Abstract
Background: This study explored the antimicrobial prescribing pattern for upper respiratory tract and dental infections in prisoners in Italy, with specific attention paid to the appropriateness of indication and its potential determinants. Methods: This investigation was conducted through the consultation of clinical records of adult male inmates in a prison in the south of Italy. Results: Prescription of antimicrobials for upper respiratory tract infections ranged from 41.9% in influenza diagnoses to 88% in pharyngitis diagnoses, with high prevalence also for bronchitis (73.5%) and common cold (57.7%), and those for dental infections ranged from 82% in pulp necrosis and symptomatic apical periodontitis/pulp necrosis and localized acute apical abscess diagnoses, to 85.7% in symptomatic irreversible pulpitis with or without symptomatic apical periodontitis diagnoses. The most frequently prescribed antimicrobial was amoxicillin and clavulanic acid (33.8%), followed by amoxicillin (26.5%), macrolides (19.8%) and third-generation cephalosporins (7.9%). The overall antimicrobial overprescription was 69.4%, whereas an antimicrobial prescription was provided in all 52 cases in which it was indicated. The inappropriate antimicrobial prescriptions were significantly less likely for bronchitis, influenza and symptomatic irreversible pulpitis with or without symptomatic apical periodontitis compared to common cold/pharyngitis/rhinosinusitis, and when the antimicrobial prescription was provided by medical specialists compared to prison physicians, whereas antimicrobial overprescriptions without indications were significantly more frequent in patients with underlying chronic clinical conditions. Conclusions: A concerning widespread practice of inappropriate antimicrobial prescriptions in prisoners was found. Diagnoses-specific monitoring of antimicrobial use and prison-focused antimicrobial stewardship policies are strongly needed.
Highlights
antimicrobial resistance (AMR) is alarming for the whole population, it is likely to pose more serious threats to groups at greater overall risk of contracting infections or infectious diseases, and appropriateness of antimicrobial prescribing for therapeutic or prophylactic purposes has been thoroughly investigated in more vulnerable populations, such as hospitalized patients [3], subjects with underlying clinical conditions, namely chronic conditions such as heart disease, cancer, hypertension, diabetes, etc. [4,5], institutionalized elderly [6,7], and children [8]
The antimicrobial prescribing pattern in prisoners is almost unexplored [11]. This is concerning, since it has been reported that among the most frequently diagnosed diseases in the detained populations in Italy, there are respiratory tract infections (RTI), mainly acute upper RTI (URTI) and oral diseases [12], which are among the conditions at high risk of antimicrobial overprescription
To combat the overprescription and inappropriate use of antimicrobials, a series of recommendations targeted to URTI [13–15], and dental infections [16] have been issued, and guidelines addressed to antimicrobial stewardship in prisons were published in the USA in 2013, updated in 2019 [17]. All these guidelines recommend a wise use of antimicrobials, with the aims of improving patient outcomes, decreasing unnecessary antimicrobial use, counteracting the development of AMR, and decreasing unintentional antimicrobial adverse effects. To fill this knowledge gap, this study was aimed at exploring the antimicrobial prescribing pattern for URTIs and dental infections in prisoners in Italy, with specific attention paid to the appropriateness of indication and its potential determinants
Summary
Since their discovery and introduction in the clinical practice, antimicrobials have demonstrated their extraordinary therapeutic effectiveness, as well as their potential for the selection of resistant microorganisms. The antimicrobial prescribing pattern in prisoners is almost unexplored [11] This is concerning, since it has been reported that among the most frequently diagnosed diseases in the detained populations in Italy, there are respiratory tract infections (RTI), mainly acute upper RTI (URTI) and oral diseases [12], which are among the conditions at high risk of antimicrobial overprescription. This study explored the antimicrobial prescribing pattern for upper respiratory tract and dental infections in prisoners in Italy, with specific attention paid to the appropriateness of indication and its potential determinants. The inappropriate antimicrobial prescriptions were significantly less likely for bronchitis, influenza and symptomatic irreversible pulpitis with or without symptomatic apical periodontitis compared to common cold/pharyngitis/rhinosinusitis, and when the antimicrobial prescription was provided by medical specialists compared to prison physicians, whereas antimicrobial overprescriptions without indications were significantly more frequent in patients with underlying chronic clinical conditions. Diagnoses-specific monitoring of antimicrobial use and prison-focused antimicrobial stewardship policies are strongly needed
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