Frequency Of Antibiotic Prescribing Research Articles

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

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

Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea

Antimicrobial stewardship programs (ASPs) have gained prominence with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescriptions is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescriptions at a tertiary care hospital in Korea. We analysed the patterns of oral antibiotic prescription from June 1, 2018 to May 31, 2023, at the outpatient department of Seoul National University Bundang Hospital. Appropriateness was assessed for prescriptions issued between May 15 and May 19, 2023. The assessment criteria included: indications for antibiotic use, antibiotic choice, duration, dose, and frequency. Pharmacists and infectious diseases specialists performed evaluations. A total of 7,282,407 outpatient visits were recorded within the 5-year duration. Of these, 243,967 (3.4%) were prescribed oral antibiotics. The frequency of antibiotic prescription was highest in dentistry, dermatology, and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins, and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Inappropriate prescriptions were identified in 28.4% (82/289) and 70.9% (95/134) of the treatment and prophylaxis cases, respectively. The primary reason for inadequacy in both treatment and prophylaxis was inappropriate indications, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions. Antibiotics were administered in 3.4% of all outpatient visits, with 28.4% of treatment and 70.9% of prophylactic antibiotics prescribed inappropriately. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.

Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

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

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

Exploring treatment burden of Oral Nutritional Supplements (ONS) and impact on antibiotics using a data linkage approach

Abstract Introduction Treatment burden associated with thickeners is significant1. Understanding of potential treatment burden associated with ONS is lacking, however wastage due to ONS partial or full nonconsumption, and stock piling are recognised2. Wastage is evidence of over prescribing. Improving fluid intake by increasing variety is evidence based3 - ONS reduces opportunity. Whether thickener or ONS is prescribed, patients can withdraw consent by not drinking (verbally/silently). We investigated a potential correlation between ONS and low intake dehydration, and if detectable using a proxy measure: antibiotic prescribing for urinary tract infection (UTI). We explored using ePACT2 data to investigate co-prescribing of interventions that inter-relate, a type of data linkage study. Improved fluid intake can decrease laxative use, but did not reduce antibiotic use3. We hypothesized that with a large data set, it may be possible to detect associations of treatment burden and antibiotic use. Aim To explore the relationship between prescribing of ONS with antibiotics for UTIs in older adults in Primary Care (England). Methods We investigated co-prescribing of antibiotics prescribed for UTI (nitrofurantoin, trimethoprim) and ONS in older adults (> 65 years) in Primary Care. Data was obtained from the NHS Business Services Authority Data Services Support as bespoke analysis of prescribing ePACT2 data linked by NHS number. Retrospective analysis was performed on anonymised data for 3 years (January 2019 to December 2022). Ethical approval was not required. Data unattributable to a specific region was excluded. Results Initial analysis suggested that prescribing of UTI antibiotics was 3 times more common in older adults prescribed ONS compared with controls (an average 2.86% of the patients on GP list were prescribed an antibiotic for a UTI, increasing to 8.59% for those co-prescribed ONS). This correlation appeared consistent, however, due to high volume and level of detail of UTI antibiotic prescribing, this interpretation is incorrect. On further analysis, the population rate of UTI antibiotic and ONS was plotted to show trend over time, demonstrating no correlation. Prescription of UTI antibiotic over time is consistent, reflecting that acute lower UTI is not very reducible, and antibiotic prophylaxis use is common and repeated monthly. Additionally, from this data set you cannot ascertain if frequency of antibiotic prescription(s) pre-dates initiation of ONS. We did not investigate confounding factors such as co-prescribing of catheter use, gender, frailty and advancing age. Our oldest patients with decreased thirst, reduced appetite cues and ability to eat and drink will also be those most likely to get an UTI. Discussion/Conclusion Future data linkage work in this area should include a wider range of data e.g. detailed demographics, medical and prescribing history over time and all adverse events from low intake dehydration. Exploration of the impact of ONS and thickener prescription on patient experience, perceived treatment burden and the impact on fluid intake would be useful. Audit of shared decision making at initiation and review would also be beneficial in obtaining baseline data on consent at start and throughout duration of prescription.

The effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children

Background. Recurrent and prolonged course of respiratory infections leads to the formation of chronic foci of inflammation, the persistence of viruses, impaired physical and psychomotor development, and a decrease in the child’s immunity. Given the participation of vitamin D (VD) in the regulation of the body’s immune response, the study of its role in the development and course of recurrent respiratory diseases in children remains re­levant. The purpose is to study the effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children. Materials and methods. We examined 52 children with recurrent respiratory infections aged 4 to 10 years. Children were examined before and after VD supplementation according to the study criteria: the average frequency of acute respiratory infection (ARI) episodes per year, the severity of the clinical manifestations of ARI episode, its average duration, the frequency of antibiotic prescriptions and outpatient visits to the doctor. Results. It was found that at the beginning of the exa­mination, the level of 25(OH)D in the blood serum ranged from 11.1 to 29.9 ng/ml, 22 (42.3 %) children had VD deficiency. An analysis of the frequency of ARI episodes per year showed that children with VD deficiency were ill more often than children with a sufficient level of VD (p < 0.001). According to the results of the study, it was found that VD supplementation contributes to a decrease in the frequency of ARI episodes from 8.7 ± 1.7 to 6.8 ± 1.2 times a year (p < 0.001), a decrease in the average number of symptoms of an episode of acute respiratory infections per year from 5.5 ± 0.5 to 4.5 ± 0.5 and their manifestations from 9.2 to 7.41 points (p < 0.001), a decrease in the duration of ARI episode from 6.0 ± 1.7 to 5.7 ± 1.5 days (p = 0.003), as well as a decrease in the number of outpatient visits from 5 to 4 (p = 0.004) and antibiotic prescriptions from 61 to 38 (p < 0.001). Conclusions. VD supplementation improves the course of respiratory diseases in children. The study was carried out in accordance with the Declaration of Helsinki principles. The study protocol was adopted by the ethics committee of the institution indicated in the work. The informed consent of the children’s parents was obtained.

Perception of Antibiotic Prescribing and Resistance Among Hospital Physicians in Medina City, Saudi Arabia.

Background Overuse or misuse of broad-spectrum antibiotics appeared to be a major cause of increased antibiotic resistance. This study aimed to explore awareness and knowledge of antibiotic prescribing and resistance among hospital physicians in Medina, Saudi Arabia. Methodology A cross-sectional study was conducted among 223 physicians in seven public hospitals in Medina, Saudi Arabia.A validated self-administered questionnaire was used, including questions on sociodemographics, awareness about the current scope of antibiotic resistance, knowledge and frequency of antibiotic prescribing, confidence and input seeking, factors influencing antibiotic prescribing, and attitude toward antibiotic use.t-Test and analysis of variance (ANOVA) tests were used to compare total knowledge scores across the sociodemographic variables. The level of significance was set at 0.05. Results Most participants were aware that antibiotic resistance is a problem in Saudi Arabia (87.4%) and worldwide (93.3%).The majority of physicians (77.6%) were classified as having moderate knowledge, the mean knowledge score on antibiotics was 4.41, and 26.5% of the respondents prescribed antibiotics more than once daily. Most physicians (91.4%) were confident in antibiotic prescribing, and 94.1% of them consulted (at least sometimes) colleagues before prescribing. Factors associated with knowledge were age (P= 0.001), educational level (P= 0.002), working years (P= 0.004), current position (P= 0.003), specialty (P= 0.023), duration since graduation from medical school (P= 0.002), and duration since the last qualification (P= 0.022). Conclusions The majority of physicians had a moderate knowledge level of antibiotics, and most of them were prescribing antibiotics more than two times per week. Most respondents agreed that antimicrobial resistance is a worldwide concern and that it is a problem in Saudi Arabia. This study recommends training and courses on the fact that appropriate antibiotic prescribing should be ensured to have the best practice in antibiotic prescription among physicians.

Antibiotic Prescribing Patterns for Pediatric Urgent Care Clinicians.

Previous studies have reported high rates of inappropriate antibiotic prescriptions in urgent care (UC). Specific prescribing patterns for the most common diagnoses are not known. The aim of the study is to determine the diagnoses for which antibiotics are prescribed in pediatric UC settings. We recruited pediatric UC providers via email to participate in a national multisite quality improvement study. Participants completed a survey on 10 consecutive encounters in which an antibiotic was given between March and May 2018. Encounters in which only topical antibiotics were prescribed were excluded. We categorized the encounters into 3 previously established tiers to determine appropriateness of antibiotic use. The tiers represent a descending order for antibiotic need based on diagnoses, with the first tier representing diagnoses almost always requiring antibiotics and the third tier representing diagnoses when an antibiotic is almost never required. We reported the diagnoses and frequency of antibiotic prescription within each tier. The 157 providers from 20 institutions submitted a total of 2809 encounters. We excluded 339 encounters in which only topical antibiotics were prescribed. Most diagnoses fell into the tier 2 category (85.81%), with only 9.12% in tier 1 and 5.06% in tier 3. The most common diagnoses reported were acute otitis media (48.96%), pharyngitis (25.09%), and skin and soft tissue infections (7.29%). In this sample of pediatric UC encounters, only 5% of diagnoses receiving antibiotic prescriptions were made up of tier 3 diagnoses, determined to almost never require antibiotics. While viral respiratory infections have been reported to frequently be treated with antibiotics in general UC centers, our study of pediatric UC centers showed that this was infrequent. However, otitis media with effusion and otalgia should be further investigated. With most antibiotic prescriptions being tier 2 diagnoses, pediatric UC providers can use evidence-based prescribing practices, shared decision making, and contingency plans to reduce unnecessary antibiotic exposure.

Use of the Bacterial Lysate OM-85 in the Paediatric Population in Italy: A Retrospective Cohort Study.

Background: In Italy, the bacterial lysate OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®) is registered for the prophylaxis of recurrent respiratory tract infections (RTIs) in adults and children above one year of age, but there are limited data on its use in the paediatric population. We aim to estimate the impact of OM-85 treatment on RTIs and antibiotic prescriptions in children. Methods: This study included children aged 1 to 14 years enrolled in Pedianet, a paediatric general practice research database, from January 2007 to June 2017, having at least one prescription of OM-85. Children with less than 12 months of follow-up before (PRE period) and after (POST period) the OM-85 prescription were excluded. The frequency of antibiotic prescriptions and the frequency of RTI episodes in the PRE and POST periods were compared through the post-hoc test. Subgroup analysis was performed in children with recurrent RTIs. Results: 1091 children received 1382 OM-85 prescriptions for a total follow-up of 619,525.5 person-years. Overall, antibiotic prescriptions decreased from a mean of 2.8 (SD (standard deviation) 2.7) prescriptions in the PRE period to a mean of 2.2 (SD 2.6) prescriptions in the POST period (p < 0.0001). RTIs decreased from a mean of 3.4 (SD 2.9) episodes in the PRE period to a mean of 2.5 (SD 2.6) episodes in the POST period (p < 0.0001). No change in antibiotic class was noted, and co-amoxiclav remained the preferred therapy in 28% of cases, followed by amoxicillin. These results were confirmed among children with recurrent RTIs. Conclusions: OM-85 is effective in preventing both antibiotic prescriptions and RTIs in children.

Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study.

The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these agents in this and other LMIC. A cross-sectional retrospective study was designed and 2,266 handwritten veterinary records from 2017 were sampled from 23 animal health premises (AHPs) to estimate individual and an overall proportion of consultations that resulted in an antibiotic prescription. The frequency of antibiotic prescription per species, type of AHP, and according to WHO's AWaRe index and OIE list of priority antimicrobials were also explored. It was estimated that 31% (95% confidence interval: 29–33%; intracluster correlation: 0.03) of the veterinary consultations resulted in an antibiotic prescription. The incidence of antibiotic prescription was highest in consultations of poultry across AHP. Across species, diarrhea and wounds were frequently treated with broad-spectrum antibiotics including sulfonamides, tetracyclines, trimethoprim + sulfa, and penicillin. Between 45% and 70% antibiotics prescribed correspond to AWaRe's access group and up to 25% to AWaRe's watch group. Over 70% of antibiotics dispensed in veterinary consultations for any species correspond to the OIE's veterinary critically important antimicrobial agents. Overall, the study demonstrated positive features of veterinary antimicrobial stewardship in Bhutan, given the conservative proportion of consultation that results in this type of prescription and the type of antibiotic prescribed. Although the veterinary service closely follows the Bhutanese Standard Treatment Guidelines, the prescription of antibiotics to key species should be closely monitored. Our study suggests that further improvements of antibiotic stewardship can be achieved through standardisation of antibiotic prescription to some species, a revision of the guidelines toward reducing the prescription of antibiotics of high relevance for human medicine, and by including details of clinical investigation, use of tests, and treatment outcomes in veterinary consultation records.

Interim results of a multicenter retrospective-prospective observational post-marketing study of Extimia® BIOCAD (INN: empegfilgrastim) to evaluate safety and efficacy in patients with lymphoproliferative diseases receiving cytotoxic therapy

Aim. To assess the efficacy and safety of using the drug Extimia BIOCAD (international nonproprietary name INN: empegfilgrastim) in order to reduce the frequency and duration of neutropenia, the frequency of febrile neutropenia (FN) and infections manifested by FN in patients with lymphoproliferative diseases receiving myelosuppressive therapy.&#x0D; Materials and methods. This publication presents the interim results of a multicenter retrospective prospective observational post-marketing study of the safety and efficacy of the drug Extimia BIOCAD (INN: empegfilgrastim) in patients with lymphoproliferative diseases receiving cytotoxic therapy (LEGERITY). The interim data analysis included 40 patients with lymphoproliferative diseases (Hodgkins lymphoma, diffuse large B-cell lymphoma, multiple myeloma, primary mediastinal large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukemia, splenic marginal zone lymphoma), who were treated in ten research centers of the Russian Federation (Moscow, St. Petersburg, regional clinics). The median age of patients was 48 (2172) years, 13/40 (32.5%) patients belonged to the older age group (60 years). Patients had functional status on the ECOG scale of 02 and received at least 2 chemotherapy injections against the background of prophylaxis with empegfilgrastim. Empegfilgrastim was administered at a dose of 7.5 mg subcutaneously once 24 hours after the end of the administration of cytotoxic chemotherapeutic agents. Primary endpoint: frequency of neutropenia 35 degrees of severity; secondary endpoints: frequency of FN; frequency of severe infections (34 stages); frequency of antibiotic prescription; relative dose intensity of therapy of the conducted chemotherapy courses; the incidence of all adverse reactions in patients who received at least one dose of the study drug empegfilgrastim; the incidence of all serious adverse reactions in patients who received at least one dose of the study drug empegfilgrastim; the incidence of CTCAE 5.0 grade 34 HP in patients who received at least one dose of the study drug empegfilgrastim; discontinuation rate of study drug empegfilgrastim due to adverse reactions.&#x0D; Results. The results of this study demonstrate that the incidence of neutropenia of 3 degree of severity after the 1st cycle of chemotherapy developed in 2/40 patients (5%) and as a result of high-dose therapy (R-DHAP). Neutropenia of any severity was reported in 5/40 patients (12.5%). Cases of FN development have not been registered. Severe infections (mucositis, enteropathy, pneumonia, etc.), as well as the use of antibacterial and antifungal drugs during 1 cycle of chemotherapy and in the inter-course period after 1 cycle of therapy were not recorded in any patient. The next course of myelosuppressive therapy was not delayed due to the development of neutropenia in any of the patients during the study. Adverse events, according to the researcher, associated with the use of empegfilgrastim, were registered in 2/40 patients (5%): moderate generalized pain syndrome (diffuse pain) of 1 severity and in one case ossalgia of 2 severity. No serious adverse reactions were reported.&#x0D; Conclusion. The results of the interim analysis of the study demonstrate the high efficacy of the first Russian original pegylated granulocyte colony-stimulating factor empegfilgrastim after a single administration of a fixed dose in the treatment of patients with aggressive and indolent lymphomas. The drug has a favorable tolerance profile in any age group of patients, especially in elderly patients. Administration of empegfilgrastim as a prophylaxis of neutropenia in patients with lymphoproliferative diseases receiving myelosuppressive therapy of varying intensity can reduce the burden on medical personnel, improve patient adherence to treatment, and contribute to the implementation of the therapeutic plan.

Frequency and Antimicrobial Susceptibility of Bacterial Agents Causing Peritoneal Dialysis-Related Peritonitis: A Two-Center Experience

Background: Peritonitis remains a significant complication of peritoneal dialysis (PD) in children. Objectives: The current study aimed to evaluate the causative agents of PD-related peritonitis in pediatric patients treated by continuous ambulatory peritoneal dialysis (CAPD) in order to provide evidence for improving the empirical treatment of PD-related peritonitis and avoid antimicrobial resistance. Methods: The medical records of children diagnosed with PD-related peritonitis hospitalized at Mofid and Ali-Asghar Children’s Hospitals from January 2018 to December 2019 were retrospectively reviewed. Cases of relapsing peritonitis and fungal peritonitis were excluded. Data on demographics, clinical manifestations, para-clinical evaluations, peritoneal fluid culture and antibiogram, and antibiotic regimen were analyzed. Results: A total of 23 CAPD children aged 1 - 17 years were hospitalized with a confirmed diagnosis of PD-related peritonitis, accounting for a total of 27 peritonitis cases. The most frequent manifestation of peritonitis was cloudy dialysate (85.2%), followed by abdominal pain (59.3%). Gram-negative organisms were isolated in 48.1% of cases, and 4 cases had negative cultures. The frequency of antibiotic prescription within 14 days of admission was significantly higher in culture-negative cases (P = 0.002), and abdominal pain was more prevalent in Gram-negative peritonitis (P = 0.004). All Gram-negative organisms were sensitive to ceftazidime and imipenem; while 61.6% of them were sensitive to gentamycin. All Gram-positive organisms were sensitive to cefazolin, and vancomycin was effective against all Staphylococcus strains. Oxacillin resistance was reported in 50% of Staphylococcus strains. Conclusions: PD-related peritonitis should be suspected even in cases with clear dialysis effluent who present with other manifestations of peritonitis such as fever or abdominal pain. Moreover, intraperitoneal administration of a first-generation cephalosporin (cefazolin) combined with ceftazidime was an appropriate therapeutic option for empiric therapy.

Antibiotic Administration Along with Endodontic Therapy in the Republic of Croatia: a Pilot Study.

ObjectiveTo evaluate the type and the frequency of antibiotic prescribing along with endodontic therapy in Croatia. The aim is, also, to assess the attitudes of Croatian doctors towards endodontic treatment of patients at risk of developing bacterial endocarditis.Material and methodsData were collected by a survey questionnaire.Results8.4% of the examined practitioners stated that they prescribe antibiotics often, and 91.6% of them stated that they prescribed them never/ very rarely/rarely. Most of them (41%) prescribe antibiotics once or twice a month, 32.5% once or twice in several months and 20.5% once or twice a week. The most commonly used antibiotic was penicillin with clavulanic acid. Also, 26.2% of examined practitioners prescribed antibiotics for gangrene pulp, 51.2% of them for localized acute apical periodontitis without swelling, 85% of them for cellulitis, 75% of them for fever and enlarged lymph nodes, 16.9% of them for tooth with fistula and 94.1% of them for prophylaxis of infectious endocarditis. According to the results of study, 54.4% of dental practitioners did not prescribe antibiotics without intervention on susceptible tooth; 76% of participants often/almost always/ always accepted endodontic treatment of patients requiring antibiotic prophylaxis to prevent infectious endocarditis, and 96.7% of participants indicated they were familiar with recent instructions for antibiotic prophylaxis.ConclusionThese findings point to inappropriate use of antibiotics in the practice of 83 dental practitioners questioned regarding the frequency of administration and indications. The most commonly used antibiotic was penicillin with clavulanic acid. A high percentage of surveyed practitioners stated that they were familiar with recent instructions for antibiotic prophylaxis. They also stated that they performed endodontic procedures on patients who were at risk of bacterial endocarditis. There is a noticeable need for targeted continuing education of dental practitioners in the Republic of Croatia.

Prescribing patterns of antibiotics outpatients received by pharmacies in Medan city, Indonesia in 2017

IntroductionThis study aimed to determine the patterns of antibiotic use from prescriptions of physicians received by pharmacies in Medan from January to March 2017.MethodsThis study was conducted in a cross-sectional method using direct observation of prescriptions received by 100 pharmacies in Medan city. The data obtained were analyzed descriptively and grouped based on the antibiotic names, antibiotic classes, type of drugs, dosage forms and prescriptions.ResultsA total of 12,388 prescription sheets were obtained from 100 pharmacies in Medan during the study period in which 3,823 of the prescription sheets (30.96%) contained antibiotics. According to the data, 4,029 antibiotics were prescribed by physicians in which amoxicillin (20.63%) and cephalosporin groups (25.94%) as the most widely prescribed antibiotic and antibiotic class, respectively. A total of 1,923 antibiotics (47.73%) were prescribed with generic names and more than half of the antibiotics were prescribed in the dosage form of tablets (65.65%). This study also found that Ear Nose Throat (ENT) specialists are medical doctors who prescribe antibiotics the most.ConclusionBased on the study results, it can be concluded that the frequency of antibiotic prescriptions is still quite high in which amoxicillin as the most commonly prescribed antibiotic. In addition, ENT specialists as the most frequent prescribers of antibiotics.

77. Antimicrobial Prescribing Practices for Enteric Bacterial Infections in an Integrated Rural Healthcare System, 2004–2017

BackgroundBacterial enteric infections are common in the United States, but few studies have evaluated antibiotic prescribing practices for these illnesses. Unnecessary antibiotics can lead to adverse events and emergence of antimicrobial resistance. We assessed treatment practices among patients with laboratory-confirmed enteric infections in a large regional healthcare system.MethodsWe used electronic health records to identify patients with laboratory-confirmed nontyphoidal Salmonella, Shigella, Shiga toxin-producing E. coli (STEC), and Campylobacter infections from 2004 to 2017. We extracted relevant clinical data, including diagnosis codes for chronic conditions and receipt of immunosuppressive medications in the 60 days before and after the encounter, and antibiotic prescriptions in the 14 days after the encounter. We defined an appropriate treatment based on pathogen, patient characteristics, and IDSA practice guidelines for the study period.ResultsWe identified 2,064 patients infected with enteric pathogens: 1,251 (61%) with Campylobacter, 564 (27%) Salmonella, 199 (10%) STEC, and 50 (2%) Shigella. Overall, 425 (20%) patients were immunocompromised, ranging from 17% for Salmonella to 46% for STEC. There were 220 (11%) hospitalizations. The frequency of antibiotic prescribing was highest for Campylobacter (60%), followed by Shigella (50%) and Salmonella (49%). Prescriptions were appropriate for 62% of Campylobacter cases, 92% of Shigella, and 70% of Salmonella. Antibiotics were prescribed for 39% of STEC infections although they are generally not indicated. Appropriate treatment was highest for children with Campylobacter (87%) and lowest for adults ≥50 years with Campylobacter (42%). Among those with Salmonella, appropriate treatment was higher in those with a comorbidity (79% vs. 68% without, P < 0.05). Rates of appropriate use did not improve over time.ConclusionAntibiotic prescribing for laboratory-confirmed enteric infections was frequently inappropriate and inconsistent with practice guidelines. Antibiotic stewardship initiatives should address acute bacterial gastrointestinal infections in addition to other common infections.Disclosures All Authors: No reported Disclosures.

Antibiotic Prescription Patterns among Children Younger than 5 Years in Nouna District, Burkina Faso.

Understanding antibiotic use may help predict emergence of antimicrobial resistance. We evaluated antibiotic prescription trends in rural Burkina Faso, where little is known about antibiotic consumption. Antibiotic prescription data for 20 communities were extracted through record review in six primary health-care facilities serving the communities. The number of antibiotic prescriptions per child-year was calculated using population-based census data from the communities. A total of 1,444 antibiotic prescriptions were made from March to June 2017 among 3,401 children in the communities. The frequency of antibiotic prescription was 1.70 prescriptions per child-year (95% CI: 1.61-1.79). Penicillins were the most common (1.04 prescriptions per child-year, 95% CI: 1.01-1.06), followed by sulfonamides (0.69 prescriptions per child-year, 95% CI: 0.67-0.71) and macrolides (0.38 prescriptions per child-year, 95% CI: 0.37-0.40). Continued monitoring of antibiotic consumption in diverse settings will be important to understand the potential for emergence of antibiotic resistance.

An educational intervention to promote appropriate antibiotic use for acute respiratory infections in a district in Egypt- pilot study

BackgroundAntibiotic overuse is the most important modifiable factor contributing to antibiotic resistance. We conducted an educational campaign in Minya, Egypt targeting prescribers and the public through communications focused on appropriate antibiotic use for acute respiratory infections (ARIs).MethodsThe entire population of Minya was targeted by the campaign. Physicians and pharmacists were invited to participate in the pre-intervention assessments. Acute care hospitals and a sample of primary healthcare centers in Minya were randomly selected for a pre-intervention survey and all patients exiting outpatient clinics on the day of the survey were invited to participate. The same survey methodology was conducted for the post-intervention assessments. Descriptive comparisons were made through three assessments conducted pre- and post-intervention. We quantitated antibiotic prescribing through a survey administered to patients with an ARI exiting outpatient clinics. Additionally, physicians, pharmacists, and patients were interviewed regarding their attitudes and beliefs towards antibiotic prescribing. Finally, physicians were tested on three clinical scenarios (cold, bronchitis, and sinusitis) to measure their knowledge on antibiotic use.ResultsPost-intervention patient exit surveys revealed a 23.1% decrease in antibiotic prescribing for ARIs in this population (83.7 to 64.4%) and physicians and pharmacists self-reported less frequently prescribing antibiotics for ARIs on their follow-up surveys. We also found an increase in correct responses to the clinical scenarios and in attitude and belief scores for physicians, pharmacists, and patients regarding antibiotic use in the post-intervention sample.ConclusionsOverall, the samples surveyed after the community-based educational campaign reported a lower frequency of antibiotic prescribing and improved knowledge and attitudes regarding antibiotic misuse compared to the samples surveyed before the campaign. Ongoing interventions educating providers and patients are needed to decrease antibiotic misuse and reduce the spread of antibiotic resistance in Egypt.

Antibiotic use in the management of children with the common cold at a provincial hospital in Papua New Guinea: a point-prevalence study

ABSTRACTBackground: Antibiotic prescribing for self-limiting viral infections such as the common cold or viral upper respiratory tract infection (URTI) is irrational and increases the risk of antibiotic resistance. However, such a practice is widespread and is likely to be as common in Papua New Guinea as in many other countries.Methods: In a cross-sectional descriptive study, children were recruited who had been diagnosed with a common cold or URTI by attending clinical staff—mostly nurses—in a provincial hospital’s children’s outpatient department using a standard definition. The frequency of antibiotic prescribing was determined and the clinical knowledge and practices of nurses, health extension officers, community health workers and doctors working in the children’s outpatients department regarding the common cold and its management was assessed.Results: One hundred and eight children diagnosed with the common cold were enrolled; 89 (82.4%) were prescribed antibiotics. Children with fever on examination, those older than 12 months and those whose symptoms lasted ≥7 days were more likely to be prescribed antibiotics. Of the health workers surveyed, 95% knew that viruses were the cause of the common cold, but 30% thought that antibiotics were needed for treatment.Conclusions: Although among healthcare workers, there was a gap between knowledge of aetiology and knowledge of appropriate management of the common cold, there was a larger apparent gap between that knowledge and practice. Findings from this study could be used to identify interventions promoting rational antibiotic use, targeting both health-care workers and the community.

Antimicrobial prescribing for children in primary care.

To describe the patterns of antimicrobial prescribing in general practice for children aged ≤18 years. This is a review of routinely collected patient data extracted from computerised medical records from 39 general practices in eastern metropolitan Melbourne over a 5-year period, 2010-2014. Proportion of paediatric consultations resulting in antibiotic prescription, type and frequency of antibiotics prescribed, antibiotic prescribing stratified by age, reason for indication and inter-practice variation. There were 744 883 consultations for 89 983 individual paediatric patients and 85 913 prescriptions for antibiotics during the study period. Of these antibiotic prescriptions, 75 410 were associated with a consultation, and 10 503 (12.2% of all prescriptions) had no associated consultation in the data. On average, one in five individual children was prescribed an antibiotic each year. The most commonly prescribed antibiotics were cephalexin, amoxycillin/clavulanate, cefaclor, phenoxymethylpenicillin and roxithromycin. Less than 3% of all prescriptions were for amoxycillin. Prescribing of cefaclor and roxithromycin decreased, although cefaclor remained the third most common antibiotic choice for general practitioners. Peaks in prescribing were noted over winter months. Reason for prescription was not recorded for 82% of prescriptions. The frequency of antibiotic prescription per consultation varied substantially (2.1-19.7%) between general practitioner clinics. Overall, antibiotic prescribing decreased by 2.3% over the 5-year period. This study provides a focused examination of antibiotic prescribing practices for children in Australian general practice. More information is required to better understand specific prescribing practices in children, including the low frequency of amoxycillin prescription and ongoing prescription of cefaclor.

Antibiotic prescriptions in the case management of acute watery diarrhea in under fives

Background: Diarrhea disease is a leading cause of under-five mortality globally. The World Health Organization recommends low osmolality oral rehydration solution, zinc supplementation and adequate nutrition in the management. Antibiotic is indicated only in specific circumstances. This study was aimed at determining the antibiotic prescription in the management of under-fives with acute watery diarrhea.Methods: An audit of under-fives managed for acute watery diarrhea was conducted between January and February 2012. A multi-stage stratified random sampling technique was used to select 32 health facilities (21 primary and 11 secondary) from two local government areas of Cross River State. Case records of children managed for the condition six months prior to the audit were retrieved and evaluated. The appropriateness, types and frequency of antibiotic prescriptions were assessed.Results: A total of 370 case records were evaluated. Antibiotic was not indicated in any of the children but was prescribed for 291 (78.6%). Of this number, 169 (45.7%) received one antibiotic while 122 (33.0%) received two or more antibiotics. The difference in the prescription of multiple antibiotics between health workers in the primary and secondary facilities was statistically significant (p value = 0.00001). Metronidazole was the most prescribed antibiotic 228 (50.9%), followed by co-trimoxazole 88 (19.6%) and gentamicin 55 (11.8%).Conclusions: There is a high level of irrational antibiotic prescriptions in the State with oral metronidazole being the most prescribed. Periodic training of health workers on indications for antibiotic prescriptions in the management of diarrhea in under-fives is necessary.