Antibiotic Prescribing Practices Research Articles

Reducing Improper and Missed Peri-Procedure Antibiotics Prescriptions in a Regional Oncology Centre.

Background In the realm of oncology care, patients undergoing invasive procedures are particularly vulnerable to infections due to their compromised immune systems. Antibiotics play a pivotal role in preventing such infections. However, inappropriate or missed administration of peri-procedure antibiotics poses a significant risk in the form of treatment complications, contributing to antibiotic resistanceand increased healthcare costs. Methods The study was a two-cycle, closed-loop quality improvement project utilizing both retrospective and prospective data analysis of peri-procedure antibiotics prescription in a regional oncology centre. Two audit cycles were carried out in total; the first cycle was carried out in November 2023 where six-week data were collected retrospectively. As a result, formal and informal teaching sessions about the importance of correct peri-procedure antibiotics and the availability of complete institutional peri-procedure antibiotics guidelines in clinical areas were ensured. The second cycle was carried out prospectively for two weeks in January 2024. Patients were included if they underwent selected procedures performed by interventional radiology or gastroenterology while the patients operated on by the general surgeons and any day case procedures were excluded. Results We identified a total of 82 interventional procedures during the first cycle that fulfilled the inclusion criteria. Six out of 82 patients (7.3%) did not receive the correct peri-procedural antibiotics as per hospital antibiotics guidelines. A prospective two-week data after implementing the change revealed that 25 patients had documented interventional procedures done during this period using electronic patient records. Out of 25 patients, only one patient (4%) did not receive the peri-procedural antibiotics as per guidelines. We were able to demonstrate increased adherence to the peri-procedural guidelines (from 93% to 96%) during the two cycles. However, this change was not statistically significant (p = 0.50). Conclusion By educating and engaging healthcare professionals in adhering to evidence-based guidelines and best practices, we have observed notable, although statistically significant improvement in peri-procedure antibiotics prescription practices. Continued educational efforts and reinforcement strategies will be vital in further improvements over time. By providing ongoing support and resources, healthcare providers can be empowered to consistently make informed decisions regarding peri-procedure antibiotic administration. This commitment to maintaining high standards of antibiotic prescribing practices is expected to result in improved patient outcomes, including reduced rates of surgical site infections and antibiotic resistance. It is imperative to recognize the critical role that accurate peri-procedure antibiotic prescriptions play in patient safety and overall healthcare quality. By fostering a culture of continuous improvement and adherence to established guidelines, we can ensure that patients receive optimal care while minimizing the risks associated with antibiotic overuse or misuse.

Hungarian general practice paediatricians’ antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study

ObjectivesInappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners’ (GP Peds) antibiotic prescription practice in suspected respiratory...

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya.

The COVID-19 pandemic has significantly impacted healthcare systems, including antibiotic use practices. We present data on patterns of antibiotic dispensing and use in community and hospital settings respectively in Nairobi, Kenya during the pandemic. We conducted interviews with 243 pharmacies in Nairobi using a standardised questionnaire from November to December 2021. The data collected included demographic characteristics, antibiotic customers, types of antibiotics sold, and antibiotic prescribing practices. Additionally, we retrospectively reviewed health records for 992 and 738 patients admitted in COVID-19 and general wards at two large inpatient hospitals between April 2020 and May 2021, and January 2019 to October 2021, respectively. Demographic, utilisation of laboratory services, treatment, clinical, and outcome data were collected using a modified Global WHO Point Prevalence Surveys (Global-PPS) tool. Almost all pharmacies (91.4%) served customers suspected of having COVID-19 with a mean weekly number of 15.6 customers. All pharmacies dispensed antibiotics, mainly azithromycin and beta lactams to suspected COVID-19 infected customers. 83.4% of hospitalised COVID-19 patients received at least one antibiotic at some point during their hospitalisation, which was significantly higher than the 53.8% in general ward patients (p<0.001). Similarly, the average number of antibiotics administered to COVID-19 patients was higher than that of patients in the general ward (1.74 vs 0.9). Azithromycin and ceftriaxone were the most commonly used antibiotics in COVID-19 patients compared to ceftriaxone and metronidazole in the general wards. Only 2% of antibiotic prescriptions for COVID-19 patients were supported by microbiological investigations, which was consistent with the proportion of 6.8% among the general ward population. Antibiotics were commonly prescribed to customers and patients suspected of having COVID-19 either in community pharmacies or in hospital, without a prescription or laboratory diagnosis. These findings emphasize the crucial role of antibiotic stewardship, particularly in community pharmacies, in the context of COVID-19.

Factors associated with the use of antibiotics for children presenting with illnesses with fever and cough obtained from prescription and non-prescription sources: a cross-sectional study of data for 37 sub-Saharan African countries

IntroductionFever and cough in under-five children are common and predominately self-limiting illnesses. Inappropriate prescribing of antibiotics in sub-Saharan Africa is a significant public health concern. However, prescription sources and use among children with fever or cough have not been explored. Therefore, we explored the factors associated with the use of antibiotics obtained from prescription and non-prescription sources for children with illnesses associated with fever and cough.MethodsA secondary data analysis was conducted based on the Demographic and Health Survey (DHS) data from 37 sub-Saharan African countries. A total weighted sample of 18,866 under-five children who had a fever/cough and took antibiotics were considered for this study. Given the hierarchical nature of DHS data and the use of antibiotics prescribed from the formal healthcare setting (> 10%), a multilevel modified poisson regression model was fitted. Deviance was used for model comparison and the model with the lowest deviance value was chosen as the best-fitted model. Variables with p ≤ 0.2 in the bivariable analysis were considered for the multivariable modified poisson regression model. In the multivariable multilevel modified poisson regression model, the Adjusted Prevalence Odds Ratio (APOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were reported to declare a significant association with taking antibiotics for fever/cough prescribed from formal healthcare setting.ResultsIn sub-Saharan Africa, the proportion of use of antibiotics from informal healthcare setting for fever and cough among under-five children was 67.19% (95% CI: 66.51%, 67.85%). In the multilevel modified poisson regression analysis; residing in a rural area (APOR = 1.08, 95% CI: 1.04, 1.12), a child aged 36–47 months (APOR = 0.94, 95% CI: 0.90, 0.98), a child aged 48–59 months (APOR = 0.89, 95% CI: 0.84, 0.94), maternal primary education (APOR = 0.96, 95% CI: 0.93, 0.99), maternal secondary education (APOR = 0.95, 95% CI: 0.92, 0.99), belonged the middle household wealth status (APOR = 1.07, 95% CI: 1.02, 1.11), maternal exposure to news/electronic media (APR = 1.06, 95% CI: 1.02, 1.10), being from a household with 2 under-five children (APR = 0.94, 95% CI: 0.91, 0.97), being from a household with 3 under-five children (APR = 0.89, 95% CI: 0.85, 0.93), being from a household with 4 under-five children (APR = 0.90, 95% CI: 0.83, 0.98), and children of caregivers who were not involved in decision-making for their child health issues were significantly associated with taking antibiotics prescribed from formal healthcare setting for fever/cough among under-five children.ConclusionOnly two-thirds of the antibiotics used for children under five who had fever and cough were prescribed from formal healthcare setting. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education, and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in under-five children.

Appropriateness of antibiotic prescribing for urinary tract infection in the emergency department of a tertiary care hospital

BackgroundUrinary tract infections (UTIs) are frequently diagnosed in the Emergency Departments (EDs) in Saudi Arabia. Despite their prevalence, there is a lack of localized data on antibiotic prescribing practices for UTIs in EDs, hampering optimal patient care and antibiotic resistance management. ObjectiveThis study aimed to evaluate the appropriateness of antibiotic prescriptions for UTI patients by examining adherence to treatment guidelines at a tertiary care ED in Saudi Arabia. MethodsA retrospective cohort analysis was performed in UTI patients with ≥18 years of age who were presented to the ED at a tertiary care hospital between January 2022 and January 2023. 179 patients were randomly selected for enrollment, and data related to their demographics, medical history, microbial isolation, administered antibiotics, and incidence of recurrent infections were collected. ResultsCiprofloxacin (38 %), Cefuroxime (26.8 %), and Nitrofurantoin (16.8 %) were the most prescribed antibiotics. The female population accounted for 87.3 % of UTI cases. Notably, 40.7 % lacked microbial growth or data. Inappropriateness was found in 55.3 % of selection, 27.9 % of dosing, and 38.5 % of treatment duration confined to antibiotics in UTI management. Moreover, complicated UTIs rather than duration and indication for antibiotic therapy were independent risk factors for the re-occurrence of UTIs. ConclusionsThe study depicted an overall 44.7 % of appropriate antibiotic prescriptions in UTI patients. However, it also highlighted the necessity for tailored interventions and promotional efforts aimed at promoting the rational use of antibiotics in patients, thereby preventing resistance and treatment failure.

Barriers and Facilitators Affecting Long-Term Antibiotic Prescriptions for Acne Treatment

Dermatologists prescribe more oral antibiotics per clinician than clinicians in any other specialty. Despite clinical guidelines that recommend limitation of long-term oral antibiotic treatments for acne to less than 3 months, there is little evidence to guide the design and implementation of an antibiotic stewardship program in clinical practice. To identify salient barriers and facilitators to long-term antibiotic prescriptions for acne treatment. This qualitative study assessed data collected from stakeholders (including dermatologists, infectious disease physicians, dermatology resident physicians, and nonphysician clinicians) via an online survey and semistructured video interviews between March and August 2021. Data analyses were performed from August 12, 2021, to January 20, 2024. Online survey and qualitative video interviews developed with the Theoretical Domains Framework. Thematic analyses were used to identify salient themes on barriers and facilitators to long-term antibiotic prescriptions for acne treatment. Among 30 participants (14 [47%] males and 16 [53%] females) who completed the study requirements and were included in the analysis, knowledge of antibiotic guideline recommendations was high and antibiotic stewardship was believed to be a professional responsibility. Five salient themes were to be affecting long-term antibiotic prescriptions: perceived lack of evidence to justify change in dermatologic practice, difficulty navigating patient demands and satisfaction, discomfort with discussing contraception, iPLEDGE-related barriers, and the absence of an effective system to measure progress on antibiotic stewardship. The findings of this qualitative study indicate that multiple salient factors affect long-term antibiotic prescribing practices for acne treatment. These factors should be considered in the design and implementation of any future outpatient antibiotic stewardship program for clinical dermatology.

An Evaluation of Antibiotic Prescribing Practices Among Dentists in Turkey for the Management of Periodontal and Peri-Implant Diseases

Objective: The utilization of antibiotics alongside surgical and nonsurgical mechanical interventions for the management of periodontal and peri-implant diseases lacks standardization. Hence, this study aims to investigate the antibiotic prescribing practices among dentists in Turkey to elucidate the rationale and timing behind systemic antibiotic usage in the treatment of these ailments. Materials and Methods: Between May 2021 and October 2022, 312 dentists across Turkey were invited to participate in a cross-sectional survey. A chi-squared test was used to compare categorical variables according to groups. G-power analysis was used to determine the sample size before the study. Results: The frequency of antibiotic prescriptions during the initial management of periodontitis, peri-implant mucositis, and gingivitis was observed to be lower compared to other procedures. As treatments progressed from nonsurgical to surgical interventions, there was a concurrent rise in the frequency of antibiotic prescriptions. Amoxicillin + clavulanic acid emerged as the most frequently prescribed antibiotic, with the primary reasons for prescription being the mitigation of infection risk and adherence to established literature guidelines. Conclusions: A discernible upward trend in antibiotic prescription is evident as treatment transitions from nonsurgical to more complex surgical modalities. The findings of our survey offer valuable insights for dentists in selecting appropriate antibiotics for the management of periodontal and peri-implant diseases.

Antibiotic prescription sources and use among under-5 children with fever/cough in sub-Saharan Africa.

Childhood febrile illness is among the leading causes of hospital admission for children <5y of age in sub-Saharan Africa (SSA). Antibiotics have played a pivotal role in enhancing health outcomes, especially for children <5y of age. Antibiotics prescription pattern evidence exists for SSA, however, prescription sources (either from qualified or unqualified sources) and use among children with fever or cough have not been explored. Thus the present study assessed antibiotic prescription sources and use among children <5y of age with fever and cough in SSA. We used Demographic and Health Survey data from 37 countries with a total of 18866 children <5y of age who had fever/cough. The surveys span from 2006 to 2021. The dependent variable was antibiotics taken for fever/cough based on prescriptions from qualified sources. The data were weighted using sampling weight, primary sampling unit and strata. A mixed-effects logistic regression model (both fixed and random effects) was fitted since the outcome variable was binary. Model comparison was made based on deviance (-2 log likelihood) and likelihood ratio tests were used for model comparison. Variables with p≤0.2 in the bivariable analysis were considered for the multivariable mixed-effects binary logistic regression model. In the final model, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p<0.05 in the multivariable model were used to declare a significant association with taking antibiotics for fever/cough prescribed from qualified sources. The percentage of unqualified antibiotic prescriptions among children <5y of age who had a fever/cough and took antibiotics was 67.19% (95% CI 66.51 to 67.85), ranging from 40.34% in Chad to 92.67% in Sao Tome. The odds of taking antibiotics prescribed from unqualified sources for fever/cough among children <5y of age living in rural areas were 1.23 times higher (AOR 1.23 [95% CI 1.13 to 1.33]) compared with urban children. The odds of taking antibiotics prescribed from qualified sources for fever/cough among children <5y of age whose mothers had primary, secondary and higher education decreased by 14% (AOR=0.86 [95% CI 0.79 to 0.93]), 21% (AOR 0.79 [95% CI 0.72 to 0.86]) and 21% (AOR 0.79 [95% CI 0.65 to 0.95]) compared with those whose mother had no formal education, respectively. The study showed that the majority of the children who received antibiotics obtained them from unqualified sources in the 37 SSA countries. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in children <5y of age.

Antibiotic Prescribing Practices for Upper Respiratory Tract Infection Among Clinical Officers at Kiambu County

Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.

Expert Opinion on the Clinical use of Antibiotics for the Management of Infections and Enteric Fever in Indian Settings

Objective: The present survey-based study aims to gather clinicians’ perspectives regarding the antibiotic prescription pattern for the management of infections and enteric fever in Indian settings. Methodology: The current multiple-response questionnaire-based survey consisted of 17 questions pertaining to clinical observations, clinical experience, and antibiotic prescription practice of specialists involved in the management of infections and enteric fever. Result: Out of 246 participants, 89% recommended cefixime as the preferred monotherapy drug for enteric fever. The recommended combination therapies for enteric fever were cefixime and ofloxacin, cefixime and azithromycin, and cefpodoxime and ofloxacin, as indicated by 38%, 32%, and 25% of clinicians, respectively. Approximately 61% of the clinicians reported frequently prescribing cefixime for urinary tract infections (UTI). According to 68% of the clinicians, the recommended cefixime dose for treating typhoid fever is 15-20 mg/kg. More than half (55%) of the clinicians recommended amoxicillin/clavulanic acid for the treatment of respiratory infections. Majority (78%) of the clinicians chose cefixime as an effective option for managing recurring infections. A considerable proportion (76%) of clinicians reported no side effects following antibiotic therapy. Conclusion: The study provides valuable insights into the use of antibiotics in infection and enteric fever in Indian settings. Cefixime therapy is recommended by clinicians in the treatment of enteric fever, UTI, and recurring infections. The preferred treatment option for enteric fever includes a combination of cefixime with either ofloxacin or azithromycin. The recommended cefixime dose for typhoid fever is in the range of 15-20 mg/kg. Respiratory infections are typically treated with amoxicillin/clavulanic acid.

Use of Antibiotics in Tertiary Care Hospitals of Meteropolitan City Islamabad

Background: The global threat of antimicrobial resistance (AMR) necessitates a deeper understanding of antibiotic use patterns within healthcare settings. Previous studies have indicated variable prevalence rates of antibiotic use across different regions, underscoring the need for localized data to inform antimicrobial stewardship initiatives. Objective: This study aimed to determine the prevalence and patterns of antibiotic use in two tertiary care hospitals in Islamabad, Pakistan, to identify opportunities for improving antibiotic prescribing practices and inform the development of targeted antimicrobial stewardship programs. Methods: A descriptive cross-sectional study was conducted through a point prevalence survey in two tertiary care hospitals over three months, from January to March 2022. Data on antibiotic use were collected from patient files, employing a two-stage random sampling method for both hospital and ward selection. The survey assessed the prevalence of antibiotic use, categorized according to the WHO Aware classification (Access, Watch, Reserve, Not Recommended), and analyzed the indications, dosages, routes of administration, and compliance with prescribing guidelines. Statistical analysis was performed using SPSS version 25. Results: The prevalence of antibiotic use among the surveyed population (n=255) was 78%, with a higher prevalence observed in neonatal (100%) and pediatric (100%) departments compared to the adult department (74.66%). Ceftriaxone (27.06%), meropenem (10.98%), and moxifloxacin (9.41%) were the most frequently used antibiotics. The majority of antibiotics prescribed belonged to the 'Watch' group (70%), with 17.6% in the 'Access' group, and 11.6% in the 'Reserve' group. Prophylactic use accounted for 62.9% of all antibiotics prescribed. The study also noted a lack of compliance with prescribing guidelines and a scarcity of culture sensitivity testing. Conclusion: The study reveals a high prevalence of antibiotic use in tertiary care hospitals in Islamabad, with a significant reliance on 'Watch' and 'Reserve' group antibiotics. These findings highlight the critical need for the implementation of antimicrobial stewardship programs and national action plans to promote rational antibiotic use and combat AMR. Background: Antimicrobial resistance is one of the biggest global healthcare concerns as per the World Health Organization. It has impacted high, mid, and low-income countries with mid and low-income countries taking higher tools. Lack of data on the pattern of antibiotic use will lead to difficulty in the implementation of antimicrobial stewardship programs at the facility level. The purpose of this study is to determine the point prevalence of antibiotic use among hospitals in Islamabad and to determine the pattern of the WHO-aware group antibiotics in paediatrics. Methodology: The point prevalence survey methodology was used to collect random sample of 255 in two tertiary care hospitals in Islamabad in three months. All the inpatients admitted on the day of PPS were included in the survey. Data was collected through questionnaires from patients' files and analysed in SPSS Results: Total of two tertiary care hospitals with 375 beds were assessed in this study. Out of these, 255 patients 78.03% patients were receiving at least one antibiotic. Out of 255 antibiotics were used in which 32.1% were prescribed for medical prophylaxis, while 29.8% of the antibiotics prescribed were for surgical prophylaxis. Ceftriaxone and Maropenm accounted for 27% &amp; 10.98% of total antibiotic prescribed respectively. The result also indicates high use of watch group antibiotics in children under 5 years of age. The majority of antibiotics were used as Empirical therapy. There was no specific institutional guideline for the use of antibiotics, while in 95% of cases there was no reason notes available for the use of antibiotics. Conclusion: We concluded that use of antibiotics in the two hospitals is very high. It has been also seen that there was no proper guideline for the use of antibiotics in hospitals with poor quality documentation. It is an immediate need for the implementation of a national action plan on the antimicrobials resistance and the development of an antibiotics stewardship program at each facility level to protect the resistance to the antibiotic.

Shorter and Longer Antibiotic Durations for Respiratory Infections: To Fight Antimicrobial Resistance-A Retrospective Cross-Sectional Study in a Secondary Care Setting in the UK.

As antimicrobial resistance (AMR) escalates globally, examining antibiotic treatment durations for respiratory infections becomes increasingly pertinent, especially in the context of the COVID-19 pandemic. In a UK secondary care setting, this retrospective study was carried out to assess the appropriateness of antibiotic treatment durations-shorter (≤5 days) versus longer (6-7 days and >8 days)-for respiratory tract infections (RTIs) in 640 adults across 2019 and 2020, in accordance with local antimicrobial guidelines. The analysis employed these guidelines and clinical evidence to examine the effectiveness and suitability of antibiotic prescribing practices. This study considered the 'Shorter Is Better' approach, noting an increased rate of patient discharges associated with shorter antibiotic regimens (≤5 days). It further demonstrates that shorter treatments are as effective as longer ones for conditions such as COPD exacerbation, COVID-19 pneumonia, and hospital-acquired pneumonia (HAP), except in cases of community-acquired pneumonia (CAP) and unspecified diagnoses. Nevertheless, this study raises concerns over an observed increase in mortality risk with shorter treatment durations. Although these mortality differences were not statistically significant and might have been influenced by the COVID-19 pandemic, the need for extended research with a larger sample size is highlighted to confirm these findings. This study also emphasises the critical need for accurate and specific diagnoses and considering risk assessments at admission, advocating for tailored, evidence-based antibiotic prescribing to ensure patient safety. It contributes to antimicrobial stewardship efforts by reinforcing the importance of adapting antibiotic use to current healthcare challenges and promoting a global commitment to fight antimicrobial resistance. This approach is crucial for enhancing patient outcomes and saving lives on a global scale.

A qualitative analysis of the unwritten rules influencing antibiotic prescribing practices among French poultry veterinarians.

It is now recognized that a better understanding of prescriber behaviour is needed to improve antimicrobial stewardship programmes. Most studies conducted in the livestock sector have focused on farmers' perspectives, while the prescribing habits of veterinarians have remained overlooked. Our study explored the psychosocial determinants associated with antibiotic prescribing practices in the French poultry sector by analysing the informal norms and unwritten rules that influence veterinarians' prescribing decisions. A qualitative study was conducted in four French regions in February 2021. Using the biographical narrative interpretive method, semi-structured interviews were conducted with 16 poultry veterinarians with varying professional experience. Three main themes were retained for data analysis: (i) compliance with and deviations from prescribing recommendations, (ii) the influence of fellow veterinarians on antibiotic decisions and (iii) the key role of veterinary corporate groups. When prescribing antibiotics, junior veterinarians were strongly influenced by senior veterinarians who acted as role models driving clinical practices. Prescribing habits were shared through peer networks in which veterinarians participated throughout their careers. Finally, veterinary corporate groups helped to shape veterinarians' prescribing habits by promoting existing guidelines and even producing in-house recommendations. We show that, in parallel with official guidelines, prescribing habits circulate among veterinarians and are shared in professional circles. Therefore, antimicrobial stewardship interventions should focus not only on official guidelines and communication channels, but also unwritten professional rules and organizations influencing veterinarians' prescribing practices.

Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam.

To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia. We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors. Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients' expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (P < 0.0001), whereas negative perceptions about colleagues' practices reduced this confidence (P < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed. This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.

A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report.

Guidelines recommend treating asthma exacerbations (AAEs) with bronchodilators combined with inhaled and/or systemic corticosteroids. Indications for antibiotic prescriptions for AAEs are usually not incorporated although the literature shows antibiotics are frequently prescribed. To investigate the antibiotic prescription rates in AAEs and explore the possible determining factors of those practices. A digital survey was created to determine the antibiotic prescription rates in AAEs and the influencing factors for the prescription practices. The survey was distributed among European academy of allergy and clinical immunology (EAACI) members by mass emailing and through regional/national societies in the Netherlands, Italy, Greece, and Poland. Furthermore, we retrieved local antibiotic prescription rates. In total, 252 participants completed the survey. Respondents stated that there is a lack of guidelines to prescribe antibiotics in AAEs. The median antibiotic prescription rate in this study was 19% [IQR: 0%-40%] and was significantly different between 4 professions: paediatrics 0% [IQR: 0%-37%], pulmonologists 25% [IQR: 10%-50%], general practitioners 25% [IQR: 0%-50%], and allergologists 17% [IQR: 0%-33%]) (p=0.046). Additional diagnostic tests were performed in 71.4% of patients before prescription and the most common antibiotic classes prescribed were macrolides (46.0%) and penicillin (42.9%). Important clinical factors for health care providers to prescribe antibiotics were colorised/purulent sputum, abnormal lung sounds during auscultation, fever, and presence of comorbidities. In 19% of patients with AAEs, antibiotics were prescribed in various classes with a broad range among different subspecialities. This study stresses the urgency to compose evidence-based guidelines to aim for more rational antibiotic prescriptions for AAE.

Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016–2018

ObjectiveTo identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia. DesignRetrospective cohort. Setting and ParticipantsThis national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018. MethodsMinimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class. ResultsThere were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole. Conclusions and ImplicationsThere were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.

Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics.

Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician-caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within inpatient healthcare settings, their implementation in pediatric emergency medicine presents specific challenges. Existing biomarkers like white blood cell count, C-reactive protein, procalcitonin, and presepsin have limitations in their ability to distinguish (serious) bacterial infections from other etiologies of fever. Furthermore, rapid antigen detection tests and guidelines aimed at guiding antibiotic prescriptions for children have not consistently reduced unnecessary antibiotic use. To improve antibiotic prescribing practices, potential strategies include the utilization of decision support tools, audit and feedback, establishing follow-up procedures, implementing safety netting systems, and delivering comprehensive training and supervision. Notably, host genome signatures have also gained attention for their potential to facilitate rapid and precise diagnoses of inflammatory syndromes. Standardized metrics are crucial for evaluating antimicrobial use within pediatric healthcare settings, enabling the establishment of benchmarks for assessing antibiotic utilization, quality enhancement initiatives, and research endeavors.

Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: A survey and contingent valuation study of hospitalists.

Clinical guidelines suggest that hospital antibiograms are a key component when deciding empiric therapy, but little is known about how often clinicians use antibiograms and how they influence clinicians' empiric therapy decisions. We surveyed hospitalists at seven healthcare systems in the United States on their reported practices related to antibiograms and their hypothetical prescribing for four clinical scenarios associated with gram-negative rod pathogens. Each was given a randomly assigned antibiogram susceptibility percentage, and we used contingent valuation analysis to assess whether the antibiogram susceptibility percentage was associated with prescribing practices. Of the 193 survey responders, only 52 (26.9%) respondents reported using antibiograms more than monthly. Across all four clinical scenarios, there was no evidence that antibiogram susceptibility levels influenced antibiotic prescribing practices. With limited utilization and no evidence that they influenced practice, antibiograms may have a limited role in hospitalist care delivery for common gram-negative rod infections.

Assessment of Physicians' Practice in Implementing Antibiotic Stewardship Program in Najran City, Saudi Arabia: A Cross-Sectional Study.

One of the main causes of illness, mortality, and rising medical costs is antimicrobial resistance, which is a global healthcare concern. This study explores the practice of physicians toward the effective implementation of Antibiotic Stewardship Programs (ASPs) in Najran city, Saudi Arabia. This cross-sectional study was conducted among physicians working at primary care setting in Najran city, Saudi Arabia, between May and August 2023. A self-administered questionnaire was distributed among the physicians composed of three parts: socio-demographic data, a questionnaire about physicians' practice in the efficacy of ASP, and a questionnaire about physicians' practice regarding prescribing antibiotics. Of the 128 physicians who participated in the study, 60.2% were males, and 43.8% were aged between 36 and 45 years. Among the practices in implementing the ASP effectively, controlling the source of infection domain received the highest score (mean score: 4.83). Every practice domain mean score was greater than 3, indicating that study participants possessed a moderate level of ASP practice and implementation skills. The overall mean practice score in the effective implementation of ASP was 154.9 ± 25.5 out of 185 points, with good, moderate, and poor practices constituting 67.2%, 28.1%, and 4.7%, respectively. The physicians showed a moderate level of practice for the effective implementation of ASPs in Najran city. The factors significantly associated with increased practice score include older age, male gender, Saudi nationality, handling five or fewer infection cases daily, and infection-initiated antibiotic prescribing treatment managed per day. These findings suggest the need for targeted interventions and educational programs to enhance physicians' adherence to ASP guidelines and promote appropriate antibiotic prescribing practices, ultimately contributing to global efforts in combating antimicrobial resistance and improving patient outcomes.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation.

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.