Higher Prescription Rates Research Articles

Postoperative Brace Prescription Practices for Elective Lumbar Spine Surgery: A Questionnaire-Based Study of Spine Surgeons in Japan.

The efficacy of postoperative braces for degenerative lumbar disorders has long been debated, with conflicting reports regarding the promotion of bone fusion and pain relief. The current aspects of postoperative brace prescriptions have been previously reported in Western countries but not in Asia. This study aimed to elucidate prescription practices in Japan and identify factors influencing prescription decisions. The survey was conducted at a spine group research meeting comprising spine surgeons from multiple institutions. The questionnaire assessed aspects of postoperative brace prescription, including the type, purpose, and duration of usage, categorized by surgical procedures for degenerative lumbar disorders: endoscopic decompression, open surgery decompression, and fusion involving 1 or more than 3 levels. The respondents' backgrounds, scientific knowledge of postoperative braces, nonscientific reasons, and basis for prescription decisions were also investigated. There were 63 valid responses. The overall postoperative brace prescription rate was 83%, with 66% for decompression and 98% for fusion procedures, surpassing the rates reported in Western studies. The primary prescription purpose was to slow down patient activity (83%, double the previously reported rates). Prescription rates for endoscopic and open surgical decompression were significantly correlated with facility attributes and annual number of surgeries. Scientific knowledge of postoperative braces was lacking in 56% of respondents, with scientific evidence being the least frequent decision for brace prescription (14%). Nonscientific reasons influenced the prescription decisions of 84% of participants. The postoperative brace prescription rate among spine surgeons in Japan was significantly higher than that in Western studies, largely due to nonscientific factors such as physician reassurance and the intention to slow down patient activity. Comprehensive, evidence-based guidelines are needed regarding consistent brace usage to optimize patient outcomes. This study highlights the high postoperative brace prescription rates among spine surgeons in Japan, which are significantly influenced by nonscientific factors, such as tradition, physician reassurance, and patient satisfaction, rather than scientific evidence. These findings underscore the need for evidence-based guidelines to improve consistency in postoperative brace usage. The results are particularly relevant in regions with aging populations and a high prevalence of osteoporosis, providing insights for improving postoperative management strategies and patient outcomes in Japan as well as in similar demographic settings globally.

P-1697. Antibiotic prescribing patterns among outpatients with acute sinusitis in Michigan

Abstract Background Acute sinusitis is a common presenting illness in the outpatient setting. While antibiotics are often prescribed, they are infrequently indicated in adults. Limited data are available assessing prescribing practices. This study aimed to describe statewide antibiotic prescribing for sinusitis among outpatients in Michigan to identify opportunities for antimicrobial stewardship (AMS) interventions for clinical and public health partners.Figure 1:Outpatient antibiotic prescribing practices for sinusitis in Michigan, 2019-2021 Methods The Michigan Department of Health and Human Services received medical and pharmacy claims data from IQVIA from 2019 – 2021. Outpatients with medical claims data with a diagnosis code (J01) for acute sinusitis were included, while those with concomitant upper respiratory tract, urinary tract, or skin and soft tissue infectious diagnoses codes were excluded. Patients with a J01 diagnosis in their medical claims were linked to their corresponding antibiotic prescriptions from pharmacy claims based on patient identifier, prescription date, ordering provider, and antibiotic utilized. Prescribing patterns of antibiotics (frequency of prescription, agent selection, and duration of therapy) were analyzed for the overall cohort and stratified by place of service, provider specialty, year of service, patient zip code, age, and gender.Figure 2:Frequency of acute sinusitis encounters with an antibiotic prescription by 3-digit zip code Results From 2019 - 2021 there were 560,255 unique encounters from 424,684 patients for acute sinusitis in Michigan within the IQVIA medical claims database. Antibiotics were prescribed in 66% of these cases. Amoxicillin-clavulanic acid (33%), azithromycin (25%), and amoxicillin (20%) were the most prescribed antibiotics, with median durations of 10 days, 5 days, and 10 days, respectively. The prescription patterns among different groups are shown in Figures 1 and 2. Prescription rates, agent selection, and durations were remarkably consistent across calendar year, age group, sex, place of service, provider specialty, and patient zip code. Conclusion The study revealed a concerning pattern of high antibiotic prescription rates, inappropriate antibiotic selection, and prolonged durations of therapy in the outpatient management of acute sinusitis in Michigan. These findings were consistent in all subgroups analyzed and emphasize the need to prioritize outpatient AMS practices for sinusitis. Disclosures jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant

Barriers to prescription of hormonal contraception and hormone replacement therapy in gynecological cancer survivors: Results of a survey and literature review.

The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions. To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions. A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes. 185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6 %) and 34 oncology gynecologists (18.4 %). Of these, 49.7 % and 55.1 % had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (p < 0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes. The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.

Opioid-Prescribing Trends in Dermatology From 2014 to 2020 in the United States.

Introduction The opioid epidemic is a critical public health crisis, with opioid overdose deaths being a leading cause of injury-related deaths in the United States. Dermatology, though a small contributor to overall opioid prescriptions, still accounts for over 700,000 opioid pills annually. Reducing opioid prescribing in this specialty has been challenging due to limited comprehensive research. This study aimed to investigate opioid-prescribing trends in dermatology across all nine US regions over seven years. Methods Data on opioid prescriptions by dermatologists from 2014 to 2020 were collected retrospectively from the Medicare Part D Prescribers by Provider database, available through the United States Centers for Medicare and Medicaid Services (CMS). The data were analyzed nationally and by geographic division, using US census population estimates for the respective states to calculate rates per population. Over the years studied, opioid prescription claims, the number of dermatologists, and the proportion of dermatologists prescribing opioids gradually decreased both by average and by population. Results Over the years evaluated, there were a total of 618,714 claims for short-acting opioids throughout the United States. Prescription claims, the number of dermatologists, and the proportion of dermatologists prescribing opioids all saw a gradual decrease in numbers by average and by population. Claims per year decreased from2,023 in 2014 to 1,124 in 2020. Dermatologists per 10,000 people decreased from 0.35 in 2014 and 2015 to 0.32 in 2020. The percentage of dermatologists prescribing opioids decreased from 16.5% (0.06 per 10,000 people) in 2014 to 9.14% (0.03 per 10,000 people) in 2020. Over the seven-year period, the geographic state divisions that make up the south region had the most claims by population with 3330 claims in division 5 (3.9 per 10,000 people), 2531 claims in division 6 (5.2 per 10,000 people), and 3287 claims in division 7 (2.97 claims per 10,000 people). Division 1 had the least amount, with 0.6 claims per 10,000 people. Conclusion The findings show a gradual decline in opioid prescriptions by dermatologists, consistent with the national trend. Moreover, there are significant regional variations in opioid prescribing, with the southern states having the highest prescribing rates. The study highlights the need for targeted education policies to address regional variations and promote standardized opioid protocols in dermatology practice.

Antimicrobial prescribing practices and factors associated with antimicrobial prescribing in hospitalized COVID-19 patients in Oyo state: A retrospective study.

Proportion of hospitalized COVID-19 patients receiving antimicrobial drug is significantly high despite evidence of low level of actual bacterial co-infection, potentially contributing to poor health outcome and global antimicrobial resistance. A retrospective study was performed on antimicrobial agents prescribed to adult patients with confirmed COVID-19 admitted across three isolation facilities between 1 March 2020 and 30 April 2021 in Ibadan, Oyo state, Nigeria. From individual records, we evaluated patient demographics, COVID-19 risk factors, diagnostic testing, disease severity and antimicrobial utilization. The primary aim was to determine the prevalence of antimicrobial prescription as well as factors associated with antimicrobial prescribing in hospitalized patients with COVID-19 in Oyo state. In total, 271 patients were included in this study. The median age of the population was 51 years (IQR; 32-62 years). The mean duration of hospital admission was 13 days (IQR: 10-14 days). Majority of participants were symptomatic (81.5%). All participants had a COVID-19 PCR test performed and none had bacterial culture performed. All patients received antimicrobial therapy across the entire cohort. The mean DOT per LOT across cohorts was 1.2 for mild cases, 1.4 for moderate cases and 1.3 for severe cases. Factors associated with the number of antimicrobials per prescription were being single (P = 0.02), being below 60 years of age (P = 0.04), mild COVID-19 symptoms (P < 0.001) and diabetes comorbidity (P = 0.03). Given the high rate of antimicrobial prescription and absence of bacteriological culture analysis in these patients, there is risk of development and spread of antimicrobial resistant. Continuous review of antimicrobial prescription is critical in the management of hospitalized COVID-19 patients.

Hospital Utilization in Sickle Cell Disease Patients: A One-Year Retrospective Study in Urban Underserved Communities

Introduction Sickle cell disease (SCD) is a common genetic disorder affecting approximately 100,000 people in the United States. It significantly reduces quality of life and leads to early death. Despite available FDA-approved medications that can reduce painful episodes, these treatments are often under prescribed due to healthcare access barriers, socioeconomic challenges, and psychosocial factors. This study examines how these factors impact healthcare use among SCD patients at NYCHHC/Lincoln Medical Center. Method We reviewed records of SCD patients admitted to Lincoln Medical Center between January 1 and December 31, 2022. We collected data on emergency department (ED) visits, hospital admissions, average length of stay (LOS), medication, and psychiatric disorders from electronic medical records. Data analysis was performed with SPSS. Results We identified 30 patients, and 2 who died within a year of their first 2022 admission were excluded. The remaining 28 patients accounted for 105 admissions during the study period. Of these patients, 21.4% were male (N=6) and 78.6% were female (N=22). The majority identified as Black (75%), while 25% identified as Hispanic. The average age was 20.3 years. Black patients, compared to Hispanic patients, had more ED visits (13.5 vs 4.6, p=0.101), more readmissions (4.2 vs 2.4, p=0.052), and longer LOS (5.3 vs 3.0 days, p=0.267). Regarding medication use, 78.6% of patients (N=24) were taking Hydroxyurea, 3.6% (N=1) were receiving Voxelotor, and 7.1% (N=2) were enrolled in the clinical trial (Etavopivat). Patients on FDA-approved SCD medications (Hydroxyurea and Voxelotor in our case) had fewer readmissions (2.17 vs 4.18, p=0.011) to compared to who were not. In terms of healthcare provider access, 21.4% of patients lacked a primary care provider (PCP), and 28.6% lacked a hematologist for SCD follow-up. Patients without hematologist follow up had more ED visits (24.75 vs 5.85, p&amp;lt;0.001), more readmissions (5.75 vs 2.95, p=0.013), and longer LOS (5.9 vs 4.3 days, p=0.045). Regarding insurance, 20 patients (71.3%) used Medicare or Medicaid as their primary payer, and 8 (28.6%) had private insurance. There was no statistically significant difference in ED visits, readmissions, or LOS between the insurance groups. Psychiatric disorders were diagnosed in 28.6% of patients (N=8). These patients had more readmissions (27.7 vs 5.8, p=0.015), more ED visits (9.29 vs 1.9, p=0.015), and longer LOS (8.2 vs 3.6 days, p&amp;lt;0.001) compared to those without psychiatric diagnoses. Discussion Our study highlights key insights into healthcare use among SCD patients in an urban underserved community. Black patients had more frequent ED visits, readmissions, and longer hospital stays than Hispanic patients, reflecting disparities in healthcare access, socioeconomic status, and potential treatment biases. Psychiatric disorders significantly influenced healthcare utilization, with conditions like depression, bipolar disorder, and anxiety leading to higher readmission rates, more ED visits, and longer hospital stays. This underscores the need for integrated mental health services within SCD management. Despite the high prescription rate of Hydroxyurea, the use of newer FDA-approved medications like Voxelotor and participation in clinical trials were minimal. Given that patients on FDA-approved treatments had fewer readmissions, optimizing pharmacological management is crucial. The study also highlights the importance of consistent follow-up care. Patients without regular hematologist follow-up experienced significantly higher ED visits, readmissions, and longer LOS, emphasizing the need for continuous care relationships with both primary care providers and specialists. Conclusion The study highlights the substantial hospital use burden among SCD patients, characterized by frequent ED visits and readmissions. Despite known benefits, usage of Hydroxyurea and newer FDA-approved medications was suboptimal. Lack of regular hematologist follow-up and presence of psychiatric disorders were associated with increased healthcare utilization. These findings emphasize the need for improved access to hematology follow-up and integrated psychiatric care, to enhance the quality of life for SCD patients.

Guideline-directed medical therapy patterns in heart failure with reduced ejection fraction: the OPTIMA-HF registry

Abstract Background/Introduction European guidelines strongly recommend an optimized pharmacological treatment in patients with heart failure with reduced ejection fraction (HFrEF) with a fast introduction of the four-pillars. Purpose Aim of the Optimization of Therapy in the Italian Management of Heart Failure [OpTIMa-HF] Registry was to collect data on HF patients to describe the current Italian population of HF patients with a specific focus on HFrEF treatment adherence and prescription rates, according to the most recent European Guidelines. Methods OPTIMA-HF is an observational, cross-sectional, multicenter, real-life study conducted in two different clinical settings: HF outpatients’ clinics of Italian University Hospitals and territorial Italian Cardiology outpatients’ services, that enrolled patients with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined. Results Overall, 1390 patients from 29 ambulatory cardiology practices and university hospitals were included. Mean age was 69.5 ± 11.9 years, 24% were female, and median EF was 33 (28-37). Among enrolled patients, 72.2% were prescribed ARNI, 17.1% ACEI/ARB, 95% beta-blocker, 75.5% MRA and 63% SGLT2i therapy (Figure 1). Despite high prescription rates for each single class, a still not sufficient number of patients was on treatment with all four pillars, in particular 40.4% considering the presence ARNI and 6.2%. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (31.7%), ARNI (16%), and beta-blocker (33.3%), whereas a higher proportion were receiving target doses of MRA therapy (38%), and all were receiving target dose for SGLT2i. Among patients eligible for all classes of medication, only 1.1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, MRA and SGLT2i. Prescription rates did not significantly differ between the type of center (University Hospital vs. territorial Cardiology outpatients’ services). As regards patients not on treatment with any of the four pillars, a small but still present amount of patients had no contraindications to these drugs (Figure 1). Conclusions In this contemporary outpatient HFrEF Italian registry, significant high prescription rates of the four-pillars were observed, however therapy combination rate is still not sufficient and drugs' titration need to be implemented to receive the greatest benefits from an optimized treatment. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

S732 The Burden of Pain: High Rates of Opioid and Non-Opioid Analgesic Prescription in Patients With Irritable Bowel Syndrome

S732 The Burden of Pain: High Rates of Opioid and Non-Opioid Analgesic Prescription in Patients With Irritable Bowel Syndrome

Prescription patterns and symptom relief of antitussives and expectorants in patients with cough: a nationwide study in Korea.

Limited data are available on the prescription patterns and efficacy of antitussives and expectorants for patients with acute and chronic cough. This study examined the use and efficacy of these medications in a nationally representative sample of Korean patients. We examined 4,206,016 individuals from the National Health Insurance Service (NHIS)-National Health Information Database (NHID) between 2015 and 2017. Among them, a sample of 10% (n=420,602) was retrieved for the diagnosis of respiratory diseases using the International Classification of Diseases, 10th edition (ICD-10; J00-J99), or the prescription of antitussives and expectorants for cough (ICD-10; R05). The acute cough group included those who were prescribed medications within 4 weeks of initial diagnosis (prescription within 14 days), whereas the chronic cough group included patients who were prescribed medications within 16 weeks of initial diagnosis (prescription within 56 days). If the prescription was discontinued or not changed to an alternative drug after the initial prescription, these cases were considered to have achieved symptom relief. This study included 288,460 patients (971,065 cases) with acute cough and 5,888 patients (15,399 cases) with chronic cough. 'Expectorants, excluding combinations with cough suppressants' had the highest prescription rates in both groups (acute cough, 63.8%; chronic cough, 61.7%), and showed the highest symptom relief regardless of the number of medications prescribed (acute cough, 84.3%; chronic cough, 70.4%). 'Expectorants, excluding combinations with cough suppressants' were the most prescribed and effective medications for relieving cough symptoms in Korea patients. Further studies are needed to determine the optimal duration for using antitussives and expectorants in cough management.

Prescription patterns of antibiotics and associated factors among outpatients diagnosed with respiratory tract infections in Jinja city, Uganda, June 2022–May 2023

BackgroundMost respiratory tract infections (RTIs) are viral and do not require antibiotics, yet their inappropriate prescription is common in low-income settings due to factors like inadequate diagnostic facilities. This misuse contributes to antibiotic resistance. We determined antibiotic prescription patterns and associated factors among outpatients with RTIs in Jinja City, Uganda.MethodsWe conducted a retrospective observational study that involved data abstraction of all patient records with a diagnosis of RTIs from the outpatient registers for the period of June 1, 2022, to May 31, 2023. An interviewer-administered questionnaire capturing data on prescribing practices and factors influencing antibiotic prescription was administered to drug prescribers in the health facilities where data were abstracted and who had prescribed from June 1, 2022, to May 31, 2023. We used modified Poisson regression analysis to identify factors associated with antibiotic prescription.ResultsOut of 1,669 patient records reviewed, the overall antibiotic prescription rate for respiratory tract infections (RTIs) was 79.8%. For specific RTIs, rates were 71.4% for acute bronchitis, 93.3% for acute otitis media, and 74.4% for acute upper respiratory tract infections (URTIs). Factors significantly associated with antibiotic prescription included access to Uganda Clinical Guidelines (Adjusted prevalence ratio [aPR] = 0.61, 95% CI = 0.01–0.91) and Integrated Management of Childhood Illness guidelines (aPR = 0.14, 95% CI = 0.12–0.87, P = 0.002), which reduced the likelihood of prescription. Prescribers without training on antibiotic use were more likely to prescribe antibiotics (aPR = 3.55, 95% CI = 1.92–3.98). Patients with common cold (aPR = 0.06, 95% CI = 0.04–0.20) and cough (aPR = 0.11, 95% CI = 0.09–0.91) were less likely to receive antibiotics compared to those with pneumonia.ConclusionThe study reveals a high rate of inappropriate antibiotic prescription for RTIs, highlighting challenges in adherence to treatment guidelines. This practice not only wastes national resources but also could contribute to the growing threat of antibiotic resistance. Targeted interventions, such as enforcing adherence to prescription guidelines, could improve prescription practices and reduce antibiotic misuse in this low-income setting.

Racial and Ethnic Disparities in Prescription of a Novel Agent in Medical Management of Primary Open-Angle Glaucoma

ABSTRACT Purpose To investigate racial and ethnic inequalities in prescription of Netarsudil, one of two anti-glaucoma medications with a novel mechanism to be introduced in the past two decades, among patients with primary open-angle glaucoma. Methods This retrospective cohort matched study, based on electronic health records consisting of 92 million patients in the U.S, utilized Propensity Score Match, Relative Risk, Kaplan–Meier survival, and Chi-Square analysis to identify differences in rates of Netarsudil prescribing between racial and ethnic groups (non-Hispanic White, non-Hispanic Black, non-Hispanic Other Race, and Hispanic). Results Among the sample of patients that met Primary Open-Angle Glaucoma inclusion criteria (55,942), more White patients were prescribed Netarsudil than Black; (RR:1.24, 95% CI: 1.15-1.34) and Hispanic; (RR:1.63, 95% CI: 1.29-2.07) patients. White patients had higher prescription rates than Black patients in the Midwest (6.5% vs 4.2%; p < 0.0001) and West (11.2% vs 7.1%; p = 0.0002), higher rates than Hispanic patients in the South (4.9% vs. 2.0%; p < 0.0001) and West (11.2% vs. 7.8%; p < 0.008), but lower rates than Black patients in the Northeast (7.2% vs. 13.2%; p < 0.0001). Conclusions Differences in Netarsudil prescription rates within the United States exist between White and Black patients, and White and Hispanic patients. These differences exist when stratified by regions within the U.S. by varying degrees. Future studies are needed to investigate factors contributing to disparities in accessing new medications and to identify ways to eliminate such barriers to improve equity in care of glaucoma patients, especially among those historically disadvantaged.

Variations in antihypertensive medication treatment and blood pressure control among Veterans with HIV and existing hypertension

BackgroundHypertension is a leading risk factor for cardiovascular disease among patients living with HIV (PLWH). Understanding the predictors and patterns of antihypertensive medication prescription and blood pressure (BP) control among PLWH with hypertension (HTN) is important to improve the primary prevention efforts for this high-risk population. We sought to assess important patient-level correlates (eg, race) and inter-facility variations in antihypertension medication prescriptions and BP control among Veterans living with HIV (VLWH) and HTN. MethodsWe studied VLWH with a diagnosis of HTN who received care in the Veterans Health Administration (VHA) from January 2018 to December 2019. We evaluated HTN treatment and blood pressure control across demographic variables, including race, and by medical comorbidities. Data were also compared among VHA facilities. Predictors of HTN treatment and control were assessed in 2-level hierarchical multivariate logistic regression models to estimate odds ratios (ORs). The VHA facility random-effects parameters from the hierarchical models were used to calculate the median odds ratios to characterize the variation across the different VHA facilities. ResultsA total of 17,468 VLWH with HTN (mean age 61 years, 97% male, 54% Black, 40% White) who received care within the VHA facilities in 2018-2019 were included. 73% were prescribed antihypertension medications with higher prescription rates among Black vs White patients (75% vs 71%) and higher prescription rates among patients with a history of cardiovascular disease, diabetes, and kidney disease (>80%), and those receiving antiretroviral therapy and with controlled HIV viral load (∼75%). Only 27% of VLWH with HTN had optimal BP control of systolic BP <130 mmHg and diastolic BP <80 mmHg, with a lower rate of control among Black vs White patients (24% v. 31%). In multivariate regression, Black patients had a higher likelihood of HTN medication prescription (OR 1.32, 95% CI: 1.22-1.42) but were less likely to have optimal BP control (OR 0.82; 0.76-0.88). Important positive correlates of antihypertensive prescription and optimal BP control included: number of outpatient visits in prior year, and histories of diabetes, coronary artery disease, and heart failure. There was about 10% variability in both antihypertensive prescription and BP control patterns between VHA facilities for patients with similar characteristics. There was increased inter-facility variation in antihypertensive prescription among those with a history of heart failure and those not receiving antiretroviral therapy. ConclusionIn a retrospective analysis of large VHA data, we found that VLWH with HTN have suboptimal antihypertensive medication prescription and BP control. Black VLWH had higher HTN medication prescription rates but lower optimal BP control.

Exposure to doxycycline increases risk of carrying a broad range of enteric antimicrobial resistance determinants in an elderly cohort

High rates of antibiotic prescription in residential aged care are likely to promote enteric carriage of antibiotic-resistant pathogens and increase the risk of antibiotic treatment failure. Despite their importance, relationships between antibiotic exposures and patterns of enteric resistance carriage in this population remain poorly understood. We conducted a cross-sectional metagenomic cohort analysis of stool samples from residents of five long-term aged-care facilities in South Australia. Taxonomic composition was determined, and enteric carriage of antibiotic resistance genes (ARGs) was identified and quantified against the Comprehensive Antibiotic Resistance Database. Both the detection and abundance of stool taxa and ARGs were related to antibiotic exposures up to 12 months prior. Factors associated with the abundance of ARGs of high clinical concern were identified. Stool samples were provided by 164 participants (median age: 88 years, IQR 81-93; 72% female). Sixty-one percent (n=100) of participants were prescribed antibiotics at least once in the prior 12 months (median prescriptions: 4, range: 1-52), most commonly a penicillin (n=55, 33.5%), cephalosporin (n=53, 32.3%), diaminopyrimidine (trimethoprim) (n=36, 22%), or tetracycline (doxycycline) (n=21, 12.8%). More than 1100 unique ARGs, conferring resistance to 38 antibiotic classes, were identified, including 20 ARGs of high clinical concern. Multivariate logistic regression showed doxycycline exposure to be the greatest risk factor for high ARG abundance (adjusted odds ratio [aOR]=14.8, q<0.001) and a significant contributor to inter-class selection, particularly for ARGs relating to penicillins (aOR=3.1, q=0.0004) and cephalosporins (aOR=3.4, q=0.003). High enteric ARG abundance was associated with the number of separate antibiotic exposures (aOR: 6.4, q<0.001), exposures within the prior 30 days (aOR: 4.6, q=0.008) and prior 30-100 days (aOR: 2.6, q=0.008), high duration of antibiotic exposure (aOR: 7.9, q<0.001), and exposure to 3 or more antibiotic classes (aOR: 7.4, q<0.001). Carriage of one or more ARGs of high clinical concern was identified in 99% of participants (n=162, median: 3, IQR: 2-4), involving 11 ARGs conferring resistance to aminoglycosides, four to beta-lactams, one to glycopeptides, three to fluoroquinolones, and one to oxazolidinones. Carriage of ARGs of high clinical concern was positively associated with exposure to doxycycline (aminoglycoside, fluoroquinolone, and oxazolidinone ARGs) and trimethoprim (fluoroquinolone and beta-lactam ARGs). Analysis of doxycycline impact on microbiota composition suggested that observed resistome changes arose principally through direct ARG selection, rather than through the antibiotic depletion of sensitive bacterial populations. The gut microbiome of aged care residents is a major reservoir of antibiotic resistance. As a critical antibiotic in medical practice, a comprehensive understanding of the impact of doxycycline exposure on the gut resistome is paramount for informed antibiotic use, particularly in an evolving landscape of prophylactic applications. Near-universal asymptomatic carriage of clinically critical resistance determinants is highly concerning and reinforces the urgent need for improved management of antibiotic use in long-term aged care.

Analysis of Prescription Trends for Narcotic Appetite Suppressants: Utilizing the Narcotics Information Management System.

The aim of this study was to systematically analyze the prescription trends of medical narcotic appetite suppressants in South Korea. Data was extracted from the Narcotics Information Management System dataset from 2020, which encompasses nationwide information concerning the use of medical narcotics. The selected variables for this study included the types of prescribed medical narcotic appetite suppressants, gender, age, region, and the category of medical institution. Regional prescription trends were compared by utilizing the defined daily doses for statistical purposes (S-DDD). The prescription of medical narcotic appetite suppressants was predominantly for females (94%), with the highest prescription rates identified in the 30-40 age group. The majority of these prescriptions were dispensed by clinics. Within the category of narcotic appetite suppressants, phentermine and phendimetrazine were found to have higher prescription rates. Notably, the region of Daegu recorded the highest S-DDD value (12.66) in phentermine consumption. Our findings underscore the need for governmental policy and guidance to address the risks linked to the long-term use of medical narcotic appetite suppressants. This is crucial to ensure their safe and efficacious prescription and administration.

Understanding antibiotic purchasing practices in community pharmacies: A potential driver of emerging antimicrobial resistance

IntroductionAntimicrobial resistance (AMR), a transboundary health issue, critically impacting low- and middle-income countries (LMICs) where 80% of antibiotics are used in the community, with 20–50% being inappropriate. Southeast-Asia, including Bangladesh, faces heightened AMR risk due to suboptimal healthcare standard and unregulated antibiotic sales. This study aimed to audit antibiotic dispensing patterns from community pharmacies, identifying factors influencing purchasing behaviors. MethodsA cross-sectional survey of 385 antibiotic customers and structured observations of 1000 pharmacy dispensing events were conducted in four urban and rural areas in Bangladesh. Descriptive analysis defined antibiotic use, while Poisson regression examined how patients' demographics and health symptoms influenced prescription behaviors. ResultsAmong 1000 observed medicine dispensing events, 25.9% were antibiotics. Commonly purchased antibiotics included macrolides (22.8%), third-generation-cephalosporins (20.8%), and second-generation-cephalosporins (16.9%). Following WHO-AWaRe classifications, 73.5% of antibiotics were categorized as Watch, and 23.1% as Access. From the survey, 56.6% antibiotics were purchased without a prescription from drug-sellers and informal healthcare providers, primarily for “non-severe” health-symptoms such as upper-respiratory-tract infections (37.4%), fever (31.7%), uncomplicated skin infections (20%), gastrointestinal-infections (11.2%), and urinary-tract infections (7.9%). The likelihood of presenting a prescription while purchasing antibiotics was 27% lower for individuals aged 6–59 compared to those ≤5 or ≥ 60. Lower-respiratory-tract infections and enteric-fever had higher prescription rates, with adjusted prevalence ratios of 1.78 (95% CI: 1.04, 3.03) and 1.87 (95% CI: 1.07, 3.29), respectively. After adjusting for confounders, sex, urban-rural locations, income, education, and number of health-symptoms exhibited no significant influence on prescription likelihood. ConclusionThis study underscores unregulated antibiotic sales without prescriptions, urging tailored interventions considering prevailing health-seeking practices in diverse healthcare settings in LMICs. Enforcing prescription-only regulations is hindered by easy access through community pharmacies and conflicts of interest. Future strategies should consider how stewardship impacts the financial interests of pharmacy personnel in settings lacking clear authority to ensure optimal compliance.

Prescriptions of respiratory medications in children aged 0–10 years: A longitudinal drug utilization study in the POMME database

IntroductionRespiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children. Material and methodsThis longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties. ResultsOut of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low. DiscussionThis study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.

Understanding the impact of COVID-19 on antibiotic use in Canadian primary care: a matched-cohort study using EMR data

BackgroundInappropriate or overuse of antibiotic prescribing in primary care highlights an opportunity for antimicrobial stewardship (AMS) programs aimed at reducing unnecessary use of antimicrobials through education, policies and practice audits that optimize antibiotic prescribing. Evidence from the early part of the pandemic indicates a high rate of prescribing of antibiotics for patients with COVID-19. It is crucial to surveil antibiotic prescribing by primary care providers from the start of the pandemic and into its endemic stage to understand the effects of the pandemic and better target effective AMS programs.MethodsThis was a matched pair population-based cohort study that used electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Participants included all patients that visited their primary care provider and met the inclusion criteria for COVID-19, respiratory tract infection (RTI), or non-respiratory or influenza-like-illness (negative). Four outcomes were evaluated (a) receipt of an antibiotic prescription; (b) receipt of a non-antibiotic prescription; (c) a subsequent primary care visit (for any reason); and (d) a subsequent primary care visit with a bacterial infection diagnosis. Conditional logistic regression was used to evaluate the association between COVID-19 and each of the four outcomes. Each model was adjusted for location (rural or urban), material and social deprivation, smoking status, alcohol use, obesity, pregnancy, HIV, cancer and number of chronic conditions.ResultsThe odds of a COVID-19 patient receiving an antibiotic within 30 days of their visit is much lower than for patients visiting for RTI or for a non-respiratory or influenza-like-illnesses (AOR = 0.08, 95% CI[0.07, 0.09] compared to RTI, and AOR = 0.43, 95% CI[0.38, 0.48] compared to negatives). It was found that a patient visit for COVID-19 was much less likely to have a subsequent visit for a bacterial infection at all time points.ConclusionsEncouragingly, COVID-19 patients were much less likely to receive an antibiotic prescription than patients with an RTI. However, this highlights an opportunity to leverage the education and attitude change brought about by the public health messaging during the COVID-19 pandemic (that antibiotics cannot treat a viral infection), to reduce the prescribing of antibiotics for other viral RTIs and improve antibiotic stewardship.

Prescribing practices in the treatment of wasting: secondary analysis from a randomised trial

IntroductionCurrent guidelines for the outpatient treatment of severe acute malnutrition (SAM) recommend the provision of routine medications to all children at admission and prescribed medications as clinically indicated thereafter. The...

Patterns of antibiotic prescription in implant dentistry and antibiotic resistance awareness among European dentists: A questionnaire-based study.

Antimicrobial resistance is an alarming global public health concern, threatening the effective treatment of common infections. This phenomenon is driven by the improper prescription of antibiotics. This study aimed to elucidate the patterns of antibiotic prescription in implant dentistry among European dentists and their awareness of antibiotic resistance. An anonymous online validated questionnaire was distributed via e-mail to 6431 recipients through the European Association for Osseointegration. It comprised of 17 structured questions investigating demographic variables, working environment, clinical experience, attitude towards antibiotic prescription in particular in relation to implant dentistry and COVID-19 pandemic, and awareness of antibiotic resistance. Data were collected from April to May 2023. 281 dentists from 33 European countries completed the survey. Almost 80% affirmed to routinely prescribe antibiotics as prophylaxis as well as after dental implant placement, especially in medically compromised patients or in cases of bone grafting. Amoxicillin, alone (61%) or in combination with clavulanic acid (56%), was the most common antibiotic of choice. Awareness of penicillin resistance among respondents was high. For peri-implantitis treatment, more than half reported the use of systemic antibiotics. The large majority (95%) did not prescribe more antibiotics since the beginning of COVID-19 pandemic. Less than 40% declared to follow national guidelines for antibiotic prescription. This survey revealed a high prescription rate of antibiotics in implant dentistry, despite the awareness about antibiotic resistance among the respondents. The development and adherence to European guidelines has been identified as a potential strategy for improving antimicrobial stewardship.

Viral Meningitis (Enterovirus) Outbreak in The Pediatric Population of Sulaymaniyah Governorate, Iraq: A Multi-Center Experience

Introduction Viral meningitis, often caused by enteroviruses in children, is prevalent globally but is difficult to distinguish from bacterial forms. Molecular testing like PCR is vital; however. This study investigates the characteristics of viral meningitis in pediatric patients during an outbreak in Sulaymaniyah Governorate, Iraq. Methods This is a multicentered prospective study that included children with a confirmed diagnosis of viral meningitis who have visited pediatric clinics throughout Sulaimani, Halabja, Kalar, and Ranya cities during the period from May 2023 to June 2023. Results In total, 116 cases were included, of whom 75 (64.7%) were male and had a mean age of 6.5 ± 3.2. Most were between the ages of 4-6 (38, 32.8%) and 7-12 years (55, 47.4%). Only 53.4% had contact with another patient. Common symptoms included fever (63.8%) and headache (62.1%). Lymphocyte predominance was observed in 46.6% of CSF samples. Upon molecular diagnosis, the inflammation in all of the cases was due to enterovirus infection. Most of the patients (75%) received empirical antibiotics. The average hospital stay was 10 days. While 95.7% of patients had no complications during recovery, a few experienced issues like weakness and malaise. All had good clinical outcomes. Conclusion The viral meningitis outbreak in Sulaymaniyah Governorate is caused by enterovirus, with epidemiological, clinical, and laboratory findings similar to that of the literature. The condition has resulted in a high prescription rate of empirical antibiotics due to late diagnosis.