Antibiotics For Respiratory Infections Research Articles

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.

Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities

ObjectivesTo identify factors contributing to general and inappropriate antibiotic prescription among long-term care facility (LTCF) residents with lower respiratory tract infections (LRTI). MethodsProspective multicentric observational study. Residents with LRTI were recruited among 32 LTCFs in Western Switzerland during winter 2022-2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. To identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription, we used multivariable logistic regression and backward selection with a p-value cutoff of <0.1. ResultsWe included 114 residents, 63% female, median age of 87 years. Overall, 59 (52%) residents had diagnostic tests performed: 50 (44%) had a PCR for respiratory viruses and 16 (14%) had a blood test with CRP and/or blood count. A total of 63 (55%) residents received antibiotics.Factors associated with antibiotic prescriptions were CFS ≥ 7 (aOR 6.8, 95% CI 1.5-24.4), oxygen saturation < 92% (3.5, 1.4-8.8), performing a blood test (0.1, 0.0-0.6), rural LTCFs (0.3, 0.1-0.7), and female physician (0.3, 0.1-0.8). Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with as only protective factor performing a respiratory virus PCR test (0.1, 0.0-0.4). Conclusions and ImplicationsWhile half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53-80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs.

Impact of Educational Films on Antibiotic Prescription among Physicians: A Web-Based Survey in Japan.

Although antibiotics are most frequently prescribed for respiratory tract infections, effective interventions for their proper use by physicians have not been fully established. We assessed the impact of educational films on the rates of antibiotic prescriptions for respiratory tract infections using fictitious scenarios. In this nationwide web-based survey prospective study, a total of 1100 physicians were included. The physicians were required to view educational short films and determine the need for prescribing antibiotics in 10 fictitious scenarios involving adults diagnosed with different acute respiratory tract infectious diseases. The antibiotic prescription rates for each scenario were compared before and after viewing the educational short film. The rates of antibiotic prescription significantly decreased after viewing the educational film, especially in cases with a narrowly defined common cold (from 51% to 15%), mild pharyngolaryngitis (from 71% to 25%), and acute bronchitis without chronic respiratory underlying diseases (from 63% to 23%). Alternatively, a slight decrease in rates was observed in cases with moderate or severe rhinosinusitis (from 94% to 79%), moderate or severe acute pharyngitis (from 88% to 69%), and acute bronchitis with chronic lung disease (from 70% to 58%), for which antibiotics are recommended. Educational short films may encourage the proper use of antibiotics for respiratory tract infections; however, the possibility of undertreatment in patients requiring antibiotics must be considered.

Impact of antibiotic therapy in patients with respiratory viral infections: a retrospective cohort study

Objectives The impact of antibiotics in patients with positive polymerase chain reaction (PCR) for respiratory viruses without evidence of a respiratory bacterial co-infection is largely unknown. The aim of this study was to assess the association of antibiotics on 30-day mortality and length of hospital stay in patients with an acute respiratory infection and PCR documented presence of respiratory viruses. Methods We conducted a retrospective cohort study of adult patients admitted to hospital between 2012 and 2021 with positive PCR for influenza virus (H3N2, H1N1, influenza B), respiratory syncytial virus, human metapneumovirus or severe acute respiratory syndrome coronavirus 2. We used logistic regression, the Kaplan–Meier estimator and Poisson’s regression to assess the impact of antibiotic therapy on outcomes. Results Among 3979 patients, 67.7% received antibiotics. In adjusted analyses, antibiotics initiated in the emergency department (adjusted OR 1.23, 95% CI 0.77–1.96) and days of antibiotic therapy (adjusted OR per day of therapy 0.98, 95% CI 0.95–1.00) had no significant impact on mortality, whereas antibiotics initiated later during admission (adjusted OR 2.25, 95% CI 1.26–4.02) was associated with increased mortality. Patients prescribed antibiotics had longer duration of hospital admission. Conclusions We observed no protective association between in-hospital antibiotic therapy and outcomes, suggesting overuse of antibiotics in respiratory infections with proven respiratory viruses. A restrictive antibiotic strategy may be warranted.

Behaviour change interventions addressing antibiotic treatment seeking behaviour for respiratory tract infections in primary care settings: A scoping review protocol

Objective This scoping review aims to synthesise the extent and type of evidence on behaviour change interventions which address antibiotic treatment seeking behaviour for respiratory tract infections in the primary care/community setting. Introduction Antimicrobial Resistance is recognised as a global health and economic threat by the World Health Organization and World Bank. Several lines of evidence point to patient and public demand as a key driver of inappropriate antibiotic use. Current policy initiatives acknowledge the need to prepare for the future by managing public expectations regarding antibiotics, especially for influenza-like illness and other respiratory tract infections. These initiatives emphasise the importance of designing and evaluating effective interventions that generate actionable knowledge for policy and practices related to the appropriate use of antibiotics. Behaviour change interventions, in this context, can aim to modify patients' attitudes, beliefs, and behaviours regarding antibiotics. Inclusion criteria Identified studies will describe behaviour change interventions aimed at potential patients/participants within the primary care/community setting that address patient expectations of antibiotic use for respiratory tract infections. Diagnoses for respiratory tract infections will be classified by ICD-10 criterion. Methods This scoping review will search the literature in Medline, Embase, CINAHL, PsycINFO, Web of Science Core Collection, Scopus, and Google Scholar to explore behaviour change interventions used to reduce expectations of antibiotics for respiratory tract infections in primary care. This review will follow the Joanna Briggs Institute guidelines for scoping reviews. It will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Risk of bleeding amongst warfarin and direct oral anticoagulant users prescribed immediate antibiotics for respiratory tract infection: Cohort study.

Incidence of bleeding amongst warfarin and direct oral anticoagulant (DOAC) users is greater following a respiratory tract infection (RTI). It is unclear whether immediate antibiotics modify this association. We estimated the risk of bleeding amongst warfarin and DOAC users with RTI by antibiotic treatment. This retrospective cohort study used data from the Clinical Practice Research Datalink (CPRD) GOLD for adults in England prescribed warfarin or a DOAC, who sought primary care for an RTI between 1st January 2011 and 31st December 2019. Outcomes were major bleeding (hospital admission for intracranial or gastrointestinal bleeding), and non-major bleeding (hospital admission or General Practice consult for epistaxis, haemoptysis, or haematuria). Cox models derived hazard ratios (HRs) and 95% confidence intervals (CIs) for each outcome, adjusting for confounders using inverse probability of treatment weighting. Of 14 817 warfarin and DOAC users consulting for an RTI, 8768 (59%) were prescribed immediate antibiotics and 6049 (41%) were not. Approximately 49% were female, and median age was 76 years. Antibiotics were associated with reduced risk of major bleeding (adjusted HR 0.38, 95% CI 0.25 to 0.58). This was consistent across several sensitivity analyses. Antibiotics were also associated with a reduced risk of non-major bleeding (adjusted HR 0.78, 95% CI 0.61 to 0.99). Immediate antibiotics were associated with reduced risk of bleeding amongst warfarin and DOAC users with an RTI. Further work is needed to understand mechanisms and confirm whether a lower threshold for antibiotic use for RTI in this population may be beneficial.

Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway-an interrupted time series analysis.

Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P < 0.001), followed by a significant reduction of -2.64 prescriptions after reintroduction (95%CI -3.66, -1.63, P < 0.001). During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

Impact of COVID-19 on ‘Start Smart, Then Focus’ Antimicrobial Stewardship at One NHS Foundation Trust in England Prior to and during the Pandemic

Background: Antimicrobial resistance (AMR), a major global public health threat that has caused 1.2 million deaths, calls for immediate action. Antimicrobial stewardship (AMS) promotes judicious antibiotic use, but the COVID-19 pandemic increased AMR by 15%. Although there are paramount data on the impact of COVID-19 on AMS, empirical data on AMS implementation during the pandemic are lacking. This study aimed to investigate antibiotic prescribing and AMS implementation prior to the pandemic (PP) in 2019 and during the pandemic (DP) in 2020 at one NHS Foundation Trust in England. Method: This cross-sectional study involved adult patients admitted to one NHS Foundation Trust in England, focusing on those prescribed antibiotics for respiratory tract infections (RTIs). This included cases of pneumonia in both years under study and COVID-19 cases in 2020. Data were retrospectively extracted from medical records using a validated data extraction tool, which was developed based on the ‘Start Smart, Then Focus’ (SSTF) approach of the AMS Toolkit. Results: This study included 640 patients. The largest age group in the study was 66–85 years, comprising 156 individuals (48.8%) PP in 2019 and 148 (46.3%) DP in 2020. CAP was the predominant diagnosis, affecting approximately 126 (39.4%) PP and 136 (42.5%) DP patients. Regarding the timing of antibiotic review post-admission, reviews were typically conducted within 48–72 h, with no significant difference between 2019 and 2020, with an odds ratio of 1.02 (95% CI 0.97 to 1.08, p-Value = 0.461). During the pandemic, there was a significant difference in both AMS interventions, ‘Continue Antibiotics’ and ‘De-escalation’, with odds ratios of 3.36 (95% CI 1.30–9.25, p = 0.015) and 2.77 (95% CI 1.37–5.70, p = 0.005), respectively. Conclusion: This study emphasises the need for robust AMS to ensure adherence to guidelines. It acknowledges the impact of comorbidities and advocates for sustained stewardship efforts to combat resistance both during and after the pandemic era.

An evaluation of the five rights antibiotic safety before and during COVID-19 at an NHS Foundation Trust in the United Kingdom

IntroductionAntimicrobial Resistance (AMR) poses a significant global health threat, with AMR-related deaths projected to reach 10 million annually by 2050. The COVID-19 pandemic has further exacerbated this crisis. This study focuses on evaluating the 'Five Rights of Antibiotic Safety' in an NHS Foundation Trust in England, assessing the impact of the COVID-19 pandemic on antibiotic prescribing and Antimicrobial Stewardship (AMS) practices in 2019 and 2020. MethodsA cross-sectional retrospective study was conducted, focusing on adult patients aged 25 and older admitted to the NHS Foundation Trust and prescribed antibiotics for respiratory tract infections in 2019 and 2020. The study involved a retrospective review of 640 patient records, using descriptive analysis to evaluate the adherence to the ‘Five Rights of Antibiotics’ and assess the impact of COVID-19 on antibiotic safety practices. ResultsThe study observed significant shifts in antibiotic prescribing practices during the study period. There was an increase in instances of inappropriate dosing and route of administration, alongside a slight improvement in prescribing durations. The study also noted a stable rate of appropriate antibiotic selection according to antimicrobial guidelines, indicating a concerning rise in inappropriate prescribing patterns during the COVID-19 pandemic. ConclusionThe study revealed notable changes in antibiotic prescribing practices during the COVID-19 pandemic, advocating the importance of robust AMS to ensure appropriate use of antibiotics. The findings highlight the need for enhanced AMS educational initiatives and systematic oversight to combat AMR and protect public health in future health crises.

Five Rights of Antibiotic Safety: Antimicrobial Stewardship at One NHS Foundation Trust in England Before and During the COVID-19 Pandemic

Abstract Introduction The study highlights the urgency of combating rising multi-drug-resistant infections, projecting 10 million deaths annually by 2050. With over 1.2 million deaths in 2019, Antimicrobial Resistance (AMR) has become a significant public health issue. Antimicrobial Stewardship (AMS) promotes judicious antibiotic use1. 'The Five Rights of Antibiotic Safety' ensure appropriate usage. It encompasses the right patient, drug, dose, time, and duration2. The COVID-19 pandemic, causing around 6 million deaths by 2023, has intensified AMR challenges. The Royal Pharmaceutical Society's AMS policy advocates for maximising the use of pharmacists' expertise to promote prudent antibiotic use, strengthen stewardship, and reduce AMR3. Aim This study aimed to evaluate AMS and adherence to the 'Five Rights of Antibiotic Safety' in antibiotic prescribing at an NHS Foundation Trust during 2019 and 2020 amidst the COVID-19 pandemic. Methods This research study was conducted using a cross-sectional retrospective design and undertook an in-depth analysis of 640 patient records in 2019 and 2020. The study included adult patients aged 25 and above, immunocompromised and pregnant individuals, and those prescribed antibiotics for respiratory tract infections or pneumonia during 2019 and 2020. A validated data extraction tool facilitated data collection. This study was registered under ISRCTN number 14825813, receiving 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, ensuring public and patient involvement. Results The study evaluated inappropriate antibiotic prescribing, identifying a rise in inappropriate antibiotic prescribing with no indication from 16% in 2019 to 20% in 2020. Inappropriate routes of administration also increased from 33% to 36%. While inappropriate drug choice remained steady around 63-64%, inappropriate dosing rose from 13% to 18%. Interestingly, inappropriate duration reduced slightly from 70% to 66%. The study assessed AMS champions, pharmacists' participation increased from 19% to 21%, and doctors decreased from 19% to 12%. However, combined collaboration jumped from 58% to 71%. Discussion/Conclusion This study highlights the surge in incorrect antibiotic prescribing during the 2020 COVID-19 pandemic, stressing the necessity of the 'Five Rights of Antibiotic Safety.' Strict guideline adherence and increased professional education are pivotal. Progress in reducing improper duration was seen, indicating the significance of refining prescribing practices. This research highlights the critical role of pharmacists and doctors as AMS champions. It demonstrates that their collaborative efforts during the pandemic positively impacted patient outcomes, thus reaffirming the Royal Pharmaceutical Society's AMS policy on the importance of a multidisciplinary team in ensuring appropriate antibiotic use. This study reveals a worrying increase in incorrect antibiotic use during 2020, calling for stricter compliance with the five safety rules and enhancing professional education. Reduced inappropriate duration of use suggests improvements in prescribing practices. The critical role of pharmacists and doctors in AMS, with heightened collaboration yielding prudent antibiotic use and better patient outcomes. Despite these insights, limitations like potential reporting bias, not exploring the causes of inappropriate prescribing in-depth, and a limited focus on doctors and pharmacists in AMS need future research.

Using microbiological data to improve the use of antibiotics for respiratory tract infections: A protocol for an individual patient data meta-analysis.

Resistance to antibiotics is rising and threatens future antibiotic effectiveness. 'Antibiotic targeting' ensures patients who may benefit from antibiotics receive them, while being safely withheld from those who may not. Point-of-care tests may assist with antibiotic targeting by allowing primary care clinicians to establish if symptomatic patients have a viral, bacterial, combined, or no infection. However, because organisms can be harmlessly carried, it is important to know if the presence of the virus/bacteria is related to the illness for which the patient is being assessed. One way to do this is to look for associations with more severe/prolonged symptoms and test results. Previous research to answer this question for acute respiratory tract infections has given conflicting results with studies has not having enough participants to provide statistical confidence. To undertake a synthesis of IPD from both randomised controlled trials (RCTs) and observational cohort studies of respiratory tract infections (RTI) in order to investigate the prognostic value of microbiological data in addition to, or instead of, clinical symptoms and signs. A systematic search of Cochrane Central Register of Controlled Trials, Ovid Medline and Ovid Embase will be carried out for studies of acute respiratory infection in primary care settings. The outcomes of interest are duration of disease, severity of disease, repeated consultation with new/worsening illness and complications requiring hospitalisation. Authors of eligible studies will be contacted to provide anonymised individual participant data. The data will be harmonised and aggregated. Multilevel regression analysis will be conducted to determine key outcome measures for different potential pathogens and whether these offer any additional information on prognosis beyond clinical symptoms and signs. PROSPERO Registration number: CRD42023376769.

Improving antibiotic prescribing quality in out-of-hours primary care: a mixed-methods study using participatory action research

Abstract Background During out-of-hours (OOH) primary care, GPs overprescribe antibiotics for respiratory tract infections (RTIs). Many interventions have been shown to improve antibiotic prescribing quality, but their implementation in practice remains difficult. Participatory action research (PAR) aims to explore, implement and evaluate change in practice with an active involvement of local stakeholders, while generating knowledge through experience. Objectives To evaluate whether PAR improves antibiotic prescribing quality for RTIs during OOH primary care and simultaneously identify the pivotal lessons learned. Methods A mixed-methods study with a PAR approach in three OOH GP cooperatives (GPCs). Each GPC co-created a multifaceted intervention focusing on improving antibiotic use for RTIs through plan-do-study-act cycles. We quantified antibiotic prescribing quality indicators and formulated the lessons learned from a qualitative process analysis. Results Interventions were chosen with the GPs and adapted to be context-relevant. The willingness to work on quality and engagement of local stakeholders led to ownership of the project, but was time-consuming. In one GPC, antibiotic prescribing significantly decreased for tonsillitis, bronchitis, otitis media and acute upper RTI. In all three GPCs, use of guideline-recommended antibiotics for otitis media significantly increased. Conclusions Implementing multifaceted interventions through PAR can lower total and increase guideline-recommended antibiotic prescribing for RTIs in OOH primary care. Co-creating interventions with GPs to suit local needs is feasible, but reaching all GPs targeted is challenging.

Misconceptions and Knowledge Gaps on Antibiotic Use and Resistance in Four Healthcare Settings and Five European Countries-A Modified Delphi Study.

Misconceptions and knowledge gaps about antibiotics contribute to inappropriate antibiotic use and antimicrobial resistance. This study aimed to identify and prioritize misconceptions and knowledge gaps about antibiotic use from a healthcare professionals' perspective. A modified Delphi study with a predefined list of statements, two questionnaire rounds, and an expert meeting was conducted. The statements were rated by healthcare professionals from France, Greece, Lithuania, Poland, and Spain, and from general practice, out-of-hour services, nursing homes, and pharmacies. A total of 44 pre-defined statements covered the following themes: (1) antimicrobial resistance in general, (2) use of antibiotics in general, (3) use of antibiotics for respiratory tract infections, and (4) use of antibiotics for urinary tract infections. Consensus was defined as ≥80% agreement between the professionals during the second Delphi round. For 30% of the statements, professionals from the four settings together reached consensus. In each setting individually, at least 50% of the statements reached consensus, indicating that there are still many misconceptions and knowledge gaps that need to be addressed. Six educational tools (leaflets, posters, checklists) were developed to address the knowledge gaps and misconceptions. These can be used by patients and healthcare professionals to improve the use of antibiotics in practice.

Impact of point-of-care C-reactive protein testing intervention on non-prescription dispensing of antibiotics for respiratory tract infections in private community pharmacies in Nigeria: a cluster randomized controlled trial

ObjectivesTo ascertain if access to C-reactive protein (CRP) test kits—and staff training on how to use them in respiratory tract infection (RTI) management—in private community pharmacies (PCPs) can reduce non-prescription antibiotic dispensing for RTI. MethodsA parallel cluster randomized controlled trial was conducted in Nigeria. The clusters—which were equally the participating units—were PCPs with blood testing experience. Stratified block randomization was done. PCPs were stratified by the baseline value of the primary outcome. PCPs were not blinded. The intervention PCPs were provided with CRP kits and trained to use them to make decisions regarding non-prescription antibiotic dispensing for RTI. The control PCPs received no intervention. The primary outcome was the non-prescription antibiotic dispensing rate for RTI. Data were collected by blinded simulated clients who visited each PCP 30 times before and after the intervention without prescriptions. Analyses were by intention-to-treat. ResultsTwenty PCPs were randomized, 1:1. Ten PCPs were analyzed in each arm. Each PCP contributed 30 data points to the multiple imputation analysis where antibiotic dispensing decreased by 15.66% (209/300 [intervention] vs 256/300 [control]) in the adjusted analysis (odds ratio = 0·279, 95% confidence interval = 0.107-0.726; P-value = 0.0090) and 16% (208/300 [intervention] vs 256/300 [control]) in the crude analysis (odds ratio = 0.299, 95% confidence interval = 0.098-0.911; P-value = 0.034). ConclusionAccess to CRP kits—and staff training on how to use them in RTI management—in PCPs reduced non-prescription antibiotic dispensing for RTI.

Respiratory tract infections and risk factors for infection in a cohort of 330 patients with axial spondyloarthritis or psoriatic arthritis.

Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment and may contribute to morbidity and mortality as well as increased healthcare costs. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. In this study we assessed the occurrence of respiratory tract infections in a monocentric real-world cohort consisting of 330 patients (168 psoriatic arthritis and 162 axial spondyloarthritis patients) and determined factors associated with increased infection risk. Out of 330 SpA patients, 89.3% had suffered from ≥ 1 upper respiratory tract infection (URTI) and 31.1% from ≥ 1 lower respiratory tract infection (LRTI) within the last two years. The most common URTIs were rhinitis and laryngitis/pharyngitis with 87.3% and 36.1%, respectively. Bronchitis constituted the most common LRTI, reported in 29.7% of patients. In a multivariate binomial logistic regression model occurrence of LRTI was associated with chronic lung disease (OR 17.44, p=0.006), glucocorticoid therapy (OR 9.24, p=0.012), previous history of severe airway infections (OR 6.82, p=0.013), and number of previous biological therapies (OR 1.72, p=0.017), whereas HLA B27 positivity was negatively associated (OR 0.29, p=0.025). Female patients reported significantly more LRTIs than male patients (p=0.006) and had a higher rate of antibiotic therapy (p=0.009). There were no significant differences between axSpA and PsA patients regarding infection frequency or antibiotic use. 45.4% of patients had required antibiotics for respiratory tract infections. Antibiotic therapy was associated with smoking (OR 3.40, p=0.008), biological therapy (OR 3.38, p=0.004), sleep quality (OR 1.13, p<0.001) and age (OR 0.96, p=0.030). Hypogammaglobulinemia (IgG<7g/l) was rare (3.4%) in this SpA cohort despite continuous immunomodulatory treatment. Awareness of these risk factors will assist physicians to identify patients with an increased infection risk, who will benefit from additional preventive measures, such as vaccination and smoking cessation or adjustment of DMARD therapy.

Prescribing Pattern of Antibiotics in Respiratory Tract Infections in the Pediatric Indoor Patients at Manipal Teaching Hospital

Introduction: Respiratory tract infections are the most frequently occurring illness in childhood and antibiotics are the key drugs for its treatment which account for three-quarters of all antibiotics prescriptions. Injudicious use of antibiotics leads to the development of resistance, patients are at high risk for opportunistic infections or prolonged hospitalization. This study aimed to assess the prescribing pattern of antibiotics for respiratory tract infections in the pediatric indoor patients of Manipal Teaching Hospital.&#x0D; Methods: This study is a prospective cross-sectional study done in the paediatrics ward of Manipal Teaching Hospital Pokhara, conducted for six months. Patients aged range from 1 day to 14 years who meet the inclusion criteria were taken in this study. Data were collected from the inpatient ward and analysed using various statistical tools.&#x0D; Results: Among 170 patients, a maximum(43.3%) were in the age group of 1 day to 11 months with male predominance(74.1%). Bronchopneumonia was the most common respiratory tract infection (51.8%) followed by bronchiolitis (13%). Chest x-ray was done in all patients however blood culture was done only in 60.6% and an antibiotic sensitivity test (27.6%) before prescribing antibiotics. Cefotaxime was prescribed in maximum patients (62.4%) followed by ceftriaxone (17.1%). All the patients received at least one antibiotic by i.v route during the hospital stay.&#x0D; Conclusion: Since culture and sensitivity tests were not carried out on most of the patients before prescribing antibiotics in this study, which might lead to an increased chance of bacterial resistance and treatment failure in the future.

Assessment of Rational Antibiotic Use in Pediatric Ward in A Teaching Hospital

Introduction: Antibiotics are a class of natural and synthetic compounds that inhibit the growth of or kill other microorganisms. These are among the most frequently prescribed medications in modern medicine. The use of antibiotics has contributed to the dramatic fall in morbidity from communicable and infectious diseases over the last 50 years globally. Overuse of antibiotic is one of the most important factors for the development and spread of resistance in the hospital, as well as in the community. Methodology: The present study was conducted in pediatric ward of a tertiary care institute. The study population included 250 children. The group consisted of 250 consecutive children admitted in one unit of the pediatric ward and they were analyzed for antibiotic use without any prior priming of the members of the unit regarding rationality of antibiotic use. Results: Age and sex wise distribution of 250 children included in the study. Of these 166(57%) were males and 84 (43%) were females. 60 received antibiotics for respiratory tract infections, this being the commonest disease for which antibiotics were received. 55 (44%) children received antibiotics in rational way. Conclusion: From this study it is clear that there is lack of proper rational antibiotic usage by unit doctors. To conclude it can be stated that inappropriate use of antibiotics is increasing and is responsible for rapidly developing antimicrobial resistance. To increase rational use of antibiotics the members of the unit (treating physicians) should be motivated regarding correct uses of antibiotics and hazards of their inappropriate use. A proper workshop should be arranged for this.

The Procalcitonin-guided Antibiotics in Respiratory Infections (PARI) project in general practice \u2013 a study protocol

BackgroundAntibiotic resistance is a global health challenge and the close correlation between antibiotic use and the development of resistance makes it essential to maintain a rational use of antibiotics. Most antibiotics are prescribed in general practice against acute respiratory tract infections (ARTI), even though most of these infections are of viral etiology. Thus, a safe method to substantially reduce unnecessary use of antibiotics in general practice is needed. Procalcitonin (PCT) is a precursor protein with very low circulating levels in the blood under physiological conditions. However, in response serious bacterial infection the level of PCT in the blood may increase significantly. Until recently, quantitative analyses of PCT was performed in hospital laboratories, impeding the implementation of PCT in primary care. Our aim is to determine whether it is possible to lower the use of antibiotics in patients presenting with symptoms of ARTI, without significantly prolonging the period of illness, by using a newly released PCT point-of-care test in general practice.MethodsThe Procalcitonin-Guided Antibiotics in Respiratory Infections (PARI) study is a randomized, single-blinded, non-inferiority, multi-practice intervention study comparing a PCT-group to a control group. Patients (N = 508) will be randomly assigned 1:1 to standard care or to the PCT group. The primary outcomes the duration of illness and symptoms from ARTI measured with the Acute Respiratory Tract Infection Questionnaire. Secondary outcomes include (1) Number of participants in each trial arm exposed to antibiotic treatment at index consultation (day 1) and within 30 days, (2) Number of participants in each trial arm with side effects from antibiotic treatment within 14 days, (3) Number of participants in each trial arm with re-consultations within 30 days, (4) Number of participants in each trial arm admitted to hospital (including diagnosis and mortality) within 30 days, (5) Characterization of biomarker (CRP and PCT) level at index consultation. Tertiary outcomes include patient and general practitioner satisfaction with the use of the PCT point-of-care test, and long-term follow-up.DiscussionTo our knowledge, this is the first study to examine a PCT point-of-care test in general practice with the aim of reducing the use of antibiotics in patients with symptoms of ARTI. Results of this study may prove important in targeting antibiotic treatment only to those patients who need it, thus contributing to limiting the spread of antibiotic resistance.Trial registrationClinicalTrials.gov Identifier: NCT04216277, date of registration: 2. of January 2020.

Usage of antibiotics and monitoring of drug interactions in pediatrics at a tertiary care teaching hospital

Background: Respiratory tract infections (RTI) are more common in pediatrics. Especially in developing countries like India, RTI causes more death in children. Antibiotics are used to treat RTI even in case of viral infections. Hence rational use of antibiotics is very much needed to avoid antibiotic resistance. In this study we have analysed the prescribing pattern of antibiotics and their drug interactions involved in the management of respiratory tract infections in a tertiary care teaching hospital.Methods: A prospective observational study was conducted in the department of pediatrics at a tertiary care teaching hospital for a period of 6 months (November 2019-April 2020). A total of 144 patients were included in the study and their prescription was analysed for their antibiotic prescribing pattern and interactions.Results: Infants were more prone to RTI infections. Among RTI, lower RTI were more common in children. We have analysed prescribing pattern of antibiotics in which, mono antibiotic therapy were more commonly used. Ampicillin was the frequently prescribed antibiotic. Azithromycin had the most possible interactions among the antibiotics prescribed.Conclusions: More than 336 antibiotics were used for all types of RTI, even in the case of viral infections. So rational use of antibiotics is needed. Among 144 children who were enrolled in the study, none of them were subjected to culture sensitivity test. As of which, all of them were treated empirically. Penicillin and cephalosporin are the mostly prescribed antibiotics in RTI. Cephalosporin prescribed children had less hospital stay and hardly interactions were found.

Impact of Educational Intervention on Rational Antibiotic Use In Pediatric Ward

Introduction: Antibiotics are a class of natural and synthetic compounds that inhibit the growth of or kill other microorganisms. Overuse of antibiotic is one of the most important factors for the development and spread of resistance in the hospital, as well as in the community. Present study was designed to describe antibiotic use in children and to assess the impact of an educational intervention on antibiotic prescription. Methods: The present study was conducted in pediatric ward of a tertiary care institute. The study population included two groups of children – each having 250 children. The first group consisted of 250 consecutive children admitted in one unit of the pediatric ward and they were analyzed for antibiotic use without any prior priming of the members of the unit regarding rationality of antibiotic use. This was followed by an intervention in the form of a 3hour workshop for all members of the unit. The second group included another 250 children consecutively admitted in the wards after this intervention. Results: In Pre intervention group 55 (44%) children received antibiotics in rational way, while in Post intervention group 90(60.40%) children received antibiotic in rational way. One hundred and thirty-six children (49.4%) received antibiotics for respiratory tract infections, this being the commonest disease for which antibiotics were received. As seen in the table, unindicated use of antibiotic was significantly reduced in Post intervention group (p = 0.03). Conclusion: The present study included 500 children. There were 285 (57%) males and 215 (43%) females. Amongst these 500 patients, 178 (35.6%) were below 1 year of age. This group had the highest number of patients. In the Pre intervention group, 55 (44%) children received antibiotics rationally, while in Post intervention group 90(60.40%) children received antibiotic rationally.