection (STI). Methods A retrospective chart review on adult patients with symptoms concerning for STI presenting to an urban ED from January 2014 through June 2019 was performed. Chart discovery was performed using search terms of “STI”, “STD”, “urethritis”, “vaginitis”, and “gonorrhea”. Information abstracted included patient symptoms, type of care provider, and antibiotics prescribed or administered in the ED. The primary outcome was prevalence of allergy to PCN and CPH in patients evaluated for STI symptoms and secondary outcomes included prescribed antibiotic treatments. Chi-square and Fischer-exact tests were utilized to examine for statistical significance, with p values < 0.05 as statistically significant. Results A total of 603 patients met the inclusion criteria, of which 31 reported allergies to PCN, and another 3 reported allergies to CPH. Patients reporting PCN allergy were found to be less likely to receive a CPH antibiotic (p=0.0035). Patients reporting a non-anaphylactic allergy to PCN received a CPH at a rate of 92.3%. Attending physicians in particular were less likely to prescribe a CPH antibiotic to a patient reporting allergy compared with both resident physicians and PAs (p=0.00019). Patients reporting a PCN allergy were more likely to receive alternative antibiotics beyond CPH or azithromycin (p=0.046); the most frequently given antibiotics were metronidazole, doxycycline, and levofloxacin. Demographic Data Antibiotic Prescriptions by Type of Penicillin Allergy Antibiotic Prescriptions for Penicillin Allergy vs. No Allergy Conclusion Patients with PCN allergies represent a recurring challenge for ED physicians when faced with antibiotic selection for STI symptoms concerning for gonorrheal infection. Those with PCN allergies are significantly less likely to receive a CPH antibiotic, though these remain the only universal treatment for gonorrheal infections. These findings highlight the significant need for further physician education on allergies and antibiotic selection. Disclosures All Authors: No reported disclosures
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Foley, Kasey A., Erina L. MacGeorge, David L. Brinker, Yuwei Li, and Yanmengqian Zhou. "Health Providers’ Advising on Symptom Management for Upper Respiratory Tract Infections: Does Elaboration of Reasoning Influence Outcomes Relevant to Antibiotic Stewardship?" Journal of Language and Social Psychology 39, no. 3 (May 12, 2020): 349–74. http://dx.doi.org/10.1177/0261927x20912460.
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Antibiotic-resistant infections, fueled by unwarranted antibiotic prescribing, are an increasing threat to public health. Reducing overprescribing and promoting antibiotic stewardship requires managing patient expectations for and understanding about the utility of antibiotics. One hotspot for overprescribing is upper respiratory tract infections, for which the best treatment is often non-antibiotic symptom management behaviors. Guided by advice response theory, the current study examines how providers’ reason-giving for symptom management advice affected perceptions of advice quality, efficacy for symptom monitoring and management, and satisfaction with care for patients who were not prescribed antibiotics for their upper respiratory tract infections. Transcribed medical visits were coded for symptom management advice reason-giving and patients completed post-visit surveys. Greater provider elaboration about instruction was independently and positively associated with evaluations of advice quality. Results also indicate several significant interactions between types of reason-giving. Implications of these findings for advice theory and clinical practice are addressed in the discussion.