Irrational Antibiotics Research Articles

Incidence, antimicrobial resistance and mortality of Klebsiella pneumoniae bacteraemia in Shanghai, China, 2018–2022

Background Klebsiella pneumoniae (KP) accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs). Objectives To investigate incidence, antimicrobial resistance and risk factors for mortality of KP BSIs in East China. Methods A retrospective study of patients with KP BSIs was conducted in a tertiary care hospital from 2018 to 2022. Medical records of all hospitalised patients with KP BSIs were reviewed and analysed. The incidence, antimicrobial resistance and mortality of KP BSIs were evaluated. The Kaplan-Meier method was used to plot survival curves and logistic regression was used to analyse risk factors for crude 30-day mortality. Results A total of 379 inpatients with KP BSIs were enrolled. The incidence of patients with KP BSIs was fluctuating between 4.77 and 9.40 per 100,000 patient-days. The crude 30-day mortality rate of these patients was 26.39%. Of the 379 KPisolates, 197 (51.98%) were carbapenem-resistant (CR) and 252 (66.49%) were multidrug-resistant (MDR). All isolates showed the lowest resistance to tigecycline (13.77%) and polymyxin B (14.61%). Cases with MDR/CR isolates had significantly longer length of hospital stay, higher crude 30-day mortality and medical costs than non-MDR/non-CR isolates. Age, CR phenotype, paracentesis, indwelling central venous catheter (CVC), use of carbapenems, tetracyclines, polymyxins B, and irrational empiric treatment were independently associated with crude 30-day mortality. Conclusion MDR/CR KP BSIs are associated with increased mortality, healthcare costs and prolonged hospitalisation. Patients with advanced age, CR phenotype, paracentesis, CVC, exposure to some antibiotics, and irrational empirical antibiotic treatment are at higher mortality risk.

Prevalence of antibiotic resistance in Salmonella Typhimurium isolates originating from Iran: a systematic review and meta-analysis.

Antibiotic resistance in Salmonella represents a significant global public health concern. Among various serovars, Salmonella enterica serovar Typhimurium is prevalent in multiple countries. This study aims to conduct a systematic review and meta-analysis to evaluate the pattern of antibiotic resistance in S. Typhimurium isolates from diverse sources in Iran. We conducted a comprehensive and systematic search for relevant articles until December 2023 in the following databases: PubMed, Scopus, Web of Science, and SID. The collected data were analyzed using Stata software version 17. Eighteen studies examined the pattern of antibiotic resistance in S. Typhimurium for various antibiotics in Iran. Piperacillin and tetracycline exhibited the highest resistance rates, at 79 and 60% respectively, while cefixime and ceftriaxone had the lowest resistance rates at 0%. Our findings indicate a high level of antibiotic resistance among the studied antibiotics. This high level of antibiotic resistance raises concerns and underscores the necessity for monitoring the use of antibiotics. Moreover, resistance to these antibiotics was more prevalent in samples isolated from animals compared to other sources. This highlights the importance of animal screening to detect the presence of drug-resistant isolates, with the ultimate goal of reducing antibiotic resistance and preventing the transmission of resistant strains to humans.

Evaluation of the use of antibiotics using the anatomical therapeutic chemical/defined daily dose and Gyssens methods in pneumonia patients at a tertiary care general hospital in Medan

Background: The impact of irrational antibiotic usage in pneumonia patients is an increase in resistance, an increase in drug side effects, and a failure of therapy that causes patients' health to deteriorate, lowering their quality of life and raising their treatment costs. The primary objective of this study is to assess the extent to which antibiotics are being used rationally in the inpatient facility of a private tertiary care hospital located in Medan. Methods: The present study employs an observational design with a prospective cross-sectional approach, carried out within the timeframe of September to November 2022. The evaluation of antibiotic utilization was conducted utilizing the anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology and the Gyssens methodology. Results: The findings of the study indicate that a significant proportion of individuals diagnosed with pneumonia fell between the age range of 46 to 55 years, comprising 23.4% of the overall patient population. Moreover, the male gender was found to be the most prevalent, accounting for 55.81% of the 278 patients who satisfied the inclusion criteria. The findings from the evaluation of antibiotic utilization, employing the ATC classification system and DDD methodology, yielded a rate of 145.72 DDD per 100 days of care. Ceftriaxone exhibited the highest value, reaching 87.59 DDD/100 days of treatment. The evaluation of the Gyssens approach yielded a total of 254 patients who were administered antibiotics in an appropriate manner (category 0), while 24 patients were found to have received unsuitable antibiotics (categories I-VI). Conclusions: Based on the findings of this study, it can be inferred that the utilization of antibiotics within the hospital under investigation remains inadequate in terms of both quantity and quality.

Irrational use of antibiotics and factors associated with antibiotic resistance: Findings from a cross-sectional study in Bangladesh.

Irrational antibiotic (AB) usage poses a serious concern to third-world countries because of poor surveillance, lack of information, and patients' propensity for self-medication. Additionally, the unpredictability of the coronavirus disease 2019 (COVID-19) pandemic promoted the abuse of ABs, which accelerated the prevalence of antibiotic resistance (ABR). The primary aim of this study was to assess the pattern of AB usage and irrational use of ABs-related potential factors associated with ABR among the students and teachers of a leading public university of Bangladesh. A cross-sectional web-based survey was conducted among the students and teachers (n = 783) of the selected university, from January 1 to February 28, 2022. Descriptive statistics, χ 2 test, and logistic regression analysis were employed to analyze the collected data. The regression analysis supported that male participants had a 34% lower experience of acquiring ABR than female respondents (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.448, 0.973; p = 0.036). The 1st/2nd-year level students had more than two times higher experience with ABR than the master's or higher-class students (AOR = 2.149, 95% CI = 1.047, 4.412; p = 0.037). The participants who took ABs for 4-6 days showed more than two times ABR experience than those who took ABs for above 10 days (AOR = 2.016, 95% CI = 1.016, 4.003; p = 0.045). Respondents who finished their AB medication (dose completion) had a 57% less chance of acquiring ABR than the participants who did not complete their dose. This study found that irrational use of ABs is more prevalent among the youth and female participants. At this stage, there is an urgent need for comprehensive statutory AB control rules, as well as measures for appropriate information, education, and surveillance throughout different groups of Bangladesh.

A Retrospective Cross-sectional Study on Prevalence and Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infections at a Teaching Hospital in Tehran, Iran

Background: Urinary tract infection (UTI) is the most prevalent infection among the community and hospitalized patients. Objectives: This study aimed to investigate the current antimicrobial susceptibility patterns among UTI agents in Tehran, Iran. Methods: This retrospective study analyzed 9836 urine samples collected from hospitalized patients within 2019 - 2020. The antibiotic susceptibility for commonly-used antibiotics was tested according to Clinical and Laboratory Standards Institute guidelines. Results: Based on the findings, Escherichia coli was the most prevalent etiological agent of UTIs (72.3%), followed by Klebsiella spp. (13.4%), Pseudomonas aeruginosa (4.8%), Acinetobacter spp. (2.8%), and other species (6.7%). Of isolated microorganisms, 943 cases (97%) belonged to gram-negative bacilli; however, 32 cases (3.05 %) were gram-positive cocci. The susceptibility rates of E. coli to amikacin, nitrofurantoin, gentamicin, imipenem, and cefoperazone were 88.4%, 87.5%, 68.3%, 65.9%, and 62.6%, respectively. The sensitivity rates of Klebsiella spp. isolates for amikacin, nitrofurantoin, and imipenem were 87.6%, 71.5%, and 68.9%, respectively. Conclusions: The results of the present study characterized the misuse of antibiotics in Iran. Iranian surveillance studies will assist clinicians in choosing the most appropriate empirical treatment and preventing infections caused by resistant organisms.

Evaluation the Rationality of Clinical Outcomes of Antibiotic Use and Patterns of Bacterial Resistance to Antibiotics in Children with Pneumonia

Pneumonia is a respiratory infection that attacks the lungs in the lung parenchyma tissue or alveoli. Pneumonia is one of the leading causes of death in children worldwide. Rational use of antibiotics can reduce the risk of antibiotic resistance. This study used observational analytics with a retrospective cohort design. The research subjects were pediatric patients with a diagnosis of pneumonia who were hospitalized at Dr. Sardjito Yogyakarta period 1 January – 31 December 2020. The rationality of the use of antibiotics was evaluated using the Gyssens method. The clinical outcome observed was the patient's condition improving or not improving after 3 to 5 days of antibiotic administration. Chi-Square test to see the relationship of antibiotic rationality to clinical outcomes and multiple logistic regression analysis to analyze the relationship of confounding variables to clinical outcomes. From 141 patients, 211 antibiotic regimens were obtained, with details of 186 empiric antibiotics and 25 definitive antibiotics. The rational use of antibiotics in empirical and definitive antibiotics was 140 regimens (75.27%) and 22 regimens (88%). Total irrational antibiotics (category I-VI) from empirical and definitive antibiotics were 24.73% and 12%, respectively. There is a significant relationship between the rationality of antibiotics with clinical outcomes both empirical and definitive antibiotics (p<0.05). Meanwhile, for confounding variables, there was no significant relationship to the clinical outcome (p>0.05). The most common bacteria were Klebsiella pneumoniae and Acinetobacter baumanii. Klebsiella pneumoniae was the most resistant to ampicillin, ampicillin sulbactam and ceftriaxone antibiotics and Acinetobacter baumanii was the most resistant ampicillin.

Antibiotic resistance and rational outpatient antibiotic treatment of upper respiratory tract infections in children

On the eve of the season of respiratory infections, we would like to draw the attention of outpatient doctors to the fact that 80–90 percent of winter diseases affecting the nose, ears, throat and lungs are of viral origin. Improper and excessive consumption of antibiotics increases the risk of antibiotic resistance, and thus humanity enters the post-antibiotic era. The World Health Organization warns that the problems that antibiotic resistance could cause in the future can be compared to the spread of AIDS in the 1980s. The principles of rational use of antibiotics should always be based on the assumption that antibiotics are causal drugs, and their overuse very often leads to resistance, which negatively affects the entire population. Irrational antibiotic therapy can also lead to discomfort, worsening of acute and chronic pain. It is also important to know that in the post-antibiotic era, science has other options for fighting bacteria, such as vaccination, immunotherapy, and strengthening individual immunity. The correct attitude of doctors to the prevention of diseases and rational treatment with antibiotics can help reduce the resistance of bacterial strains, discomfort and pain.

Effectiveness of Integrated Management of Neonatal Childhood Illness (IMNCI) Tool in Chest X-Ray Positive Pneumonia Cases among Children Ages 2 Months to 5 Years A Cross-Sectional Study

IMNCI tool has widely been applied in many countries for screening, clinical diagnosis, and as a management tool for many common diseases, including cases of pneumonia. This study determines the effectiveness of IMNCI tools in the diagnosis of pneumonia as that of diagnosing pneumonia by gold standard method of X-ray Chest PA view besides finding out the sustainability in using the IMNCI guided antibiotics in managing cases of pneumonia from first care to the tertiary care facilities. Methodology: We conducted a prospective, cross-sectional study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at a tertiary care hospital in Pakistan and assessed CXR examinations. The primary endpoint was interrater reliability between CXR for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: The study was done among 165 children aged between 2 months to 59 months who have visited Fatima Hospital, Baqai Medical University, due to their medical condition of cough OR fast breathing. Most of the mothers had been taking antibiotics for their sick children before they reached our set up and very few of them (15%) were found adherent to taking IMCI guided IMCI-guided antibiotic Amoxicillin, whereas the rest of all a huge majority of the cases were found using non-IMCI guided antibiotics constituting 85%, means other than oral Amoxicillin. A Sensitivity of 68.75% and a Specificity of 92.3% were found to IMCI tools validity in diagnosing pneumonia against X-ray chest positivity. Conclusion: This study concludes that the accuracy of IMCI tools in recognizing childhood pneumonia was good rather than the diagnosis as that to the positive findings in Xray Chest findings. However, with good sensitivity and the best specificity with high PPV, it can be the best screening tool for the early detection of pneumonia among children<5 years and can achieve a better outcome with in-time recognition, appropriate care seeking, and early intervention avoiding irrational antibiotics. Keywords: ARI: Acute Respiratory Infection, AIDS: Acquired Immunodeficiency Syndrome, BMU: Baqai Medical University, IMCI: Integrated Management of Childhood Illness, IMNCI: Integrated Management of Neonatal & Childhood Illness, WHO: World Health Organization, UNICEF: United Nations International Children’s Education Funds, MDG: Millennium Development Goal, SDG: Sustainable Development Goal, MNCH: Maternal, Neonatal & Child Health Program

Assessment of antimicrobial drugs utilization in tertiary care hospital-an antimicrobial stewardship implication

Background: Irrational antibiotic usage major cause of spreading antimicrobial resistance therefore goal of this research was to refine prescribing patterns and may aid in addressing issues related to irrational antibiotic usage. Method: This prospective observational research was conducted at Maharishi Markandeshwar Institute of Medical Sciences & Research to assess the prescribing pattern of Antimicrobials Agents (AMAs) as well as the logic of their use. Results: The study enlisted the participation of 100 individuals. Of all 63% were male and 37% were female. The vast majority of participants are between the ages of 41- 60.94% of the 100 subjects receive AMAs.In our study, cephalosporins and β-lactams were found to be the most widely used AMA class (52.6%).Ceftriaxone was prescribed the most (32%), followed by piperacillin and tazobactam (23%).Antibiotics were given to patients for a maximum period up to 7 days in 39% and 5% of patients were given more than 17 days. 59 % patient’s urine sample was collected AST from different sites, urine (30), pus and sputum (7), blood (5), wound and et (3), pleural (1), ascitic (1), AFB (1), and abdominal (1).Only 37.8% specimens yielded a positive result, whereas 62.71% yielded a negative result Conclusion.

Situation of Antibiotic residues in fresh meats and ready to drink cow milk sold for consumers in Bangkok

Background: Irrational antibiotic uses in livestock resulting in antibiotic residues in pork, chicken, meat and other products from animals. Objective: to examine antibiotic residues in pork, chicken, meat, and ready-to-drink cow milk Methods: The samples were tested by antibiotic residue detection kits from the Department of Medical Sciences, Thailand. These detection kits have 93% accuracy, 78.9% sensitivity, and 96.7% specificity. Convenience sampling was conducted. A total of 263 samples which consisted of 115 samples of fresh pork, 21 samples of chicken and 12 samples of fresh beef sold in the fresh markets, 43 samples of ready-to-eat cow's milk, 36 samples which advertised as organic pork, and 36 samples which advertised as hygienic chicken were tested for antibiotic residues; Tetracycline, Macrolide, Aminoglycoside, Sulfonamide, Penicillin. Result: From a total of 263 samples, the results showed that 148 sample of fresh pork, chicken and meat bought from fresh market were found antibiotic residues in 103 samples (69.59%); fresh meat (n=12, 100%), fresh chicken (n=18, 85.71%) and fresh pork (n=73, 63.49%). Results of ready-to-drink cow milk showed that from a total of 43 samples, 6 samples (13.95%) were found to contain Tetracycline residues. 72 samples of fresh pork and chicken, 36 each, which advertised as hygienic were examined, no sample was detected of Tetracycline residue Conclusion: 69.59% (103/148)of fresh pork, chicken and meat samples and 13.95% (6/43) of ready-to-drink cow milk samples were detected antibiotic residues. No antibiotic residues found in 72 samples consisted of 63 samples of fresh pork and 36 samples of chicken which advertised as hygienic.

Qualitative Evaluation of Antibiotics Use with Gyssens Method in Sepsis Patients at Fatmawati Central General Hospital Jakarta

Sepsis still becomes a major health problem worldwide, with a fairly high mortality rate ranging from 20 to 50%. Antibiotic therapy with rational use can reduce the mortality rate. In contrast, the irrational use of antibiotic therapy will increase the occurrence of resistance, which impacts the increase of morbidity, mortality, and health costs. The objective of this study was to evaluate the quality in the use of antibiotics using the Gyssens method in patients with sepsis. This study was an observational study with a cross-sectional method conducted at Fatmawati Central General Hospital Jakarta from January to December 2020. The research subjects were 110 patients with sepsis who met the inclusion criteria. In this study, 49.09% of patients used rational antibiotics and 50.91% of patients used irrational antibiotics that were found in category VI (0.91%), V (17.28%), IVa (3.63%), IVb (0.91%), IVc (0.91%), IIIa (3.63%), IIIb (20%), IIa (0.91%), and IIb (2.73%). The duration of antibiotic therapy was the only factor that affected the quality of antibiotic use (p = 0.012). There was no difference in mortality between patients with rational and irrational use of antibiotics (p = 0.333, OR = 1.654, 95% CI 0.714-3.829). However, after adjusting for the duration of therapy, irrational use of antibiotics significantly affected mortality (p = 0.017, OR = 3.5, 95% CI 1.255-9.761). In conclusion, the antibiotic use in half of the sepsis patients were irrational. Since irrational use was associated with mortality, efforts need to be taken to improve the quality of antibiotic use.

Analysis of the Antimicrobial Stewardship Program Policy on Inpatients Antibiotics Use

The Exploration of Antimicrobial Consumption to Identify Targets for Quality Improvement in Indonesian Hospitals study showed that 97% of the use of empirical antibiotics was 81% empiric therapy, 12% medical prophylaxis, 4% surgical prophylaxis, and 16% without clear indications. The most common diagnoses are typhoid, pneumonia. and dengue fever. The Antimicrobial Stewardship Programme (ASP) Team supports the national program to reduce the use of irrational antibiotics. This study aims to analyse the ASP policy implementation on the use of antibiotics at the Royal Taruma Hospital. A secondary data on the use of Defined Daily Dose (DDD)/100 patient-days for the quarterly months of February, May, and August 2020. The 14 key informants' perceptions, opinions, thoughts are the primary data of qualitative research on the use of antibiotics during the ASP policy implementation. The three most antibiotics used were Ceftriaxone (64.7%), Levofloxacin (20.1%), and Meropenem (6.9%), which belong to the broad-spectrum antibiotic class. The total use of antibiotics was 1206.59 DDD/100 patient-days. The implementation of ASP policies has not been running optimally. It is necessary to formulate a pattern of germs and antimicrobial resistance, not only in the intensive room, but also in the care ward to achieve ASP quality indicators.

Ampicillin-Gentamycin Were Equivalent to Cefotaxime-Gentamycin Therapy Outcome on Neonatal Sepsis in Rural Area of West Borneo

The limited facilities in rural areas, such as Ketapang, make it hard for clinicians in charge to provide the most effective treatment while also considering preventing irrational antibiotic usage at once for neonatal sepsis. This study aimed to compare the length of stay of neonatal sepsis patients given Ampicillin-Gentamycin and Cefotaxime-Gentamycin as empiric antibiotic therapy. This was a retrospective observational study of patients admitted to Fatima Hospital, Ketapang, West Borneo, from June 2020-June, to 2021, with neonatal sepsis diagnosis based on the clinical presentation and routine blood lab. Slovin formula was used to determine the minimum sample size. Data were analyzed using Mann-Whitney Test. From 105 samples collected, the most common symptoms of neonatal sepsis found were fever (32.4%), vomitus (29.5%), and breathing difficulty (26.7%). Routine blood lab mostly showed leukocytosis with a mean of 28.369, and the mean length of hospitalization in patients given the Ampicillin-Gentamycin combination was 6.35 days. In comparison, the Cefotaxime-Gentamycin combination was 4.68 days. There was an insignificant difference in hospitalization between the two groups (p=0.274). Therefore, administration of Ampicillin-Gentamycin as empiric therapy in neonatal sepsis showed a good outcome as with Cefotaxime-Gentamycin therapy.

Rational use of antibiotics and covariates of clinical outcomes in patients admitted to intensive care units of a tertiary hospital in Kenya

Objectives : Rational use of antibiotics implies appropriate choice of an antibiotic administered at correct dose, frequency and duration using the most suitable route of administration. Irrational antibiotics use is associated with antimicrobial resistance, drug failure and high mortality in the critical care units (CCUs). This study sought to establish rational use of antibiotics and determinants of clinical outcomes of patients admitted in the CCUs at the Kenyatta National Hospital (KNH). The findings would guide policy formulation of antibiotics use in hospital CCUs in Kenya and the region. Methods : Retrospective review of 220 admissions to the KNH CCUs over the period February 2018–February 2020 was conducted. Participants’ sociodemographics, clinical characteristics, antibiotics therapy, and outcome of admission were extracted from patient files and analyzed using STATA version 23. Determinants of irrational antibiotic use and covariates of clinical outcomes were computed at 95% confidence. Results The prevalence of rational use of antibiotics was only 18.5%. Inappropriate choice of antibiotics (51.0%) and incorrect duration (32.3%) were the most common irrational practices. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%) and ceftriaxone (83.0%) were the most irrationally used antibiotics. Irrational use of ceftriaxone was significantly associated with clinical diagnosis (p=0.012) while that of amoxiclav was associated with patient risk category (p=0.039). Mortality in the CCUs was 10%, and the odds of dying were almost six times among intubated patients compared to those who were not (AOR 5.5, 95% CI=1.1–28.1, p=0.042). Conclusion Irrational antibiotics prescribing is high in the KNH CCUs, attributable largely to incorrect choice and wrong duration of antibiotic use. Mortality was significantly associated with intubation. Intensification of management in critical care settings should be directed towards intubated patients while ensuring appropriate choice of antibiotics administered for the correct duration. Future studies should explore factors that could promote rational antibiotics use in critical care settings.

When do common medicines become dangerous or inefficient?

Irrational prescriptions and ineffective use of drugs cause harm to the patient’s health, increase the financial costs of both the patient and the medical institution to remove the consequences of incorrect treatment, contribute to the occurrence of „drug disease”, unnecessarily burden the cost of treatment, increase the resistance of microorganisms ( due to irrational antibiotic therapy) and the lethality of patients due to serious infectious diseases usually lead to an increase in the frequency of side effects and complications of drug treatment. Realizing that harmless drugs do not exist, important and logical in rational pharmacotherapy, quite desirable, but also without unpleasant consequences, would be to know and inform with the most important moments, appeared in the process of using drugs, with the possible measures to prevent (avoid) them by answering the question „When do ordinary drugs become dangerous or do not work?”. Knowledge of the basic mechanisms of drug interactions, evidence of risk factors in performing pharmacotherapy, and a clearly arranged system of information on important clinical behaviors of drugs in various situations contribute to increasing the efficacy and harmless pharmacotherapeutic effect.

Rational Prescription Pattern of Antibiotics: A Quantitative Analysis Based on Khwaja Yunus Ali Medical College and Hospital (KYAMCH), Sirajganj, Bangladesh

Antibiotics, alternatively known as antibacterial drugs, prevent or reduce the development of germs. A decade has been added to the life expectancy of human beings since the discovery of antibiotics. Antibiotic overuse can result in resistance to a wide spectrum of diseases and bacteria. Antibiotic utility is being jeopardized by the rise of resistance. There aren't enough innovative agents to deal with the problem of resistant strains. The current study targeted to highlight the current status of antibiotic use.The study was designed as a prescription-based survey where the medicines in prescriptions were checked containing antibiotics, whether the drugs were prescribed rationally or not. The study was conducted from February to July 2018 at Khwaja Yunus Ali Medical College and Hospital, Bangladesh. Patient’s data were collected through review of patient medical records and prepared questionnaires. 100 people were interviewed, and their prescriptions were captured as photos and then checked for rationality.The antibiotics are prescribed in the group of 10 to 30 years, 31 to 50 years and more than 50 years of age.The survey demonstrated that 46% of patients know about antibiotics partially, about 74% of patients fulfill their entire course of medication and the rest of the patients stop taking medication after feeling better. Only 21% of patients knew about antibiotic resistance, whereas 37% of patients only heard about antibiotic resistance. According to the age group from low to high, 92.9%, 91.67%, 86.36% prescriptions were rational; 2.4%, 2.78%, 4.55% prescriptions were contraindicated and 4.7%, 5.56%, 9.1% prescriptions where medicines interacted with other non-antibiotic drugs, respectively. The overall rational prescription is 91%, whereas 3% of prescriptions are contraindicated and 6% of prescriptions showed interaction between antibiotics and other drugs (non-antibiotics).The study concluded that lack of knowledge and awareness of patients and inaccurate prescription data by physicians are two key factors that contribute to irrational antibiotic usage.

Antibiotics and the Nervous System-Which Face of Antibiotic Therapy Is Real, Dr. Jekyll (Neurotoxicity) or Mr. Hyde (Neuroprotection)?

Antibiotics as antibacterial drugs have saved many lives, but have also become a victim of their own success. Their widespread abuse reduces their anti-infective effectiveness and causes the development of bacterial resistance. Moreover, irrational antibiotic therapy contributes to gastrointestinal dysbiosis, that increases the risk of the development of many diseases, including neurological and psychiatric. One of the potential options for restoring homeostasis is the use of oral antibiotics that are poorly absorbed from the gastrointestinal tract (e.g., rifaximin alfa). Thus, antibiotic therapy may exert neurological or psychiatric adverse drug reactions which are often considered to be overlooked and undervalued issues. Drug-induced neurotoxicity is mostly observed after beta-lactams and quinolones. Penicillin may produce a wide range of neurological dysfunctions, including encephalopathy, behavioral changes, myoclonus or seizures. Their pathomechanism results from the disturbances of gamma-aminobutyric acid-GABA transmission (due to the molecular similarities between the structure of the β-lactam ring and GABA molecule) and impairment of the functioning of benzodiazepine receptors (BZD). However, on the other hand, antibiotics have also been studied for their neuroprotective properties in the treatment of neurodegenerative and neuroinflammatory processes (e.g., Alzheimer’s or Parkinson’s diseases). Antibiotics may, therefore, become promising elements of multi-targeted therapy for these entities.

Are Antibiotics Prescribed to Inpatients According to Recommended Standard Guidelines in South Sudan? A Retrospective Cross-Sectional Study in Juba Teaching Hospital.

PurposeAntibiotic resistance is spreading at an alarming rate globally, mainly because of antibiotics misuse. The World Health Organization developed guidelines for the rational use of antibiotics to prevent antibiotic misuse and reduce the potential development of antibiotic resistance. Although many countries adhere to these guidelines and have contextualized them to their needs, data on antibiotics use are limited in African countries, particularly in South Sudan. This study explored prescription patterns and use of antibiotics at Juba Teaching Hospital (JTH) to clarify the potential for antibiotic resistance in South Sudan.Materials and MethodsWe conducted a retrospective, cross-sectional study of archived patient data from 2016 to determine the prevalence of inappropriate antibiotics use at JTH. We used methodology developed in a previous study to assess the appropriate use of antibiotics. The study sample comprised 384 files. After reviewing and cleaning the files, 316 files were included in our analyses. This study was approved by the South Sudan Ministry of Health Ethics Review Board (approval number: MoH/ERB 51/2018) and all procedures were consistent with the Declaration of Helsinki.ResultsAntibiotics use was highest in the medical ward (75.4%). Most antibiotics prescriptions were for infectious diseases (23.7%), followed by ailments affecting the digestive system (19.9%). Commonly prescribed antibiotics were ceftriaxone (21.2%) and metronidazole (20.0%). The mean number of antibiotics prescribed per patient encounter was 2.09 (95% confidence interval: 1.98–2.19). Most files (n=233, 70.57%) demonstrated incorrect use of antibiotics with 78.8% (n=249) of prescriptions being inappropriate (misuse).ConclusionThis study revealed a high level of inappropriate antibiotics use at JTH despite the existence of local guidelines, which suggested there was an increased risk for antibiotic resistance. Therefore, it is necessary to introduce antibiotic stewardship activity, along with continuous national surveillance. Enforcement of guidelines to reduce irrational antibiotics use may reduce the risk for antibiotic resistance.

Pseudomonas aeruginosa as a priority group representative of bacteria with multiple antibiotic resistance

The aim: the aim of the research is an analytical review of the scientific literature on Рseudomonas aeruginosa as a priority group representative of bacteria with multiple antibiotics resistance.
 Materials and methods. The research was conducted by the method of scientific literature open source analysis: PubMed, Elsevier, electronic resources of the National Library named after V. I. Vernadsky and others.
 Results. The problem of antibiotic resistance is rightly called the “apocalypse of the XXI century”.
 P. aeruginosa bacteria are characterized by a very high natural ability to form resistant forms to antimicrobial drugs due to the formation of specific resistance genes, the ability to resist the entry of antibiotics into the cell or remove antibiotics from the cell, and form biofilms.
 A characteristic feature of the epidemic and epizootic processes of P. aeruginosa, as an opportunistic ubiquitous microorganism is host-pathogenic interaction - the interaction of the pathogen with the host organism. The peculiarity of this bacterium is opportunism and long-term persistence in the body of the host and in the environment.
 The global trend towards the spread of antibiotic-resistant gram-negative bacteria, including P. aeruginosa, underscores the need to develop comprehensive response strategies targeting all sectors of health.
 Conclusions. Bacteria P. aeruginosa is classified in 1th Critical Group of the WHO list of resistant to antibiotics "priority pathogens". Among the main reasons that contribute to the emergence of resistance are irrational antibiotic therapy in both humans and animals, and the use of antibiotics as growth stimulants in animal husbandry.
 While more R&D is vital, alone, it cannot solve the problem. To address resistance, there must also be better prevention of infections and appropriate use of existing antibiotics in humans and animals, as well as rational use of any new antibiotics that are developed in future.
 New methods of combating antibiotic resistance and antibacterial substances, alternatives to antibiotics (biofilm-destroying drugs, antimicrobial peptides (AMP), bacteriophages, nanopreparations, etc.) can make a positive contribution to overcoming the multiple drug resistance of gram-negatives

Patterns of Antimicrobials Prescribed to Patients Admitted to a Tertiary Care Hospital: A Prescription Quality Audit.

IntroductionRational use of antimicrobial agents is necessary to prevent the emergence of drug resistance. This study aims to assess the prescription pattern of antibiotics using the Anatomic Therapeutic Chemical Classification (ATCC)/Defined Daily Dose (DDD) metrics in real-world practice.MethodsA retrospective audit of antibiotics prescribed to patients admitted to a tertiary hospital over 20 months. The demographics and clinical information of patients were collected. The ATCC/DDD system was used to classify antibiotics. The DDD per 100 bed-days was calculated and the quality of prescription, including generic and parenteral formulation use, was evaluated.ResultsNine-hundred ninety-four prescriptions were analyzed. The average number of antibiotics prescribed was 2±1. Only 23% of the patients had confirmed cases of bacterial infection. Imidazole derivatives (J01X) were the most prescribed antibiotics (68.8 DDDs per 100 bed-days) followed by cephalosporins (45.0 DDDs), beta-lactams (35.3 DDDs), fluoroquinolones (30.9 DDDs), and macrolides/lincosamides (14.4 DDDs). Sulphonamides/trimethoprim (4.7 DDD), aminoglycosides (0.8 DDD), penicillin (0.3 DDD), and carbapenems (0.1 DDD) were the least prescribed. Metronidazole was the most prescribed drug (34.2%). Generic names and parenteral formulations were used in 55% and 72% of antibiotics prescribed.ConclusionThe continued low generics prescribing calls for interventions to be put in place to improve prescribing quality. Parenteral formulation prescribing encountered was very high, though this may not be unexpected in in-patients, it is vital to curtail the use of parenteral formulations so as to minimize the risk of infection.Irrational antibiotics prescription remains a serious concern in Nigeria. Drug utilization research using the ATCC/DDD metric is helpful in monitoring trends of drug use over time. This will help improve antibiotics stewardship and promote the rational use of antibiotics.