Antibiotic Prescription Data Research Articles

Antibiotic resistance rates and physician antibiotic prescription patterns of uncomplicated urinary tract infections in southern Chinese primary care.

Uncomplicated urinary tract infections (UTI) are common in primary care. Whilst primary care physicians are called to be antimicrobial stewards, there is limited primary care antibiotic resistance surveillance and physician antibiotic prescription data available in southern Chinese primary care. The study aimed to investigate the antibiotic resistance rate and antibiotic prescription patterns in female patients with uncomplicated UTI. Factors associated with antibiotic resistance and prescription was explored. A prospective cohort study was conducted in 12 primary care group clinics in Hong Kong of patients presenting with symptoms of uncomplicated UTI from January 2012 to December 2013. Patients’ characteristics such as age, comorbidity, presenting symptoms and prior antibiotic use were recorded by physicians, as well as any empirical antibiotic prescription given at presentation. Urine samples were collected to test for antibiotic resistance of uropathogens. Univariate analysis was conducted to identify factors associated with antibiotic resistance and prescription. A total of 298 patients were included in the study. E. coli was detected in 107 (76%) out of the 141 positive urine samples. Antibiotic resistance rates of E. coli isolates for ampicillin, co-trimoxazole, ciprofloxacin, amoxicillin and nitrofurantoin were 59.8%, 31.8%, 23.4%, 1.9% and 0.9% respectively. E. coli isolates were sensitive to nitrofurantoin (98.1%) followed by amoxicillin (78.5%). The overall physician antibiotic prescription rate was 82.2%. Amoxicillin (39.6%) and nitrofurantoin (28.6%) were the most common prescribed antibiotics. Meanwhile, whilst physicians in public primary care prescribed more amoxicillin (OR: 2.84, 95% CI: 1.67 to 4.85, P<0.001) and nitrofurantoin (OR: 2.01, 95% CI: 1.14 to 3.55, P = 0.015), physicians in private clinics prescribed more cefuroxime and ciprofloxacin (P<0.05). Matching of antibiotic prescription and antibiotic sensitivity of E. coli isolates occurred in public than private primary care prescriptions (OR: 6.72, 95% CI: 2.07 to 21.80 P = 0.001) and for other uropathogens (OR: 6.19, 95% CI: 1.04 to 36.78 P = 0.034). Mismatching differences of antibiotic prescription and resistance were not evident. In conclusion, nitrofurantoin and amoxicillin should be used as first line antibiotic treatment for uncomplicated UTI. There were significant differences in antibiotic prescription patterns between public and private primary care. Public primary care practitioners were more likely to prescribe first line antibiotic treatment which match antibiotic sensitivity of E. coli isolates and other uropathogens. Further exploration of physician prescribing behaviour and educational interventions, particularly in private primary care may helpful. Meanwhile, development and dissemination of guidelines for primary care management of uncomplicated UTI as well as continued surveillance of antibiotic resistance and physician antibiotic prescription is recommended.

Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough

ObjectiveTo investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.DesignPrimary care feasibility cluster randomised controlled trial.Setting32 general practices in...

Outpatient Antibiotic Prescribing Among Older Adults in the United States, 2011 to 2014

BackgroundAntibiotics are some of the most commonly prescribed medications for older adults, but antibiotic prescribing practices are poorly understood. We analyzed outpatient antibiotic prescribing data for older adults to identify potential targets for antibiotic stewardship.MethodsOutpatient oral antibiotic prescriptions dispensed in the United States for older adults (i.e., ≥ 65 years) between 2011 and 2014 were extracted from the QuintilesIMS Xponent database. The number of prescriptions and U.S. Census denominators were used to calculate prescribing rates. A chi-square for trend test was used to evaluate annual trends in antibiotic prescribing rates. A descriptive analysis of prescribing rates according to antibiotic, age group, sex, state, census region, and provider specialty was completed.ResultsIn 2011–2014, antibiotic prescribing rates remained stable in U.S. older adults (P = 0.89). In 2014, older adults were prescribed 51.6 million prescriptions at a rate of 1115 prescriptions/1000 persons. Within this cohort, the rate of prescriptions increased with age; persons aged ≥75 years had a rate of 1157 prescriptions/1000 persons compared with 1084 prescriptions/1000 persons in persons aged 65–74. Rates were highest in the South census region and lowest in the West (1228 vs. 854 prescriptions/1000 persons). Although azithromycin was the most commonly prescribed drug followed by amoxicillin and ciprofloxacin, the most commonly prescribed antibiotic class was the fluoroquinolones (245 prescriptions/1000 persons), followed by penicillins and macrolides. Among individuals aged ≥75 years, ciprofloxacin was the most frequently prescribed drug. Family physicians (23%), followed by internists (20%), prescribed the most antibiotic courses for older adults.ConclusionOn average, U.S. older adults receive enough antibiotic courses for every older individual to receive a prescription each year. Fluoroquinolone use is a potential target for addressing the appropriateness of outpatient antibiotic prescribing practices among older adults. As with antibiotic use in other age groups, efforts to improve antibiotic prescribing may be most needed in the South.Figure:Antibiotic Prescribing per 1000 Persons by State for Adults ≥65 years in 2014.Disclosures All authors: No reported disclosures.

Antimicrobial Stewardship in the Neonatal Unit: A Quality Improvement Initiative

BackgroundAntimicrobial stewardship is an important component of modern medical practice. Audit and surveillance of antibiotic use with feedback to prescribing clinicains is reccomended as a high-impact core stewardship intervention. The aim of this study was to assess and reduce unnecessary antimicrobial use in a neonatal unit.MethodsA prospective audit was performed to systematically assess compliance of antimicrobial prescribing with local antimicrobial guidelines in September 2016. Following this, educational interventions were applied to improve compliance with the guideline and electronic prescribing was introduced to the neonatal unit. There were two further re-audit periods in December 2016 and March 2017. The primary outcome was a reduction in days of antibiotic therapy per 1,000 patient days (DOT/1,000 patient days). Secondary outcomes were a reduction in prolonged antibiotic courses and improved compliance with the sepsis evaluation guideline.ResultsThere were 312 neonatal admissions throughout the study. The number of admissions per day did not significantly change from the baseline to intervention period and the groups were comparable for gestation, birth weight and admission diagnosis. There was a significant overall reduction in the primary outcome of DOT/1,000 patient days from 572 to 417 DOT from September to March (P < 0.0001). This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment >36 hours in negative PSWU cases were reduced from 82 DOT to 7.5 DOT (P = 0.0004). Similarly treatment courses >5 days for culture negative sepsis were reduced from 46.5 DOT to 7 DOT (P = 0.0009). Compliance with the neonatal sepsis evaluation guideline also improved with a 35% reduction in evaluations for indications not recognized in the guideline.ConclusionAnti-microbial stewardship plays an important role in the neonatal unit in ensuring that the appropriate drug, dose, route and duration of therapy are employed to ensure adequate treatment while minimizing the risks of unnecessary antibiotic use. Monitoring antibiotic prescribing data, as in this audit, can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced.Disclosures All authors: No reported disclosures.

Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care- a retrospective study of electronic patient records.

BackgroundSwedish studies on antibiotic use in primary care have been based on one-week registrations of infections. In order to study adherence to guidelines, analyses based on large databases that provide information on diagnosis linked prescriptions, are needed. This study describes trends in management of infections in Swedish primary care particularly with regards to antibiotic prescribing and adherence to national guidelines.MethodsA descriptive study of Sweden’s largest database regarding diagnosis linked antibiotic prescription data, the Primary care Record of Infections in Sweden (PRIS), for the years 2008, 2010 and 2013.ResultsAlthough the consultation rate for all infections remained around 30% each year, antibiotic prescribing rates decreased significantly over the years from 53.7% in 2008, to 45.5% in 2010, to 38.6% in 2013 (p = .032). The antibiotic prescribing rate for respiratory tract infections (RTIs) decreased from 40.5% in 2008 to 24.9% in 2013 while those for urinary tract infections and skin and soft tissue infections were unchanged. For most RTI diagnoses there was a decrease in prescription rate from 2008 to 2013, particularly for the age group 0–6 years. Phenoxymethylpenicillin (PcV) was the antibiotic most often prescribed, followed by tetracycline. Tonsillitis and acute otitis media were the two RTI diagnoses with the highest number of prescriptions per 1000 patient years (PY). For these diagnoses an increase in adherence to national guidelines was seen, with regards to treatment frequency, choice of antibiotics and use of rapid antigen detection test. The frequency in antibiotic prescribing varied greatly between different Primary Healthcare Centres (PHCCs).ConclusionFalling numbers of consultations and decreased antibiotic prescription rates for RTIs have reduced the antibiotic use in Swedish primary care substantially. Overprescribing of antibiotics could still be suspected due to large variability in prescribing frequency, especially for acute bronchitis and sinusitis. Continuous evaluation of diagnosis linked prescribing data and feedback to doctors is essential in order to achieve a more prudent antibiotic use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2018-9) contains supplementary material, which is available to authorized users.

Could Withholding Antibiotics from Patients with Upper Respiratory Infections Cause Harm

Everyone agrees that too many antibiotics are prescribed for upper respiratory infections (URIs). Still, curtailing antibiotic prescriptions theoretically might result in additional rare but serious pyogenic complications of URI (e.g., peritonsillar abscess, pneumonia, meningitis). Few studies to date have been powered adequately to address this concern. In this study, British researchers tallied antibiotic prescription data and …

Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report

BackgroundAccurate accounting of antibiotic use is necessary for studies comparing the CF airway microbiota across clinically relevant disease states. While poor adherence to chronic therapies is well described for individuals with CF, use patterns of episodic oral antibiotics are less clear. MethodsEleven individuals with CF completed daily questionnaires regarding antibiotic use for a mean of 458days. Self-report of episodic oral antibiotic use was compared to antibiotic prescription data in the electronic medical record (EMR). ResultsSelf-reported use of episodic oral antibiotics differed from EMR data an average of 8.3% of days per subject. The majority of these discrepancies were due to self-reported use of oral antibiotics outside of the EMR-documented dates of antibiotic prescription. ConclusionsDiscrepancies exist between self-reported use of episodic oral antibiotics and EMR data that have implications for studies of the CF airway microbiota.

Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study).

To determine the nature, prevalence and description accuracy of recorded antibiotic allergy labels (AALs) in a cohort of general medical inpatients, and to assess the feasibility of an oral antibiotic re-challenge study. Multicentre cross-sectional study. All patients admitted to the general medical units of Austin Health and Alfred Health, 18 May - 5 June 2015. Baseline demographics, medical and allergy history, infection diagnoses and antibiotic prescribing data for general medical inpatients were collected. A questionnaire was administered to clarify AAL history, followed by correlation of responses with electronic and admissions record descriptions. A hypothetical oral re-challenge in a supervised setting was offered to patients with low risk allergy phenotypes (non-immediate reaction, non-severe cutaneous adverse reaction, or unknown reaction more than 10 years ago). Of the 453 inpatients, 107 (24%) had an AAL (median age, 82 years; interquartile range, 74-87 years); 160 individual AALs were recorded, and there was a mismatch in AAL description between recording platforms in 25% of cases. Most patients with an AAL were women (64%; P <0.001), and more presented with concurrent immunosuppression than those without an AAL (23% v 8%; P <0.001). β-Lactam penicillins were employed less frequently in patients with an AAL (16% v 35%; P = 0.02), while ceftriaxone (32% v 20%; P = 0.02) and fluoroquinolones (6% v 2%; P = 0.04) were used more often. Fifty-four per cent of patients with AALs were willing to undergo oral re-challenge, of whom 48% had a low risk allergy phenotype. AAL prevalence in general medical inpatients was 24%, and was associated with excessive use of broad spectrum antibiotics. Allergies in a large proportion of patients with AALs were incorrectly documented, and were non-immune-mediated and potentially amenable to oral re-challenge. A direct oral re-challenge study in carefully selected patients with low risk allergy phenotypes appears feasible.

Rationality of Antibiotic Usage in Pediatrics in Bengkulu, Indonesia: Gyssens? Criteria and Type of Therapy Analysis

Infectious diseases are one of the biggest health problems not only in Indonesia, but also in the whole world. Prescribing antibiotics in Indonesia are quite high and increased the incidence of resistance. This study is aimed to evaluate the rationality of antibiotic use in children at the hospital qualitatively. This research is descriptive analysis of retrospective antibiotic prescribing data in children use a Gyssens’ criteria and types of antibiotic therapy. Incidence of infection in children under 12 y of age amounted to 93.2%. The analysis results by using the Gyssens’ criteria are obtained category O (rational use) of 32%, V (no indication) of 27.4%, IIA (inappropriate dose) of 0.6%, IIB (inappropriate interval) of 1.7%, IIIA (duration too short) of 2.9%, IIIB (duration too long) of 11.4%, IVA (alternative more effective) of 17.7%, IVB (alternative less toxic) of 2.9%, IVC (alternative less cost) of 2.9% and IVD (alternative narrower spectrum) of 0.6%. The results showed that the grouping of most types of therapy was antimicrobial drugs empiric therapy in 47.4% cases followed successively by antimicrobial drugs unknown therapy 32.6%, antimicrobial drugs documented therapy amounted to 12%, antimicrobial drugs extended empiric therapy amounted to 6.9% and antimicrobial drugs prophylaxis therapy amounted to 1.1%. The use of antibiotics in pediatric patients at the hospital in Bengkulu, Indonesia substantively is inappropriate based on qualitative analysis.

Antibiotic use in the care home setting: a retrospective cohort study analysing routine data.

BackgroundPoint prevalence studies in care homes show a high use of antibiotics, especially to treat urinary tract infections (UTI). There is a lack of large studies presenting annual antibiotic prescription data in care homes compared to those not in care homes. This study aimed to describe the pattern of antibiotic prescribing in those 75 years and over, with a focus on UTI.MethodsIn this retrospective longitudinal cohort study we used the Hampshire Health Record (HHR) containing routine data from general practices in Hampshire area, UK covering 1.24 million residents. Data were extracted throughout 2011 from the Hampshire Health Record on age, gender, care home status, antibiotic prescriptions, urinary catheters and comorbidity. Prescription pattern expressed as rate per 100 people. Nursing home residence defined by postcode. Logistic regression was used to assess independent risk of one or more antibiotic prescriptions in care home residents adjusting for age, sex and comorbidity, separately by catheter use.Results102,020 of 1,244,313 residents in the Hampshire Health Record (8.2 %) were aged ≥75 years of whom 7481 (7.3 %) were resident in care home settings. The annual antibiotic prescriptions increased from 53/100 inhabitants among those <75 years, to 142/100 among those ≥75 years not in a care home and to 199/100 among those ≥75 years in a care home. Care home residents with urinary catheters (4.4 %) had even higher use at 440/100 versus 188/100 if no catheter. UTI antibiotics showed a similar but more rapidly increasing pattern. For those in care homes without a urinary catheter, the odds ratio was 2.2 (2.1–2.3) higher for prescriptions of UTI antibiotics compared to those not in care homes after adjusting for age, gender and comorbidity. For those with a urinary catheter the odds ratio was 1.4 (1.1–1.8) for UTI antibiotics compared to those not in care homes. For all antibiotics the odds ratio was 1.2 (1.2–1.3).ConclusionsResidence in a care home setting is associated with high antibiotic consumption; this is especially evident for UTI antibiotics where the odds of prescription is doubled.

US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.

Appropriate antibiotic prescribing is an essential strategy to reduce the spread of antibiotic resistance. US prescribing practices have not been thoroughly characterized. We analyzed outpatient antibiotic prescribing data to identify where appropriate antibiotic prescribing interventions could have the most impact. Oral antibiotic prescriptions dispensed during 2011 were extracted from the IMS Health Xponent database. The number of prescriptions and census denominators were used to calculate prescribing rates. Prescription totals were calculated for each provider specialty. Regression modeling was used to examine the association between socioeconomic and population health factors and prescribing rates. Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons). Penicillins and macrolides were the most common antibiotic categories prescribed. The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P < .001); this pattern was observed among all age groups, including children ≤ 2 and persons ≥ 65 years of age. Counties with a high proportion of obese persons, infants and children ≤ 2 years of age, prescribers per capita, and females were more likely to be high prescribing by multivariable analysis (adjusted odds ratio, >1.0). Efforts to characterize antibiotic prescribing practices should focus on the South census region and family practitioners. Further understanding of the factors leading to high prescribing among key target populations will inform appropriate prescribing interventions.

P82 Effect Of A Standardised Chest Clearance Pathway On Quality Of Life And Hospital Admissions In Patients With Non Cystic Fibrosis Bronchiectasis

British Thoracic Society guidelines for non-cystic fibrosis bronchiectasis (NCFB) recommend airway clearance taught by a physiotherapist for patients with chronic sputum production or mucus plugging on CT. Various techniques and adjuncts are available and the evidence for the effectiveness of these is inconsistent. We designed a stepwise chest clearance pathway for use in a specialist NCFB clinic in a large district general hospital trust. Patients were taught and commenced on active cycle breathing technique with postural drainage, positive expiratory pressure device, mucolytic and nebulised hypertonic saline, progressing to each step until chest clearance was felt to be optimised. Quality of life was assessed using Leicester cough questionnaire (LCQ) at baseline and after each intervention including the point of optimisation. Hospital admission and general practice antibiotic prescription data were retrospectively collected for 12 months pre and post initiation of the pathway. Data were compared using Wilcoxon signed rank test. 105 patients (mean age 67, 53 female, mean FEV1 1.62l) were included although data were incomplete. Total LCQ score significantly improved at the point where chest clearance was felt to be optimised, compared to baseline, with a median difference of 1.3. Subgroup analysis revealed that patients with lower baseline LCQ showed greater improvement. Further analysis revealed that all steps in the pathway resulted in significant improvements in LCQ with the exception of mucolytics. Hospital admissions for NCFB were significantly reduced in the 12 months following initiation of the pathway. There was no significant difference in antibiotic usage according to GP prescriptions. This retrospective study suggests that the use of a standardised chest clearance pathway may result in improved quality of life and reduction in hospital admissions in patients with NCFB.

Differences in outpatient antibiotic use between a Spanish region and a Nordic country

IntroductionAntibiotic use and misuse are linked to pathogen resistance and, as such, both constitute a public health issue with local, national, and global dimensions. Early studies have shown striking variations in the use of these drugs between Nordic and Mediterranean countries. The aim of the present study was to describe and compare antibiotic prescribing in Primary Care in Denmark and Aragón (a North-eastern Spanish region). MethodsOutpatient antibiotic prescription data (2010) were obtained from the National Institute for Health Data and Disease Control (Denmark), and the Information System on Medication Consumption in Aragón. The consumption of antibiotics (ATC J01) was analyzed from the prescription rates and the number of defined daily dose (DDD) per 1000 inhabitants/day (DID). ResultsThe rate of antibiotic prescription in 2010 in Aragón was greater than in Denmark (407 compared to 315 exposed individuals/1000 inhabitants). There were significant differences as regards overall consumption of antibiotics (23.2 DID in Aragón and 17.0 DID in Denmark), as well as the therapeutic group selection. There was an elevated use of broad spectrum penicillins, quinolones and cephalosporins in the Spanish region while, in Denmark, the most-consumed antibiotic was narrow spectrum penicillin. ConclusionThe use of antibiotics in the Spanish region is very high, and there are marked differences in the choice of drug between this region and Denmark. Interventions are needed that promote the rational use of these drugs to reduce potential bacterial resistance, and to avoid unnecessary risks to patients.

P110 Does previous exacerbation history predict future exacerbations in non-CF bronchiectasis?

IntroductionThe British Thoracic Society bronchiectasis guidelines recommend consideration of long term antibiotic therapy in patients with 3 or more exacerbations per year. A major goal of treatment in bronchiectasis is...

A comparison of the quality of outpatient antibiotic prescribing between two areas of northern and southern Europe

Background Interventions aimed at improving the quality of antibiotic prescribing can be targeted more effectively if we have deeper knowledge about where the efforts should be focused. The aim of this study was to analyse and compare the quality of outpatient antibiotic prescribing in Denmark and Aragon, a Northeastern Spanish region. Methods Outpatient antibiotic prescribing data (2010) were obtained from the National Institute …

Higher systemic antibiotic consumption in a population of South Korea (2008 – 2009)

This study was conducted to investigate overall systemic antibiotic consumption levels and specific patterns using standardized Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. National Health Insurance claims data during 2008 and 2009 was used. Antibiotic prescription data was classified using the ATC system and converted into DDD. Consumption figures were presented as the number of DDD per 1,000 inhabitants per day (DID). Detailed information on indications and seasonal variations, age and institutional determinants on antibiotic consumption were also explored. Total consumption was slightly increased from 24.3 to 25.2 DID in 2009 compared to 2008. The most frequently prescribed antibiotic was amoxicillin/clavulanic acid (5.1 and 5.2 DID, in 2008 and 2009, respectively), followed by cefaclor (3.0 and 3.3 DID) and amoxicillin (3.3 and 3.2 DID). Respiratory system diseases were the main causes of antimicrobial prescription (47.3%) and acute forms of bronchitis, tonsillitis and sinusitis were the most common diseases. There were typical seasonal fluctuations with heightened winter peaks. Consumption figures under 5 years of age (41.6 and 43.3 DID) were even higher than figures in aged 65 - 80 (36.2 and 39.1 DID). Antibiotic consumption in South Korea remained high compared with other OECD countries. Efforts to increase prudent antibiotic use, especially for upper respiratory system infections and for younger children, should be made to decrease antibiotic use.

The antibiotic prescription and redemption gap and opportunistic CRP point-of-care testing. A cross-sectional study in primary health care from Eastern Austria

The aim of this study was to analyse the frequency of C-reactive protein (CRP) rapid test use by general practitioners (GPs), the role of the test in the antibiotic treatment decisions and the efficacy of the test in a primary care setting, with special emphasis on the redemption rate of antibiotic prescriptions. For this cross-sectional study, GPs documented their CRP test use for 2.5 years. In addition, demographic and the antibiotic prescription and redemption data of the patients were documented. Three groups were clustered according to the three possible CRP test results (1: < 10 mg/l, 2: 10-30 mg/l, 3: > 30 mg/l); analyses were conducted by using descriptive statistical methods and tests. Thirty GPs documented 692 initial CRP tests. The antibiotic prescription rate was 9.2 % for the first, 71.7 % for the second and 98.7 % for the third group (p < 0.001). A difference between the patients of the three CRP groups according to the redemption rate of antibiotic prescriptions (30.8 vs. 62.7 vs. 64.0 %; p = 0.013) could be found, with the lowest rate in the first group. Overall, 16.3 % of the patients filled an antibiotic at a pharmacy that was not in accordance with the CRP test result documentation form. The CRP test results show an association with both the antibiotic prescribing and redemption behaviour. Noticeable was the antibiotic redemption behaviour of the patients: 36 % of patients with a CRP test result over 30 did not fill the antibiotic prescribed which is an important finding related to patients adherence and of special interest due to the fact that none of these patients had a hospital admission afterwards. On the contrary, nearly one-fifth of the patients who did not get an antibiotic in connection with the CRP test result finally filled an antibiotic prescription.

Using linked healthcare data to create a randomised controlled trial: the rapid trial (reducing antibiotic prescribing in dentistry)

We report the design of a three-arm RCT to compare the effectiveness of enhanced audit and feedback strategies for the translation into practice of published guidance on antibiotic prescribing in dentistry. The trial uses linked healthcare data from administrative datasets (dental workforce data linked with claims for treatment provision and pharmacy data) in five aspects of the trial to: 1. identify participants: all currently practicing General Dental Practitioners (GDPs) in Scotland. 2. apply inclusion/exclusion criteria; based on dental practice contract status and a minimum level of recent treatment provision. 3. carry out stratified randomisation; all eligible dental practices in Scotland were simultaneously randomised at baseline to current audit practice or to one of two audit and feedback interventions. Randomisation was stratified by single-handed/multi-handed practices. Intervention practices were further randomised using a factorial design. 4. generate the trial intervention; individualised graphical feedback on antibiotic prescribing. The initial feedback report contained 14 months retrospective antibiotic prescribing data. 5. analyse trial outcomes; the primary outcome is the total antibiotic prescribing rate per 100 courses of treatment over the year following the delivery of the baseline intervention. In describing the design of this study, we demonstrate that linked administrative datasets have the potential to be used efficiently and effectively across all stages of an RCT. We also discuss the various challenges and limitations that such an approach presents.

Trends in Antibiotic Prescribing in Adults in Dutch General Practice

BackgroundAntibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age.MethodologyRetrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000–2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed.Principal FindingsIn total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000–2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independent determinant for ADEs.Conclusion/DiscussionThe rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance.

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

BackgroundUrinary tract infections (UTIs) are the most commonly treated infection among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection. This research investigates factors associated with the use of antibiotics to treat asymptomatic bacteriuria (ASB) among nursing home residents.MethodsThis was a cross-sectional study involving multi-level multivariate analyses of antibiotic prescription data for residents in four nursing homes in central Texas. Participants included all nursing home residents in these homes who, over a six-month period, received an antibiotic for a suspected UTI. We investigated what factors affected the likelihood that a resident receiving an antibiotic for a suspected UTI was asymptomatic.ResultsThe most powerful predictor of antibiotic treatment for ASB was the presence of an indwelling urinary catheter. Over 80 percent of antibiotic prescriptions written for catheterized individuals were written for individuals with ASB. For those without a catheter, record reviews identified 204 antibiotic prescriptions among 151 residents treated for a suspected UTI. Almost 50% of these prescriptions were for residents with no documented UTI symptoms. Almost three-quarters of these antibiotics were ordered after laboratory results were available to clinicians. Multivariate analyses indicated that resident characteristics did not affect the likelihood that an antibiotic was prescribed for ASB. The only statistically significant factor was the identity of the nursing home in which a resident resided.ConclusionsWe confirm the findings of earlier research indicating frequent use of antibiotics for ASB in nursing homes, especially for residents with urinary catheters. In this sample of nursing home residents, half of the antibiotic prescriptions for a suspected UTI in residents without catheters occurred with no documented signs or symptoms of a UTI. Urine studies were performed in almost all suspected UTI cases in which an antibiotic was prescribed. Efforts to improve antibiotic stewardship in nursing homes must address clinical decision-making solely on the basis of diagnostic testing in the absence of signs or symptoms of a UTI.