Antibiotic Prescribing Research Articles

Predicting individual patient and hospital-level discharge using machine learning

Abstract Background Accurately predicting hospital discharge events could help improve patient flow and the efficiency of healthcare delivery. However, using machine learning and diverse electronic health record (EHR) data for this task remains incompletely explored. Methods We used EHR data from February-2017 to January-2020 from Oxfordshire, UK to predict hospital discharges in the next 24 h. We fitted separate extreme gradient boosting models for elective and emergency admissions, trained on the first two years of data and tested on the final year of data. We examined individual-level and hospital-level model performance and evaluated the impact of training data size and recency, prediction time, and performance in subgroups. Results Our models achieve AUROCs of 0.87 and 0.86, AUPRCs of 0.66 and 0.64, and F1 scores of 0.61 and 0.59 for elective and emergency admissions, respectively. These models outperform a logistic regression model using the same features and are substantially better than a baseline logistic regression model with more limited features. Notably, the relative performance increase from adding additional features is greater than the increase from using a sophisticated model. Aggregating individual probabilities, daily total discharge estimates are accurate with mean absolute errors of 8.9% (elective) and 4.9% (emergency). The most informative predictors include antibiotic prescriptions, medications, and hospital capacity factors. Performance remains robust across patient subgroups and different training strategies, but is lower in patients with longer admissions and those who died in hospital. Conclusions Our findings highlight the potential of machine learning in optimising hospital patient flow and facilitating patient care and recovery.

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.

Antibiotic Prophylaxis Prior to Dental Procedures

Antibiotic prophylaxis in dentistry has been recommended for different groups of patients, such as patients with impaired immunologic function, patients at risk of developing infective endocarditis or prosthetic joint infection, patients previously exposed to high-dose irradiation of the head and neck regions, and patients receiving intravenous bisphosphonate and antiangiogenic treatment. The guidelines have been changed over the years, and the list of medical conditions requiring antibiotic prophylaxis has been shortened considerably in the context of antibiotic resistance and unnecessary antibiotic prescription.

Antimicrobial stewardship implementation in primary and secondary tier hospitals in India: interim findings from a need assessment study using mixed method design.

Anti-microbial stewardship program (AMSP) is practiced only in tertiary hospitals in India, though, the lower tier hospitals remain the first point of contact in patient care. This study was conducted in lower tier hospitals to calculate antibiotic and multiple antibiotic prescription rate (APR, MPR) for common infections and finding existing strength of health system for optimizing antibiotic prescription. We conducted a cross sectional convergent parallel mix-method study in eight lower tier hospitals of three districts of West Bengal, India. Six hundred OPD prescriptions of UTI, ARI, AUFI, ADD were evaluated. Qualitative data collected through in-depth interviews of medical officers/officers in administrative positions, infection control nurses were analyzed using content analysis method. APR was 63.8% in primary tier hospitals and 60.8% in secondary tier hospitals. The MPR was higher in secondary tier hospital (23.8%). Presence of infection control committee, designated nursing staff, initiation of prescription audit, increased monitoring were identified as few facilitators for future implementation of AMSP in lower tier hospitals. The routine infection control activities of lower tier hospitals are currently delinked from AMR containment measures and thus, customized AMSP needs to be established in these hospitals catering two third of the population of India.

Investigation of the Prevalence and Treatment of Atopic Dermatitis in South Korea Using a Large National Dataset.

Updated reports on the population-based analysis of atopic dermatitis (AD) in Korea are rare. This study aimed to investigate the nationwide prevalence and systemic medication prescription trends of AD in Korea. Based on the Korean National Health Insurance database, the prevalence of AD and systemic medication prescription trends in patients with AD were analyzed according to age groups and regional districts from 2010 to 2015. The prevalence of AD was the highest among patients aged 0-1 year (18.6%-24.5%), decreasing rapidly with increasing age (<2% in patients aged ≥20 years). From 2010 to 2015, the prevalence of AD decreased in children but increased slightly in adolescents and adults. In 2015, the proportion of systemic steroid prescriptions increased from 11.2% in the 0-9 years age group to 41.1% in the 50-59 years age group, while that of systemic antibiotic prescriptions gradually decreased from 6.2% in the 0-9 years age group to 1.8% in the 80-89 years age group. The proportion of systemic steroid prescriptions by region remained consistently high in Gyeongbuk (34.2%- 34.9%) and low in Daejeon (20.2%-22.5%). The annual proportion of systemic cyclosporine prescriptions increased significantly from 0.6% in 2010 to 1.2% in 2015, with the highest rates observed in patients in their 30s (1.5%-2.4%), followed by those in their 20s (1.3%-2.3%) and 40s (1.1%-2.0%). From 2010 to 2015, the prevalence of AD decreased in children but increased slightly in adolescents and adults. Approximately one-fourth of the patients with AD were prescribed systemic steroids, and the percentage of cyclosporine prescriptions doubled during the study period.

Hops bitter β-acids have antibacterial effects against sinonasal Staphylococcus aureus but also induce sinonasal cilia and mitochondrial dysfunction.

Routine prescription of antibiotics to treat chronic rhinosinusitis (CRS) exacerbations may contribute to the propagation of antibiotic resistance. Hops bitter β-acids lupulone and colupulone possess potent antibacterial activities and, as T2R1, T2R14, and/or T2R40 agonists, may improve the impaired mucociliary clearance described in CRS patients. We investigated these molecules as alternative treatments to antibiotics in CRS management based on their antibacterial and T2Rs agonists properties. Human nasal primary cells (HNECs) and RPMI2650 cells cultures were used as study models. T2Rs expression in cell culture models and human nasal tissue was assessed using immunofluorescence, quantitative PCR, and Western blot. We performed calcium imaging and cilia beat frequency experiments to investigate T2Rs activation in study models in response to lupulone and colupulone stimulations. Finally, we studied hops β-acids cytotoxicity on cells using CellEvent, crystal violet, lactate dehydrogenase assays, immunofluorescence, and transepithelial electrical resistance assays. We confirmed lupulone and colupulone potent antibacterial effect on CRS-relevant methicillin-resistant Staphylococcus aureus but found minimal impact on P. aeruginosa. We also report T2R1, T2R14 and T2R40 expression in HNECs and RPMI2650 cell cultures. Lupulone and colupulone induced an increase in cytosolic calcium that appeared dependent on T2Rs signaling. This response was accompanied by mitochondrial membrane depolarization, cellular energy stress, decreased cell proliferation, ciliostasis, and HNECs remodeling after a single exposure to lupulone at micromolar concentrations. Our data suggest that hops β-acids may not be beneficial as treatments in CRS patients and instead contribute to the disease by impairing cell health and further deteriorating the MCC.

BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age &amp;gt; 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project.

The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use. To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections. Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain. Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared. A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%. External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings.

EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases.

To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath-assisted flexible cystoscopy (eFC). EndoSheaths are single-use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time-consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced. All adult patients undergoing eFC over a 26-month period at a single institution were evaluated prospectively. Post-eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2-4 = mild, 5-7 = moderate, 8-10 = severe). The diagnosis of UTI was broad and based on any one of patient self-report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi-squared testing (P < 0.05, two-tailed). Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post-eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis. This large, prospective, unselected, real-world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.

Potential Impact of Rapid Molecular Microbiologic Diagnosis for Mechanically Ventilated Children in Intensive Care With Suspected Pneumonia

Background: Lower respiratory tract infections (LRTIs) remain a leading cause of community-acquired and nosocomial infection in children and a common indication for antimicrobial use and intensive care admission. Determining the causative pathogen for LRTIs is difficult and traditional culture-based methods are labor- and time-intensive. Emerging molecular diagnostic tools may identify pathogens and detect antimicrobial resistance more quickly, to enable earlier targeted antimicrobial therapy. Methods: This is a single-center, prospective observational laboratory study evaluating the use of the Biofire FilmArray pneumonia panel (FA-PP) (BioFire Diagnostics, Salt Lake City, UT) for bronchoalveolar lavage specimens from mechanically ventilated children admitted with suspected or presumed pneumonia. We aimed to determine its feasibility and utility for identifying pathogens, antimicrobial resistance and its potential influence on antibiotic prescribing. Results: We analyzed 50 samples taken from 41 children with a median age of 6 months. Positive agreement between culture and FA-PP was 83% and negative agreement was 76%. Agreement between FA-PP (mecA/C or MREJ) and culture was high for methicillin-resistant Staphylococcus aureus. In 3 cases, extended-spectrum beta-lactamase-producing Gram-negative organisms were detected by culture and not FA-PP. Hypothetically, FA-PP results would have affected antimicrobial prescribing in approximately half the cases (24, 48%). Conclusions: FA-PP is a useful adjunct to traditional culture methods in mechanically ventilated children with LRTIs and may influence clinical decision-making regarding antibiotic escalation or stewardship.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

Knowledge and attitudes of patients in underserved communities regarding antibiotic resistance, antibiotic stewardship, and pharmacist involvement in antibiotic prescribing: A regional survey.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Despite the effectiveness of antibiotic stewardship programs (ASPs) in improving antibiotic prescribing, these are rarely implemented in clinics serving underserved communities. Our objective was to understand patients' perspectives on the factors that can impact implementation of ASPs and integration of pharmacists in antibiotic prescribing in rural clinics. We conducted a survey using both quantitative questions and an open-ended question. To participate, patients had to receive care from a clinic serving low-income or rural communities and provide verbal consent to be included in the study. We analyzed the quantitative component of the data using descriptive statistics. The Pearson correlation coefficient was used to examine the relationship between respondents' knowledge of the prevalence of antibiotic resistance and their attitudes toward ASPs and pharmacist integration in antibiotic prescribing. Of the 189 respondents who completed a survey, 51.3% were female and 51.3% were Caucasian. In our analysis, over 60% of patients reported knowing their prescribed antibiotics' names, while less than 30% possessed adequate knowledge of the indication and duration of the prescribed antibiotics. There was a positive correlation between knowledge about antibiotic resistance and being comfortable involving pharmacists in antibiotic prescribing (P < 0.01). Many patients supported pharmacist involvement in antibiotic prescribing. Understanding patients' perceived attitudes will facilitate patient-centered, infrastructure-supported interventions by clinicians to improve antibiotic prescribing in the community.

Antibiotic prescribing in health and justice settings (HJS)-surveillance and opportunities for quality improvement

Abstract Introduction Improving surveillance of antibiotic prescribing and reducing health inequalities in antimicrobial resistance (AMR) are priorities in the new 5 year AMR national action plan (2024-2029)1. People in contact with the justice system are one of the inclusion groups in the CORE20plus5, a national NHE England approach to support reduction of health inequalities.2 Aim This project aimed to collate and analyse all antibiotic prescribing data from English prisons in order to identify opportunities for quality improvement. Method This project analysed antibiotic prescribing data from September 2022 to current date for the first time in HJS from the IT system used in all prisons in England. No ethical approval is required as surveillance is of anonymised data only. Data was broken down by age band (18 and under, 19-49, 50 and over), category of prison, region, ICB, individual prison and antibiotic type. The dashboard allows benchmarking across sites and comparison with primary care, as prisoners in HJS are considered to have similar infections to primary care patients. Results The majority of prescribing is in male prisoners, reflecting the male/female population split. The most frequently prescribed antibiotics are those used for: skin and soft tissue (including acne), respiratory tract, dental and urinary tract infections. A number of focus areas for quality improvement have been identified, including: Broad spectrum antibiotics (Cephalosporins, Co-amoxiclav and Quinolones), target of &amp;lt;10% total antibiotic prescribing in primary care, in HJS, currently 11%. Appropriate quinolone prescribing is a target in all settings due to recent MHRA alert3. Acne prescribing represents a significant proportion of antibiotic prescribing in HJS. Lymecycline 12%, whereas in primary care &amp;lt;3%. Duration of Antibiotic Courses: In primary care there is a medicines optimisation opportunity ambition to achieve 75% prescribing amoxicillin 500mg as 5 day duration. In HJS only 27% is for 5 days. When prescribing 100mg doxycycline for respiratory infections, NICE guidance recommends a 5 day course, but in HJS only 3% is prescribed as a 5 day course. For UTI in female prisons, nitrofurantoin 100mg MR is most commonly prescribed, NICE guidance for UTI in women is for 3 days; 47% in HJS are for 3 days, but 35% are 7 day courses. Discussion and Conclusion This dashboard provides insight into antibiotic prescribing data allowing opportunities for quality improvement opportunities to be identified and antimicrobial stewardship interventions to be evaluated. This work will progress to tackle the focus areas identified. Next steps are to work with antibiotic champions from HJS to co-produce intervention plans, share patient safety messages, trial available resources, rollout interventions and monitor impact via the dashboard. Limitations Indications are not available from the data but extrapolated from the antibiotic prescribed. The dashboard is currently an excel spreadsheet in NHSE. It will be moved to a platform that enables access by individual prisons.

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Republic of Korea.

This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data. Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included. Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas Plasmodium malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021. Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.

Healthcare workers' views on antibiotic prescribing and stewardship during the COVID-19 pandemic at an NHS Foundation Trust in England: a cross-sectional survey

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge, projected to cause 10 million deaths annually by 2050.1 In response, the UK Government developed a five-year national action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use and implementing antimicrobial stewardship.2 The COVID-19 pandemic has significantly impacted the healthcare system, jeopardising public health and causing millions of deaths worldwide. The pandemic has exacerbated AMR due to increased antimicrobial therapy and misuse.3 Aim This study explores healthcare workers’ (HCWs) views towards antibiotic prescribing, AMS and AMR during the COVID-19 pandemic in a UK secondary care setting. Methods This cross-sectional study employed an online questionnaire survey conducted at an NHS Foundation Trust in the East of England, targeting doctors, nurses, and pharmacists. The total eligible participants comprised 5,636 doctors, 2,140 nurses, and 206 pharmacists. Data collection was carried out using Qualtrics XM from 12 June to 13 September 2023. Inclusion criteria required healthcare workers (HCWs) to be adults aged 25 or older, registered with relevant professional bodies, and employed during the pandemic. Data analysis involved both descriptive statistics and qualitative methods to interpret participants’ open-ended responses to the question, “What lessons have been learnt during the COVID-19 pandemic?” This study was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC reference number 22/EM/0161). The Citizens Senate reviewed the study protocol to ensure public and patient involvement. Results A total of 23 HCWs completed the survey, including 12 pharmacists, nine doctors, and two nurses. The survey included an open-text section where respondents shared lessons learned during the COVID-19 pandemic. Among pharmacists, 75% (9 out of 12) identified inappropriate antibiotic use without clinical justification as a significant issue, and 67% (8 out of 12) reported an increase in healthcare-associated infections (HCAIs). Additionally, 83% (10 out of 12) noted the positive impact of technology platforms and antibiotic reviews on implementing effective and sustainable AMS. Among doctors, 89% (8 out of 9) emphasised the need for reliable information dissemination, observing that social media often overshadowed evidence-based guidelines. Additionally, 78% (7 out of 9) stressed the importance of staying informed about resistance patterns and antibiotic prescribing trends. All nurses highlighted the significance of AMR awareness and reported that mental fatigue affected decision-making during the pandemic. Discussion/Conclusion This study highlights the essential role of technology platforms in enhancing antimicrobial stewardship practices and the necessity of disseminating reliable information to counter misinformation. The pandemic highlighted the need for clear guidelines and robust communication strategies to support clinical practices. However, this study has limitations, including a small sample size of 23 participants, which may affect the generalisability of the findings. Future research should include larger, more diverse samples to validate these findings and assess specific AMS interventions. The study also revealed the importance of resilient AMS implementation to optimise antibiotic use and improve patient outcomes. Achieving this requires ongoing AMS education, interdisciplinary collaboration, and adaptive strategies to effectively mitigate antimicrobial resistance.

Trends in antibiotic use in a UK secondary care prior to and during the COVID-19 pandemic: a cross-sectional retrospective study

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge. To address this, the UK Government developed a 5-year action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use.1 The World Health Organisation (WHO) promotes antimicrobial stewardship (AMS) and developed the AWaRe classification system to guide global AMS implementation. The defined daily dose (DDD) standardises antibiotic use comparisons.2 The COVID-19 pandemic significantly impacted health services, particularly in secondary care, potentially exacerbating AMR due to increased antibiotic use.3 Aim To evaluate changes in antibiotic use in a UK secondary care setting following the onset of the COVID-19 pandemic in 2020 compared to 2019. Methods This cross-sectional retrospective study evaluated antibiotic use among adult patients admitted to an NHS Foundation Trust in England. The focus was on those prescribed antibiotics for respiratory tract infections (RTIs) and pneumonia in 2019 and 2020. Data from 640 patient records were extracted using a validated tool based on the WHO AWaRe classification, with antibiotic use measured using the Defined Daily Dose (DDD). The study included patients aged 25 and above, immunocompromised individuals, pregnant women, and those treated for RTIs. It was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA). The Citizens Senate reviewed the study protocol, ensuring public and patient involvement. Results The results show a notable increase in the Defined Daily Dose (DDD) of several antibiotics during the COVID-19 pandemic. In the "Access" category, amoxicillin usage rose from 1.33 DDD pre-pandemic to 4.33 DDD in 2020. Co-amoxiclav remained nearly constant at around 15 DDD but showed a marked increase compared to other antibiotics. In the "Watch" category, azithromycin increased from 3 to 9 DDD, and clarithromycin from 32 to 35.5 DDD. Levofloxacin usage doubled from 13 to 26 DDD. The "Reserve" category showed no significant increase, indicating stable consumption. Discussion and conclusion Understanding trends in antibiotic prescribing during the COVID-19 pandemic is pivotal for effective management in secondary care settings. The significant increase in the "Watch" category of antibiotics, particularly macrolides like azithromycin and clarithromycin, highlights the need for stringent antimicrobial stewardship. This rise may reflect changes in prescribing behaviour due to the pandemic. Monitoring antibiotic use is vital to mitigate the AMR challenge. Additionally, the increased use of levofloxacin during the pandemic, despite MHRA safety alerts about its potentially severe side effects, highlights the importance of cautious antibiotic prescribing and prompt discontinuation at the first signs of adverse reactions. The COVID-19 pandemic has significantly influenced antibiotic prescribing trends, highlighting the urgent need for sustainable antimicrobial stewardship in secondary care. This study reveals a notable increase in "Watch" category antibiotics, particularly azithromycin and clarithromycin, underscoring the need for stringent stewardship. Optimised antibiotic use is crucial for patient safety, improving treatment quality, and saving lives. The increased reliance on levofloxacin, despite known risks, emphasises the importance of careful prescribing. Prioritising responsible antibiotic use is essential to combat antimicrobial resistance, necessitating enhanced monitoring and stewardship efforts.

An audit to evaluate the prescribing of antibiotics for acne against NICE guidelines in a digital setting

Abstract Introduction According to NICE guidelines, individuals with moderate to severe acne may be recommended a fixed combination of topical treatment along with either oral lymecycline or doxycycline for a 12-week regimen1. If improvement is observed in these patients, continuation of the oral antibiotic and non-antibiotic-topical treatment for an additional 12 weeks is advised. It's important to adhere to these guidelines and avoid prescribing monotherapy topical antibiotics, monotherapy oral antibiotics, or the combination of topical antibiotics with oral antibiotics2. This audit aims to verify our compliance with these guidelines and ensure the appropriate use of antibiotics in our prescribing within a digital setting where patients undergo photo assessment consultations. Aim The objective of this audit is to ascertain our adherence to the NICE acne guidelines regarding the duration of oral antibiotic therapy prescribed and the accurate prescribing of topical treatments in conjunction with the oral antibiotic1. The audit criteria entail ensuring that 100% of consultations result in prescriptions aligning with the following: oral antibiotic treatment not exceeding 6 months, a prescribed non-antibiotic topical treatment alongside oral antibiotics, and avoidance of prescribing a combination of topical antibiotics with oral antibiotics. Method A retrospective review was conducted on all consultations involving the prescribing of oral and topical antibiotics from 22.4.2023 to 18.4.2024. Each consultation was assessed for the quantity of oral antibiotics prescribed over a 12-month period and examined for the accompanying topical treatments. Additionally, checks were made to determine if the patient was currently taking any oral or topical antibiotics from other sources, ensuring that antibiotics were not overprescribed and that co-prescribing practices adhered to guidelines. Ethical approval was not required since this is a clinical audit. Results The data extraction identified 427 consultations in which patients were prescribed either oral antibiotics (361 cases) or topical antibiotics (Duac-66 cases). In 99% of the consultations, patients were not prescribed oral antibiotics for more than six months. The remaining 1% of patients had already been prescribed oral antibiotics from other sources. It is noted that additional queries should have been conducted to ascertain the duration of antibiotic use prescribed elsewhere. Furthermore, 99% of consultations adhered to the criteria of prescribing a non-antibiotic topical treatment alongside an oral antibiotic. The remaining 1% involved patients who were already using a topical antibiotic from another source, which should have been further investigated to ensure cessation upon initiation of the prescribed oral antibiotics. In all cases, patients were prescribed an appropriate topical treatment in conjunction with an oral antibiotic from our digital setting. Discussion This audit confirms high compliance with NICE guidelines for acne treatment within our digital consultation framework1. Specifically, 99% of consultations adhered to the duration regimen of oral antibiotics, ensuring prescriptions did not exceed six months. Additionally, the majority of cases, correctly included non-antibiotic topical treatments alongside oral antibiotics, minimising the risk of antibiotic resistance. However, slight differences were noted in cases where patients had existing prescriptions from other sources. These findings highlight the effectiveness of our prescribing practices and the importance of thorough patient medication history reviews.

A scoping review of the integration of non-medical prescribing for acute common clinical conditions by community pharmacists

Abstract Introduction Non-medical prescribing enhances patient care, safety, and medication accessibility, while also maximising expertise1. Some evidence exists for a variety of factors at individual, organisational, regulatory, and policy levels impacting the implementation of PP in community pharmacy2. Common clinical conditions (CCC) can be defined as ‘a broad range of self-limiting conditions that are more complex in their diagnosis and treatment than minor ailments and management that often involves the need for prescription medicines’. Aim To collate and characterise literature on the integration of non-medical prescribing for acute common clinical conditions by community pharmacists. Method This scoping review followed the Arksey and O’Malley framework. The review team comprised a doctoral student (LK), a research fellow (TJ) and a professor of pharmacy (SC), all with experience of review methodology, community pharmacy research and /or practice. Eligibility criteria, search databases and terms were defined. Medline, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched for full text, English language, peer reviewed original papers, randomised controlled trials, cross-sectional and cohort studies, papers reporting empirical data from primary research and review articles including systematic reviews /scoping reviews /narrative reviews from January 2006 to October 2023. The (global) focus was on services delivered by pharmacists and pharmacy team members in community pharmacy for the management of CCC, using non-medical prescribing rights. Search terms included “independent prescrib*”, “pharm* independent prescri*”, “pharm* prescrib*”, “non-medical prescri*, “non-medical prescri*”, “pharm* supplementary prescri*” and “collaborative prescrib*”. Following screening and full text review a narrative synthesis approach3 was used to address the aim which involved: preliminary synthesis through data extraction and tabulation of key study characteristics, exploration of relationships and differences across the studies and finally evaluation of the robustness of the synthesis. The Consolidated Framework for Implementation Research provided a theoretical lens to support synthesis, identifying barriers and facilitators for integration. All steps were independently checked by two review team members. Ethics approval was not required because this was a scoping review. Results From a total 1018 records identified, 10 papers remained after removal of duplicates, title /abstract screening and full text review. The majority of studies were from Canada and the aims and linked outcomes of studies focused on pharmacists’ views and experiences, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antibiotic prescribing. A wide range of barriers and facilitators to implementation were identified including “regulatory constraints” and “fiscal challenges” at a macro socio-organisational level and a plethora of dichotomous challenges within organisations including a lack of clarity on the pharmacist’s scope of practice and linked consumer confusion, staffing levels and workload, with specific mention of paperwork and access to patient records. Conclusion The small number of studies included indicates that there is a paucity of research in this area. There is a need for increased efforts to consider this topic further and identify ways to address the challenges for further widespread implementation and uptake of such services.

The feasibility, acceptability and perceived impact of a theory-based intervention on non-medical prescribing students’ antibiotic prescribing behaviour: an experimental study

Abstract Introduction Acute upper respiratory tract infections (URTI) are one of the most common infections. URTIs usually resolve spontaneously but 60% of all prescriptions issued in UK primary care are for URTIs1 contributing to antimicrobial resistance. Non-medical prescribers are a growing group of prescribers but there are few if any antimicrobial stewardship (AMS) interventions to support their prescribing practices. Introducing AMS interventions when learning to prescribe can play an important role to embed appropriate practice at the start of a prescribers’ journey. Aim To test the feasibility, acceptability and perceived impact of a theory-based electronic learning intervention on the antibiotic prescribing behaviour of non-medical prescribing students. Methods Non-medical prescribing students registered at the study setting (university) were recruited via email and word of mouth. Following consent, participants completed an online pre-intervention questionnaire that explored their perceived prescribing behaviour and confidence in treating patients with URTIs. Participants then completed the intervention, accessible from any internet-enabled device via a weblink. The intervention was previously developed2 using the behaviour change wheel and comprised an animation of a prescriber opting against prescribing antibiotics for an adult with self-limiting URTI using a motivational interviewing approach. The patient felt satisfied and confident about their care. Four questions followed the scenario. Participants then completed an online post-intervention questionnaire that explored the usefulness of the intervention, and the same pre-intervention confidence questions. A one-to-one online audio-recorded semi-structured interview followed, exploring participants’ experiences of using the intervention. Questionnaire and interview questions were informed by the Capability Opportunities Motivation-Behaviour model. Questionnaire data were analysed using descriptive statistics. Interviews were transcribed verbatim and analysed using thematic analysis3. Ethical approval was given by the School Research Ethics Committee where the researchers were based. Results Twelve participants (of 50 approached) consented to take part. Eight completed the pre- and post-intervention questionnaires and the intervention. Seven completed all stages of the study. 87.5% of participants worked in a hospital setting. All were qualified for at least two years. Interviews lasted between 9-15 minutes. Participants’ confidence in treating patients with URTI increased in all statements; gain information on patient expectations, support patients’ comprehension of health information, build rapport, communicate effectively, help patients to see and examine different viewpoints (highest mean increase) and patients understand and are happy with their prescribing decision. These increases aligned with qualitative accounts. Participants agreed that the intervention would be useful to them and would change their practice positively. Participants found the intervention easy to use; access was straightforward and took between 5-20minutes to complete. The addition of a wider range of complex, challenging scenarios to the intervention were suggested. Discussion/conclusions The intervention was feasible to complete and acceptable to the participants. Participants’ confidence in treating patients increased; even though many were familiar with AMS, the intervention gave them further confidence to support a no antibiotic prescribing strategy. Participants suggested including more complex patient scenarios; this will be considered in a future study. Study limitations includes a small sample size and most participants worked in hospital settings but the intervention was set in primary care.

Antibiotics Knowledge and Prescription Patterns Among Dental Practitioners in Croatia, Bosnia and Herzegovina, and Serbia: A Comparative E-Survey with a Focus on Medically Healthy and Compromised Patients

Background: The non-specific prescription of antibiotics, especially in dentistry, contributes to the global problem of antimicrobial resistance and highlights the need for education on the proper use and serious consequences of overprescribing these drugs. The main objective of this study is to assess and evaluate antibiotic knowledge and prescribing patterns in dental practice in Croatia, Bosnia and Herzegovina, and Serbia, focusing on understanding the rationale for prescribing, adherence to evidence-based guidelines, and dentists’ awareness of antibiotic resistance. Methods: A total of 795 dentists participated in this electronic cross-sectional survey (Croatia N = 336, Bosnia and Herzegovina N = 176, and Serbia N = 283). The study utilized a self-structured questionnaire to collect data on various aspects of antibiotic use, including knowledge, prescribing practices, awareness of guidelines, and demographic and professional information about dentists. Data analysis included the Mann–Whitney test, the Kruskal–Wallis test with post hoc analysis, and chi-square tests, with statistical significance set at p &lt; 0.05. Results: The overall score for the participants’ knowledge of antibiotics was 6.40 ± 1.40 out of a maximum of eight points, which indicates a generally good level of knowledge among dentists. Factors such as gender, specialty, and practice location significantly influenced the level of knowledge (p &lt; 0.05). However, actual prescribing practice was a cause for concern. Only 66.1% of Croatian dentists felt they had received adequate training during their studies, and even fewer in Serbia (48.4%) and Bosnia (46.6%). It is noteworthy that 9.7% of dentists in Bosnia and Herzegovina prescribe antibiotics at the request of patients, while 22.3% of Croatian and 25.4% of Serbian dentists do so. Many dentists prescribe no or only one antibiotic per week. In addition, 50.9% of Croatian dentists reported adverse effects related to the use of antibiotics, while only 31.3% of Bosnian and 33.6% of Serbian dentists reported similar experiences. Conclusions: While the study results indicate that dentists in the region generally possess good knowledge of antibiotic use, there are significant discrepancies between this knowledge and actual prescribing practices. This highlights the need for enhanced educational programs and awareness initiatives focused on proper antibiotic guidelines to improve prescribing behaviors.