Antibiotic Prescribing Practices Research Articles

Computer case-based reasoning simulation versus traditional lectures for medical interns teaching of diagnosis and antibiotic prescribing for acute respiratory infection: a comparative quasi-experimental study

BackgroundAcute respiratory infections are a common presentation in clinical practice and medical interns must learn proper diagnosis and antibiotic prescribing. Traditional lecture-based teaching may not provide sufficient opportunities for students to apply their knowledge in realistic scenarios, whereas computer case-based simulations offer an alternative approach that allows active learning and decision-making in simulated patient cases. This study investigated the effectiveness of computer case-based reasoning simulation versus traditional lectures for medical interns teaching of diagnosis and antibiotic prescribing for acute respiratory infections.MethodsThis comparative quasi-experimental study was conducted from 2020 to 2022 in the Department of Infectious Diseases at Shahid Beheshti Hospital, affiliated to Kashan University of Medical Sciences. The samples were selected using a convenience method and assigned to the intervention and control groups using a permuted block randomization approach. Over a period of ten months (Each month, an average of eight medical interns), a total of 40 medical interns received traditional lecture-based teaching, while another 40 medical interns were taught using a Computer Case-based Reasoning simulation. The medical interns’ knowledge in both groups was assessed using pre- and post-tests. The collected data from the pre- and post-tests were then analyzed statistically using paired t-tests, independent t-tests, and ANCOVA.ResultsThe posttest scores of the medical interns in both groups were significantly higher than the pretest scores (P < 0.001). No statistically significant differences were observed between the two teaching methods regarding mean knowledge gains in diagnoses and antibiotic prescribing practices. (P > 0.21). The results of the ANCOVA, after controlling for pre-test scores, showed no statistically significant difference between the two teaching methods in their effect on medical interns’ diagnostic and antibiotic prescribing performance (P > 0.33).ConclusionThe study found that both computer case-based reasoning simulation and traditional lectures were effective in improving medical interns’ knowledge of diagnosis and antibiotic prescribing practices for acute respiratory infections. However, no statistically significant differences were observed between the two teaching methods. Thus, computer- based simulation could replace face-to-face teaching when this method is impractical or computerized methods are more cost-effective.

Fluconazole-Resistant Vulvovaginal Candidosis: An Update on Current Management

Currently, the rising prevalence of resistant Candida species, particularly Candida albicans, as well as non-albicans isolates such as Candida glabrata and Candida krusei, represent challenges in their management. In this review, we aimed to explore the current management of fluconazole-resistant vulvovaginal candidiasis (FRVVC). Identified studies focused on alternative antifungal therapies, including boric acid, nystatin, and newer agents like oteseconazole and ibrexafungerp. The findings highlight the need for tailored treatment regimens, considering the variability in resistance patterns across regions. Unprofessional as well as professional overuse of antifungals for vulvovaginal symptoms that are not caused by Candida infections should be combatted and banned as much as possible. Instead of high-dose maintenance regimens using weekly doses of 150 to 200 mg of fluconazole for 6 months or longer, it is advisable to use an individualised degressive regimen (ReCiDiF regimen) in order to tailor the treatment of a particular patient to the lowest dosage possible to keep the diseases controlled. Additionally, this report underscores the impact of antibiotic use on the microbiota, which can raise the possibility of VVC and lead to fluconazole resistance, emphasizing the necessity for cautious antibiotic prescribing practices.

Antibiotic Sensitivity Patterns in Pediatric Enteric Fever: A Cross-Sectional Study at a Tertiary Care Hospital in Bangladesh

Background: This cross-sectional study aimed to investigate the antibiotic sensitivity patterns among pediatric patients with enteric fever at the Department of Paediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, during the period from July 2005 to June 2006. The primary objective was to identify the prevalent antibiotic sensitivities in order to enhance the efficacy of treatment strategies for typhoid fever in children. Methods: Ninety-eight suspected cases of enteric fever, aged between 2 and 12 years, were selected from admissions to the above-mentioned hospital. Blood culture and sensitivity testing were performed for Salmonella typhi and paratyphi. Demographic information, pre-admission antibiotic usage, and sensitivity profiles to various antibiotics, including Ceftriaxone, Cefixime, Chloramphenicol, Ciprofloxacin, Azithromycin, Amoxicillin, Imipenem, Nalidixic acid, and Ampicillin, were analyzed. Results: The majority of patients (62.2%) were in the 5-9 years age group, and males constituted 61.22% of the study population. Blood cultures revealed 71.44% sensitivity for Salmonella typhi and 28.57% for paratyphi. Among the antibiotics tested, Ceftriaxone exhibited 100% sensitivity, followed by Cefixime (80.2%), Chloramphenicol (78.57%), Ciprofloxacin (65.20%), Azithromycin (60%), Amoxicillin (54.6%), Imipenem, Nalidixic acid (Intermediate sensitive, 56.3%), Ciprofloxacin (Intermediate sensitive, 25%), and Ampicillin (Intermediate sensitive, 18.8%). Nearly half of the patients (47.3%) received antibiotics before admission, and 43.8% of culture-positive patients had a history of pre-admission antibiotic use. Conclusion: The study concludes that understanding antibiotic sensitivity patterns is crucial for successful typhoid fever treatment in children. Ceftriaxone and Cefixime emerged as highly effective, while the unnecessary use of antibiotics prior to admission may influence sensitivity patterns. This information underscores the importance of judicious antibiotic prescribing practices to ensure optimal therapeutic outcomes in pediatric enteric fever cases.

Exploring Physicians' Perspectives on Antibiotic Stewardship Implementation: A Qualitative Investigation in Al-Nasiriyah Hospitals

Background: The overuse and inappropriate use of antibiotics cause antimicrobial resistance (AMR). The antibiotic stewardship program (ASP) plays a crucial role in improving prescribing antibiotics. Although the Iraqi Ministry of Health has issued ASP legislation, its full implementation in clinical practice remains incomplete. Objectives: To explore physicians' perspectives regarding the current and potential implementation of ASP in Al-Nasiriya hospitals. Methods: A qualitative study was conducted in Al-Nasiriyah public hospitals from December 17, 2023, to January 21, 2024, using face-to-face interviews. Physicians who prescribe antibiotics, work in Al-Nasiriyah public hospitals, and consent to participate in the study were recruited using purposeful and snowball sampling, and the size of the sample was specified by saturation. The interviews' audio was transcribed verbatim and analyzed thematically. Results: Nine public hospitals in Al-Nasiriyah were included in the study. One hospital was excluded because the ASP was activated after data collection began. Sixteen physicians in different specialties were recruited, 15 males and one female. Thematic analysis revealed two major themes: challenges in antibiotic prescribing practices (3 subthemes: antibiotic selection, review, and practice, antibiotic mismanagement, and antibiotic resistance) and antibiotic stewardship implementation (4 subthemes: ASP knowledge and components, perceived benefits and importance, implementation challenges and barriers, and ASP enablers). Conclusions: There were many challenges in antibiotic prescribing practice, including antibiotic mismanagement and AMR. The participants acknowledged the importance of the ASP, but they mentioned many barriers to its application.

Empiric antibiotic prescribing practices for gram-positive coverage of late-onset sepsis in neonatal intensive care units in North America.

Late-onset sepsis (LOS) in the neonatal intensive care unit (NICU) causes significant morbidity and mortality, yet guidance on empiric management is limited. We surveyed NICUs across Canada and the United States regarding their empiric antimicrobial regimens for LOS, thereby identifying large practice variations and high rates of empiric vancomycin use.

Rates of Extended Oral Antibiotic Prophylaxis After Primary Total Knee Arthroplasty Among High-Risk and Standard-Risk Patients: 2009 to 2022

IntroductionRecent evidence suggests extended courses of oral antibiotics (EOA) after total hip (THA) and knee (TKA) arthroplasty may reduce the risk of periprosthetic joint infection (PJI) in high-risk patients. EOA rates after THA have risen significantly. However, there is a lack of epidemiologic data on EOA prophylaxis following TKA. Therefore, we investigated national trends in EOA prophylaxis for primary TKA and whether these rates were reflective of changes in patient risk or prescribing practices. MethodsAdult patients undergoing TKA between 2009 and 2022 were identified in a national insurance claims database (Merative Marketscan). EOA was defined as a 7-14 day course of a first-generation cephalosporin, cefdinir, clindamycin, doxycycline, or trimethoprim-sulfamethoxazole filled between 5 days preoperatively to 3 days postoperatively. Annual EOA rates were calculated and stratified by preoperative PJI risk. Multivariable logistic regression was used to explore whether rates reflected changing patient characteristics. Future rates were predicted with time-series forecasting. ResultsWe identified 712,212 eligible TKA cases. EOA rates rose from 0.91% in 2009 to 7.95% in 2022. Rates increased by 686% among standard-risk patients and 786% among high-risk patients. Logistic regression models using patient comorbidities could not account for changes in EOA rates. EOA rates were projected to rise to 18.3% (CF: 7.5-29.0%) by 2030. ConclusionRates of EOA prophylaxis after TKA rose significantly from 2009 to 2022. This trend could not be explained by changing patient characteristics, suggesting widespread changes in antibiotic prescribing practices, which may be reflective of recent studies favoring EOA use. There is a need for further high-quality research examining the safety, efficacy, and role of EOA prophylaxis in the primary TKA patient population.

Carbapenem resistance in gram-negative pathogens in an Iranian hospital: high prevalence of OXA-type carbapenemase genes.

The widespread dissemination of carbapenem-resistant Gram-negative bacteria poses a significant threat to global public health. This study aimed to investigate the prevalence of carbapenem resistance in Gram-negative bacteria isolated from patients at the Children's Medical Center Hospital, Tehran, Iran, to understand the molecular mechanisms underlying this resistance. During the period spanning from June 2019 to June 2020, 777 Gram-negative bacterial strains were isolated. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute. Polymerase chain reaction was used to detect carbapenem resistance genes including bla OXA23, bla OXA24, bla OXA48, bla OXA51, bla OXA58, bla OXA143, bla KPC, bla IMP, bla VIM, and bla NDM. Among the total bacterial isolates, 141 (18.1%) exhibited carbapenem resistance. Escherichia coli was the most prevalent (57.4%), followed by Klebsiella pneumoniae (11.3%) and Acinetobacter baumannii (10.6%). Other notable contributors included Enterobacter spp. (5.7%), Salmonella spp. (3.5%), and Stenotrophomonas maltophilia (2.8%). Citrobacter spp., Proteus mirabilis, and Pseudomonas aeruginosa contributed to the distributions of two, one, and three isolates, respectively. Notably, bla OXA48 showed the highest prevalence (33%), followed by bla OXA143 and bla OXA58 (27% and 24%, respectively). In addition, bla OXA24 was present in 11% of the total isolates, bla OXA23 in 10%, and bla NDM in 10%, whereas bla KPC, bla VIM, and bla IMP were not detected. Our study highlights the prevalence of carbapenemase-producing Gram-negative isolates among pediatric patients. Notable resistance patterns, especially in K. pneumoniae and E. coli, underline the urgent need for proactive interventions, including appropriate antibiotic prescription practices and strengthening of antibiotic stewardship programs.

Capturing the complexity of veterinarians' antibiotic prescribing practices in the livestock sector: a meta-ethnography across contexts: Veterinarians' antibiotic prescribing in different contexts.

Strategies and policies to tackle the global public health threat of antimicrobial resistance are increasingly addressing antimicrobial use prescribing practices in both the human and animal health sectors. Veterinarians' antibiotic prescribing practices are influenced by different factors and conditioned by the context within which antibiotic prescribing decisions are made, complexifying the implementation of behaviour change interventions. A better understanding of these factors could therefore help in the design and application of such interventions. Meta-ethnography was used to explore the antibiotic prescribing behaviour of veterinarians in different contexts and to construct a new conceptual framework. A search was conducted in PubMed, Web of Science Core Collection and SciELO Citation Index between 2016 and 2024. The final sample consisted of 29 articles, 27 of which were selected from the 561 articles identified in the search and 2 of which were added by the authors. The results were synthesized and presented through four contextual situations influencing antibiotic prescribing by livestock veterinarians: priorities and pressures, uncertain field conditions, systemic challenges and an enabling environment. The results are presented as a conceptual framework that views veterinarians' antibiotic prescribing behaviour as dynamic, adapting in response to the different contextual situations they encounter. The findings provide an integrated and contextualized understanding of veterinarians' antibiotic prescribing behaviours, which could be implemented to facilitate the development and application of future antimicrobial stewardship interventions.

Impact of Antibiotic Stewardship on Treatment of Hospitalized Children with Skin and Soft-Tissue Infections.

Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014-September 2015), post-implementation (October 2015-March 2020), and COVID-19 (April 2020-August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance.

Are antibiotics overprescribed for apical periodontitis in dental practice?

There is a discrepancy in the databases and data sources mentioned by the authors. The abstract references four databases, which differ from those listed in the materials and methods section. According to the methods, the literature search was conducted across three databases: PubMed-MEDLINE, EMBASE, and Scielo. However, the abstract mentions four databases, including MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus. All relevant articles were searched using specific keywords derived from Medical Subject Headings (MeSH) terms and text words (TW) related to the topic. Following the screening of titles and abstracts, the full texts of the selected studies were reviewed, and inclusion and exclusion criteria were applied. Any disagreements regarding study inclusion were resolved by consensus. Studies that reported data on antibiotic prescription patterns by dentists for the treatment of apical disease were included. Data extraction was carried out by three independent reviewers, with a fourth author resolving any disagreements. Extracted data included publication details (authors, year of publication), number of respondents, response rate, survey location, and prescriber type (general practitioner, endodontist, or dental surgeon). The primary outcome measured was the percentage of dentists prescribing antibiotics for each form of periapical endodontic disease. The search strategy identified a total of 96 studies, of which 39 cross-sectional studies met the inclusion criteria. Dentists prescribed antibiotics in 25.8% of cases of symptomatic apical periodontitis (AP) and in 31.5% of asymptomatic AP cases. In instances of acute symptomatic apical abscess with swelling and moderate to severe symptoms, approximately 89% of dentists prescribed antibiotics, compared to nearly 100% of endodontists. Endodontists demonstrate more appropriate antibiotic-prescribing practices than general practitioners. Globally, dentists tend to over-prescribe antibiotics for managing apical disease. Therefore, there is a pressing need to enhance antibiotic prescribing practices in the treatment of endodontic infections.

Towards Wiser Prescribing of Antibiotics in Dental Practice: What Pharmacists Want Dentists to Know.

Antibiotics have various indications for treatment and prophylaxis in dental practice. While only a handful of antibiotics are typically prescribed in dentistry, unlike in medicine, clear indications and appropriate dosing and duration remain controversial among antibiotic-prescribing dentists, which may result in inappropriate or excessive antibiotic prescriptions. This practice can increase the risk of antibiotic resistance and expose patients to unnecessary side effects. Moreover, the concept of antibiotic stewardship in dental practice remains in its early stages. This review was developed by pharmacists (general and infectious disease pharmacists) in collaboration with a periodontist and a maxillofacial surgeon to provide an antibiotic prescription guide for dentists who frequently prescribe antibiotics. It also sheds light on antibiotic stewardship. The review discusses in detail antibiotic indications for treatment and prophylaxis in dental practice and provides tables that can be used by dentists in their everyday practice. It also discusses the concept of antibiotic stewardship and provides recommendations that can be applied to the practice of antibiotic prescribing in dentistry. Antibiotic prescribing in dental practice should be limited to cases with documented infections or when indicated for prophylaxis. Every dentist can act as an antibiotic steward by prescribing antibiotics wisely and only when necessary, using their discernment to identify appropriate cases and exclude those that do not meet infection criteria. Collaboration with pharmacists is encouraged to provide such recommendations and implement antibiotic stewardship interventions, such as developing antibiotic prescription protocols.

Antibiotic Prescribing Behavior of Physicians in Outpatient Departments in Hospitals in Northwest Ethiopia: Structural Equation Modeling Approach.

Antibiotic resistance, fueled by irrational prescribing, is a global threat associated with health, social, and economic consequences. Understanding antibiotic prescribing behavior and associated factors is important to promote good prescribing practice. This study aimed to determine the factors affecting antibiotic prescribing behaviors of physicians based on the theory of planned behavior in hospitals in northwest Ethiopia in 2022. A cross-sectional study was conducted from September 2022 to October 2022. A total of 185 health professionals were included, and a self-administered questionnaire was used to collect data. A structural equation model based on the modified theory of planned behavior was used to determine factors affecting antibiotic prescribing behavior. The percentages of physicians' estimated prescriptions for patients with upper respiratory tract infections (URTIs) and during weekly outpatient visits were used to predict antibiotic prescribing behavior and finally linked with behavioral constructs. A P value <.05 was considered significant. Physicians estimated that they prescribed antibiotics for 54.8% (9896/18,049) of weekly outpatient encounters, and 178 (96.2%) of the 185 physicians estimated they prescribed antibiotics for patients who presented with symptoms of a URTI. Physicians aged ≤30 years were less likely to prescribe antibiotics (48/100, 48%) for patients who presented with a URTI than physicians older than 30 years (51/100, 51%; P=.004), and general practitioners were less likely to prescribe antibiotics (47/100, 47%) for patients who presented with a URTI than residents (51/100, 51%; P=.03). Similarly, during outpatient visits, physicians ≤30 years old were less likely to prescribe antibiotics (54/100, 54%) than physicians older than 30 years (57/100, 57%; P<.001), male physicians were less likely to prescribe antibiotics (53/100, 53%) than female physicians (64/100, 64%; P=.03), and general practitioners were less likely to prescribe antibiotics (53/100, 53%) than residents (57/100, 57%; P=.02). Physicians with good knowledge were less affected by perceived social pressure (mean 4.4, SD 0.6) than those with poor knowledge (mean 4.0, SD 0.9; P<.001) and felt it was easy to make rational decisions (mean 4.1, SD 1.1) compared with those with poor knowledge (mean 3.8, SD 1; P<.001). However, intentions to reduce and prescribe antibiotics were not affected by attitudes, subjective norms, or perceived behavioral control, and perceived antibiotic prescribing behavior was not related to intentions to reduce or prescribe antibiotics. Antibiotic prescribing behavior was not under the volitional control of physicians. This calls for a systematic approach to change antibiotic prescribing practices in hospital.

Antibiotic use in pediatric dental infections: knowledge and awareness levels of dentists

Antibiotics are crucial in treating infections; however, their unnecessary and incorrect use can lead to numerous health issues, notably antibiotic resistance. Evaluating the accuracy and awareness of antibiotic prescription practices among dentists, who play a significant role in antibiotic use, is critical in developing effective health policies and professional training programs. This study assesses dentists’ knowledge levels and practice habits regarding antibiotic use. Using a structured questionnaire, the research employed a cross-sectional design and was conducted with 202 general dentists, 98 pediatric dentists, and 43 oral and maxillofacial surgeons. Data were analyzed using demographic characteristics, antibiotic prescription practices, and scenario-based questions measuring knowledge levels. The results revealed that while most participants were generally knowledgeable about antibiotic use, inconsistencies in prescription practices were evident. Notably, unnecessary antibiotic prescriptions were identified in some cases, contributing to significant health issues such as antibiotic resistance. This study emphasizes the necessity of promoting conscious antibiotic use by evaluating dentists’ practices. Therefore, the urgent need for developing professional training programs and strengthening strategies to combat antibiotic resistance is paramount.

The Impact of Tele-Stewardship on Rural Antibiotic Prescribing Practices

Abstract Background Antibiotic prescribing for children is highest in rural areas. Tele-stewardship allows for implementation of antimicrobial stewardship (AS) via telecommunication with providers. There has been limited research on the effectiveness of tele-stewardship in the outpatient setting. In this study, we address the need for better AS in rural areas by developing, implementing, and evaluating AS interventions using tele-stewardship. Methods We employed bundled outpatient AS implementation strategies in rural pediatric primary care (PC) clinics and emergency departments (EDs) affiliated with Vanderbilt University Medical Center (VUMC) using tele-stewardship. The bundle includes (1) patient/guardian educational materials, (2) antibiotic use commitment posters (3) provider education through quarterly teaching pearls on common pediatric infections, communication skills training (DART modules), app-based microlearning modules (QuizTime), and implicit/explicit bias education and (4) quarterly audit and feedback with peer comparison on guideline-concordant antibiotic use. Participants are pediatric prescribers (physician, physician assistant, nurse practitioner). We compared antibiotic prescription data for children &amp;lt;18 years collected during the “baseline” period (Jan-Dec 2022) to the intervention period (Jan-Sept 2023). Two academic urban primary care clinics and one academic urban ED at which the interventions were not implemented were included as “control” sites. The primary outcome is percent of all encounters that result in an antibiotic prescription. Pre- and post-intervention data were analyzed in aggregate (not at the provider-level). Significance was determined via calculating a 95% confidence interval (CI) for the difference of proportions. Results To date, there have been 140,077 PC patient encounters (98,409 baseline and 41,065 intervention) and 94,205 ED encounters (61759 baseline and 32,446 intervention) across all sites. Change from baseline to intervention periods in academic PC sites was 0.9 percentage points (95% CI 0.556 to 1.243; 6.6% baseline, 7.5% intervention) while change in rural intervention sites was -1.05 percentage points (95% CI -0.409 to -1.667; 11.8% baseline, 10.75% intervention; Figure 1a). Only 1 of 3 rural EDs had a decrease in percent of encounters with an antibiotic prescription (Figure 1b). Overall the academic ED showed a 3.1 percentage point increase (95% CI 2.430 to 3.769; 18.0% baseline, 21.1% intervention) while the rural sites showed a 1.0 percentage point increase (95% CI -0.817 to 2.817; 24.2% baseline, 25.2% intervention). Conclusion Interim analysis shows that bundled implementation strategies using tele-AS led to significantly decreased overall antibiotic use in rural primary care clinics compared to urban academic control sites. The study is ongoing and will continue to evaluate outcomes over a longer intervention period to reduce seasonal bias.

Long-Term Trends in Antibiotic Use in a Low-Resource Medical Setting: Amman, Jordan (2010–2023)

Abstract Background Antimicrobial resistance (AMR) contributes to substantial morbidity and mortality. The misuse and overuse of antibiotics are major drivers of AMR. Lack of point-of-care testing to discern viral from bacterial infections complicates appropriate management in low-resource settings. This study examines antibiotic prescription practices in Amman, Jordan. Methods We conducted three prospective viral surveillance studies at the largest public hospital in Amman Jordan (2010–2013, 2020, and 2023). Our target population for this study was children &amp;lt;2 years old hospitalized with fever or respiratory symptoms. Through parental interviews and chart abstractions, we collected demographic and clinical data, including antibiotic use, as well as results of any blood, urine, and cerebrospinal fluid cultures performed at providers’ discretion. We classified antibiotics according to the 2023 World Health Organization AWaRe (Access, Watch, Reserve) antibiotic classification system, focusing on the utilization of Watch group antibiotics, which are recommended when first-line Access group antibiotics are ineffective or inappropriate. Research personnel also collected nasal or throat swabs from enrolled children, and these samples were tested in a research laboratory for common respiratory viruses using RT-PCR. Providers were unaware of viral testing results. We described categorical variables using absolute and relative frequencies and summarized continuous variables using the median and interquartile range (IQR). Results Of 4,950 children enrolled, we included 4,703. The median age was 3.5 months (IQR, 1.6–8.3), and 59.4% (n=2,793) were male. Most children were enrolled from the general ward (n=4,312 [91.9%]), with the remaining 380 (8.1%) being enrolled from the pediatric intensive care unit. Only 8 children (0.2%) among those eligible for seasonal influenza vaccination (n=1,624) had been vaccinated at presentation. The five most common admission diagnoses were bronchopneumonia (n=1,255 [26.7%]), rule-out sepsis (n=1,217 [25.9%]), bronchiolitis (n=866 [18.4%]), pneumonia (n=606 [12.9%]), and paroxysmal coughing or pertussis-like cough (n=273 [5.8%]). Blood, urine, or CSF samples were collected from 2,556 children (54.5%), 355 (13.9%) of whom tested positive for at least one bacterial species (Figure 1A). During hospitalization, 4,356 children (92.6%) received at least one antibiotic. Of those, 4,227 (97.0%) received at least one antibiotic from the Watch group (Figure 1B). The three most common Access group antibiotics prescribed were ampicillin (n=830 [17.7%]), gentamicin (n=96 [2.0%]), and amikacin (n=85 [1.8%]), whereas the three most common Watch group antibiotics prescribed were ceftriaxone (n=1,956 [41.7%]), cefuroxime (n=1,628 [34.7%]), and azithromycin (n=754 [16.1%]) Overall, 3,898 children (82.9%) were positive for at least one respiratory virus (Figure 1C). Providers ordered cultures most often for children 0–2 months old (n=1,575 [73.5%]) and those with an admission diagnosis of rule-out sepsis (n=1,161 [95.4%]). Despite seasonal variation, prescription and testing practices were consistent across study years. Conclusion Inappropriate antibiotic use remains a significant healthcare challenge in Jordan. Incorporating point-of-care viral testing for suspected respiratory infections and improving diagnostic testing for bacterial infections is crucial. Preventive strategies including influenza vaccination and the use of emerging therapies for RSV or other pathogens associated with high morbidity could indirectly limit inappropriate antibiotic use. Development of context-specific management guidelines and antimicrobial stewardship programs are urgently required to guide prescription practices.

Clonal and resistance profiles of fluoroquinolone-resistant uropathogenic Escherichia coli in countries with different practices of antibiotic prescription.

Antibiotic prescription practices differ between countries, influencing regional antimicrobial resistance prevalence. However, comparisons of clonal diversity among resistant bacteria in countries with different prescribing practices are rare. The rise of fluoroquinolone-resistant Escherichia coli (FQREC), often multidrug-resistant, exacerbates global antibiotic resistance. Unlike in the USA, antibiotics are commonly dispensed in Iraq without prescriptions, leading to widespread overuse and misuse. This study aimed to assess the impact of varying antibiotic use practices on FQREC diversity. We compared FQREC prevalence, multidrug resistance, and clonality of FQREC among E. coli isolated from urine submitted between 2017 and 2018 to three US hospitals and two Iraqi hospitals. All FQREC isolates were analyzed for QRDR mutations and the presence of PMQR genes. A subset of FQREC strains from the ST131-H30R/Rx subgroups underwent whole-genome sequencing (WGS) and phylogenetic analysis. E. coli from Iraq showed significantly higher resistance to all tested antibiotics compared to those from the USA, with 76.2% being FQREC versus 31.2% in the USA (p < 0.01). Iraqi FQREC strains were more frequently multidrug resistant. The predominant subgroup in both countries was ST131-H30, with the notable absence of ST1193 among Iraqi FQREC. Iraqi-origin ST131-H30 strains exhibited higher minimum inhibitory concentrations (MICs) for ciprofloxacin and greater resistance to third-generation cephalosporins (3GC), trimethoprim/sulfamethoxazole (TMP/STX), and imipenem (IMI) than those from the USA. Increased 3GC resistance in Iraqi strains was linked to a higher proportion of bla CTX-M-15-carrying H30Rx subclade isolates. Additionally, Iraqi H30 strains exhibited higher MICs for fluoroquinolones due to more frequent carriage of PMQR determinants compared to US strains. Whole-genome sequencing was performed on 46 Iraqi and 63 US H30 isolates. Phylogenetic analysis revealed two clades-H30R and H30Rx-present in both countries, with isolates from both regions distributed throughout, without the emergence of distinct new major subclones. However, Iraqi isolates tended to cluster in separate subclades, indicating endemic circulation of the strain groups. In regions like Iraq, where antibiotics are overused and misused, resistance among uropathogenic E. coli to various antibiotics is significantly higher. Most Iraqi resistant strains belong to well-known international groups, and no new highly successful strains have emerged. The absence of ST1193 in Iraq may reflect regional, socioeconomic, demographic, or cultural factors that hinder the success of certain strain groups in the country.

Antibiotic prescribing practices according to the AWaRe classification among children under 5 of age attending public primary care centres in four West African countries: a cross-sectional study (AIRE project, 2021-2022).

To describe antibiotic prescribing practices using the WHO AWaRe (Access, Watch, Reserve) classification in West African children under 5 years of age attending public primary health centres (PHCs). Cross-sectional study. The AIRE project implemented the systematic use of pulse oximetry into integrated management of childhood illness consultations in West African countries (Burkina Faso, Guinea, Mali and Niger). We described antibiotic prescriptions for outpatient children at 16 PHCs and for severe cases referred at district hospitals. Between 14 June 2021 and 19 June 2022, 15 854 outpatients were included: 968 neonates and young infants (0-28 days) and 14 886 children (2-59 months). Among them, 78 (8.1%) neonates and young infants and 385 (2.6%) children were hospitalised. We evaluated 58 hospitalised neonates and young infants and 275 hospitalised children, respectively. Frequency of antibiotic prescriptions according to the AWaRe classification recommended by WHO. At the PHC level, proportions of neonates and young infants with ≥1 antibiotic prescription were 83%, 62%, 71% and 59% in Burkina Faso, Guinea, Mali and Niger, respectively. A total of 805 antibiotics were prescribed (85% Access and 13% Watch). The proportions of children with ≥1 antibiotic prescription reached 71%, 66%, 63% and 36% in Burkina Faso, Guinea, Mali and Niger, respectively. Out of the 9630 antibiotics prescribed, 93% were Access (mainly amoxicillin), and 7% Watch. At the hospital level, Watch antibiotics were mainly prescribed for severe cases referred. No Reserve antibiotics were prescribed. High proportions of antibiotics were prescribed to outpatient children included, the appropriateness of which needs further study. Nevertheless, in every country, the proportion prescribed in the Access group reached the minimum threshold of 60% of all antibiotic prescriptions, as recommended by WHO. PACTR202206525204526.

Appropriateness of antibiotic prescribing among patients treated for dental diseases in Mekelle city, Northern Ethiopia: a cross sectional study

BackgroundLocal operative treatments are generally preferred for most dental diseases, with antibiotics only recommended as an adjunct in specific cases. Misuse and overuse of antibiotics has been shown to significantly contribute to the development of resistant bacteria. However, the antibiotic prescribing practices of dentists in Ethiopia have not been thoroughly studied. This study aimed to assess the appropriateness of antibiotic prescribing for patients with dental diseases at dental clinics in Mekelle City, Northern Ethiopia.MethodsA cross sectional study was conducted in April and May 2020 among patients visiting dental clinics in Mekelle City. Data were collected through patient medical record reviews and dentist interviews. The appropriateness of antibiotic prescription was evaluated based on guidelines from the American Dental Association and the European Society of Endodontology. Data were analyzed using SPSS Statistics, version 29. Binary logistic regression analysis was performed, and the results were presented as odds ratios with 95% confidence intervals. A p value less than 0.05 was considered statistically significant.ResultsTwo hundred and thirty-one patients with dental diseases participated in the study. The mean age was 30.6 years with a standard deviation of 16.1. Most participants had dental pulp related disease. 89% of patients were prescribed antibiotics, with amoxicillin being the most common. Inappropriate antibiotic prescribing was identified in 175 (75.8%) of the study participants. The most common inappropriate prescribing was unnecessary antibiotic prescribing for dental conditions without systemic signs, assessed in 141 (80.1%) participants. Patients diagnosed with pulp related disease without systemic signs and those who had tooth extractions were significantly associated with inappropriate antibiotic prescription (p value < 0.001).ConclusionsThe study findings show that antibiotics are over-prescribed for dental conditions in this resource constrained setting, especially in patients who have had tooth extractions. Dentists need training on appropriate antibiotic use and antimicrobial stewardship interventions should be implemented in dental setting to reduce unnecessary antibiotic prescriptions and prevent antibiotic resistance development.

The Challenges of Treating a Helicobacter pylori Infection following the COVID-19 Pandemic in Croatia: A Review.

Background:Helicobacter pylori (H. pylori) is a prevalent bacterial pathogen implicated in different stomach and duodenal diseases, including chronic gastritis, gastric and duodenal ulcer, and stomach cancer. The COVID-19 pandemic has significantly influenced antibiotic prescription practices, potentially exacerbating antibiotic resistance in H. pylori. Objective: This study aims to investigate antibiotic prescription during the COVID-19 pandemic in Croatia and its possible impact on H. pylori antibiotic resistance, with a focus on Croatia. Methods: An extensive literature search was conducted to identify relevant studies from March 2020 to June 2024. The search strategy included terms related to COVID-19, antibiotic prescription, and Croatia. Studies were selected based on predefined eligibility criteria, focusing on observational research addressing antibiotic use during the pandemic. Results: The COVID-19 pandemic has led to significant fluctuations in community antibiotic consumption within the European Union/European Economic Area. In Croatia, antibiotic use in 2022 surpassed 2019 levels, driven by increased consumption of macrolides and other antibiotics. This surge, influenced by early pandemic treatment claims and penicillin shortages, contributed to rising antibiotic resistance in H. pylori. Resistance rates to clarithromycin and levofloxacin were notably high, driven by mutations in the 23S rRNA, gyrA, and gyrB genes. Discussion: The increased antibiotic use during the COVID-19 pandemic has highly likely complicated H. pylori eradication efforts, highlighting the necessity of judicious antibiotic use and robust antimicrobial stewardship. The pandemic underscored the need for new therapeutic strategies, optimized eradication regimens, and advanced diagnostic methods to manage bacterial infections effectively. Conclusions: The COVID-19 pandemic has significantly affected antibiotic use and resistance patterns, posing new challenges for H. pylori eradication. Addressing these challenges requires a multifaceted approach, including the development of new drugs and advanced diagnostics, coupled with sustained efforts in antimicrobial stewardship to combat emerging resistance threats.

Appropriate antimicrobial prescribing for bacteriuria before urological procedures: A room for improvement

In the presence of a positive preoperative urine culture, the prescription of a preoperative antibiotic therapy is recommended. The choice of antibiotic therapy and prescription are usually made by the urologist or the general practitioner (GP). The objective of the treatment is urinary sterilization rather than parenchymal treatment, and the treatment choice is key to reduce selective pressure and antimicrobial resistance. The objective of this study was to evaluate prescription patterns made by urologists and GPs, then to compare the antibiotics chosen by urologists or GPs to the “ideal” treatment defined by infectious diseases specialists. We retrospectively reviewed all positive preoperative urine cultures obtained between November 2022 and July 2023. Data pertaining to antibiotic prescriptions, including the duration of treatment, antibiotic class, and prescriber were collected. An infectious disease specialist conducted a blind review of each urine culture, providing recommendations for the most appropriate antibiotic based on their assessment. In cases of disagreement, a second infectious disease specialist conducted a similar evaluation. Out of 196 preoperative antibiotic prescriptions, 40 (20%) differed from the recommendations provided by the infectious disease specialist, with 39 involving the use of overly broad-spectrum antibiotics. Both infectious disease specialists yielded congruent recommendations in all cases. Notably, in 50% of these instances, the preoperative antibiotic treatment duration unduly exceeded 48hours. A statistically significant increase (4.84days vs. 2.99days) in preoperative treatment duration was observed when a GP was the prescriber (P<0.001). There is room for improvement of urologists’ antibiotic prescription practices to reduce the ecological impact on the patient's microbiota and on a global scale. The delegation to GPs resulted in unjustified longer treatment durations and should be avoided without dedicated training. Level of evidence4.