Inappropriate Antibiotic Prescribing Research Articles

Relationship Between Upper Respiratory Tract Symptoms And Treatment-Seeking Behaviour In Healthy Attendants Of Patients Presenting To Opd Clinics Of Bbs Teaching Hospital Abbottabad.

Indiscriminate use of antibiotics is a well-known reason for increasing antimicrobial resistance. Upper respiratory tract infection presents with similar symptoms and signs irrespective of its bacterial or viral causes and is either ignored or managed aggressively by the primary care physicians. The objective was to determine the relationship between upper respiratory tract infections and treatment-seeking behaviour in healthy individuals attending the OPD clinics of BBS Teaching Hospital with their sick family members. Six hundred and eighty-five healthy individuals who accompanied patients to the OPD clinics of BBS Teaching Hospital, Abbottabad were enrolled in this cross-sectional survey. They were given a modified questionnaire to respond to and their replies were analyzed for assessment. In a survey of 685 individuals, 98.2% were aware of antibiotics, but only 28.6% correctly understood their use against infections. Misconceptions about antibiotic resistance were common, with 54.5% believing it arises from human immunity. Only 31.53% consulted a doctor for upper respiratory symptoms and 72.6% of those expected antibiotics. Women showed higher antibiotic knowledge than men, but education level was a stronger predictor of both knowledge and attitudes. This study highlights a critical gap in public understanding and responsible usage of antibiotics, particularly in the context of upper respiratory tract infections. This study reveals that increased awareness and more informed attitudes about antibiotic resistance correlate with a decreased likelihood of inappropriate antibiotic prescription.

Antimicrobial Prescribing Practices in Hospital Settings in Italy: A Retrospective Study.

This study aims to evaluate the antimicrobial prescribing practices in hospital settings in Italy, focusing on the appropriateness of antibiotic use. This study was carried out through a retrospective review of medical records of patients admitted in three public hospitals located in Campania Region (Italy) between 1 January and 31 December 2018. More than one third (34.2%) of patients received at least one inappropriate antibiotic prescription (antibiotic administered and not indicated). Being female, having a >1 Charlson comorbidity index score, and having a longer hospital stay were significant determinants of an inappropriate antibiotic prescription. Instead, patients who had had a non-urgent hospital admission, an infection on hospital admission, and a microbiological culture test during hospital stay were significantly less likely to have an inappropriate prescription. When the antibiotic prescriptions were analyzed, in 26.6% of cases they were not indicated, while among the 687 antibiotic prescriptions with indication, incorrect choice of antibiotics (36.8%) was the most common reason of the inappropriateness. The findings of the study indicate that the inappropriate use of antibiotics continues to be a relevant issue in the hospital setting and specific interventions are needed to encourage a wider utilization of diagnostic tools to practice targeted therapies and to counter the antimicrobial resistance.

EPOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries.

Electronic clinical decision support algorithms (CDSAs) have been developed to address high childhood mortality and inappropriate antibiotic prescription by helping clinicians adhere to guidelines. Previously identified challenges of CDSAs include their limited scope, usability, and outdated clinical content. To address these challenges we developed ePOCT+, a CDSA for the care of pediatric outpatients in low- and middle-income settings, and the medical algorithm suite (medAL-suite), a software for the creation and execution of CDSAs. Following the principles of digital development, we aim to describe the process and lessons learnt from the development of ePOCT+ and the medAL-suite. In particular, this work outlines the systematic integrative development process in the design and implementation of these tools required to meet the needs of clinicians to improve uptake and quality of care. We considered the feasibility, acceptability and reliability of clinical signs and symptoms, as well as the diagnostic and prognostic performance of predictors. To assure clinical validity, and appropriateness for the country of implementation the algorithm underwent numerous reviews by clinical experts and health authorities from the implementing countries. The digitalization process involved the creation of medAL-creator, a digital platform which allows clinicians without IT programming skills to easily create the algorithms, and medAL-reader the mobile health (mHealth) application used by clinicians during the consultation. Extensive feasibility tests were done with feedback from end-users of multiple countries to improve the clinical algorithm and medAL-reader software. We hope that the development framework used for developing ePOCT+ will help support the development of other CDSAs, and that the open-source medAL-suite will enable others to easily and independently implement them. Further clinical validation studies are underway in Tanzania, Rwanda, Kenya, Senegal, and India.

Antibiotic Resistance in the Uropathogenic Enterobacteria Isolated from Patients Attending General Reference Hospital (GRH) of Niamey, Niger

Background: Urinary tract infections (UTIs) are a frequent reason for consultation and lead to a significant and sometimes inappropriate prescription of antibiotics. The latter favors antibiotic resistance and an increase in mortality as well as the cost of treatment. The present study aims to contribute to the fight against antibiotic resistance of enterobacteria. Methods: This is a prospective study from January to December, 2021 in the Microbiology laboratory of the General Reference Hospital (GRH) of Niamey including 3369 urine samples. The antibiotic resistance of enterobacteria was determined using the Viteck-2 method. Results: At least 280 strains of Enterobacteriaceae were isolated from the patient’s urine. Among these strains, Escherichia coli was the most predominant (74.64%), followed by Klebsiella pneumoniae (16.07%) and Enterobacter cloacae (7.14%) and other enterobacteria 2.15%. These Enterobacteriaceae are more common in community patients than in hospitalized patients. The average age of patients is 52 years and the age group most affected by these enterobacteria is 46 - 60 years (23.33%). The female sex is the most affected sex with (51.07%) against (48.97%) for the male sex with 1.04 as sex ratio. The hospitalization departments most affected by these enterobacteria are Nephrology (29.23%) and Endocrinology (21.54%). Up to 75% of the Enterobacteriaceae isolates show high resistance to ampicillin, amoxicillin-clavulanic acid, ticarcillin, piperacillin-tazobactam, cefoxitin, cefixime, ceftazidime, ceftriaxone, cotrimoxazole, nalidixic acid and ofloxacin. Conclusion: The high rate of antibiotic resistance among enterobacteria in urine is of concern. Only a few Enterobacteriaceae show low resistance to ertapenem, imipenem, amikacin, gentamicin, fosfomycin and nitrofurantoin. Therefore, these antibiotics are recommended as first line treatment for urinary tract infections.

Effect of antibiotic prescription on antibiotic resistance: a systematic review

Antibiotics are agents that are used to manage illnesses caused by bacteria. They effectively control the bacterial disease but have no impact on viral infections. The resistance against antibiotics is a significant problem that threatens the use of antibiotics for treating diseases; it is increasing over time. The inappropriate antibiotic prescription may worsen the condition and affect the organisms' sensitivity to antibiotics. This review was aimed at assessing the effect of antibiotic prescription on the resistance of antibiotics by reviewing the previous studies related to that subject. The databases, including PubMed, Scopus, Elsevier, Google Scholar, and Research Gate, were explored to search for articles published after 2010 and concerned with our subject. The included search terms were a combination of "Antibiotics, Antimicrobial, Agents, Resistance, Prescription, Effect, Impact, & Role." The inclusion criteria were original English articles that reported the impact of antibiotic prescription on antibiotic resistance. A total of 6560 articles were obtained, and only ten were eligible for the inclusion criteria. The studies included a total number of 2340227 participants and five-study designs. There was an irrational and inappropriate prescription of antibiotics. The prescription of antibiotics significantly impacts the resistance to antibiotics, where inappropriate and irrational prescriptions can increase and accelerate the resistance crisis.

Prescribing Patterns of Antibiotics Among The Pediatric Patients Attended The Outpatient Departments of The Tertiary Level Hospitals in Nigeria: A Cross-Sectional Study

Rationality analysis of the prescribing pattern of antibiotics for pediatric patients can help to point towards irrationality and can make a consensus among physicians for rational prescribing. This study was aimed at identifying the antibiotic prescription survey in pediatric outpatient prescriptions. This study was carried out in two hospitals namely; Usmanu Danfodiyo University Teaching Hospital, Sokoto, and General Hospital Katsina Nigeria during the period of October to December 2019. A total of 600 prescriptions cumulatively were used as a sample and were selected using the convenience sampling technique. For data collection, a self-designed data collection sheet was used. WHO / INRUD prescribing indicators were used for the analysis of prescription patterns. A total of 600 prescriptions (364 from UDUTHS and 236 from GHKS) were selected and used for the study. Most of the patients admitted to the two selected hospitals were male. The patient’s ages varied from a few months to 12 years, with the majority aged 4 years or less (61.0%) of age. From the 600 prescriptions evaluated, 1564 drugs (912 from UDUTHS and 652 GHKS) were prescribed. The average number of drugs per encounter in UDUTHS and GHKS were 3.0±0.4 and 3.2±0.7 respectively. The percentages of encounters with an antibiotic prescribed in both hospitals were similar: 32.1% for UDUTHS and 31.1% for GHKS. Most antibiotics were targeted at respiratory tract infections Roxithromycin 126 (21.0%) was the most frequently prescribed antibiotic and was prescribed by the proprietary name. This study has revealed inappropriate drug prescriptions in the pediatric outpatient in these hospitals. These include the low rate of prescriptions in generic names; extensive polypharmacy; and inappropriate prescription of antibiotics which could lead to drug-drug interaction and adverse drug reaction is also evident in these hospitals.

Analysis of seasonal variation of antibiotic prescribing for respiratory tract diagnoses in primary care practices.

To determine antibiotic prescribing appropriateness for respiratory tract diagnoses (RTD) by season. Retrospective cohort study. Primary care practices in a university health system. Patients who were seen at an office visit with diagnostic code for RTD. Office visits for the entire cohort were categorized based on ICD-10 codes by the likelihood that an antibiotic was indicated (tier 1: always indicated; tier 2: sometimes indicated; tier 3: rarely indicated). Medical records were reviewed for 1,200 randomly selected office visits to determine appropriateness. Based on this reference standard, metrics and prescriber characteristics associated with inappropriate antibiotic prescribing were determined. Characteristics of antibiotic prescribing were compared between winter and summer months. A significantly greater proportion of RTD visits had an antibiotic prescribed in winter [20,558/51,090 (40.2%)] compared to summer months [11,728/38,537 (30.4%)][standardized difference (SD) = 0.21]. A significantly greater proportion of winter compared to summer visits was associated with tier 2 RTDs (29.4% vs 23.4%, SD = 0.14), but less tier 3 RTDs (68.4% vs 74.4%, SD = 0.13). A greater proportion of visits in winter compared to summer months had an antibiotic prescribed for tier 2 RTDs (80.2% vs 74.2%, SD = 0.14) and tier 3 RTDs (22.9% vs 16.2%, SD = 0.17). The proportion of inappropriate antibiotic prescribing was higher in winter compared to summer months (72.4% vs 62.0%, P < .01). Increases in antibiotic prescribing for RTD visits from summer to winter were likely driven by shifts in diagnoses as well as increases in prescribing for certain diagnoses. At least some of this increased prescribing was inappropriate.

I test point-of-care per patogeni respiratori non modificano la prescrizione di antibiotici nei bambini: i risultati di un RCT

Point-of-care testing for respiratory pathogens does not change antibiotic prescriptions in children: Findings of an RCT Rapid tests to be performed in the outpatient setting, also called point-of-care testing, are a diagnostic aid that promises improved accuracy in diagnosis and consequently in treatment. However, while there is undisputed validity for some tests, for others there is no evidence of efficacy for the goal of reducing inappropriate antibiotic prescriptions. The trial by Mattila et al., conducted on more than 400 children attending a pediatric emergency room in Finland for respiratory infectious diseases, finds no reduction in antibiotic prescriptions even after testing children for 18 viruses, as well as other similar studies have shown.

Selective reporting of antibiotic susceptibility testing results for urine cultures: feasibility and acceptability by general practitioners and laboratory professionals in France.

Selective reporting of antibiotic susceptibility testing (AST) is a recommended antibiotic stewardship strategy, aiming at reducing inappropriate antibiotic prescriptions. Our objectives were to evaluate (i) the feasibility of the implementation of selective reporting of AST for urine cultures for laboratory professionals; and (ii) its acceptability by prescribers and laboratory professionals, to explore facilitators and barriers to its potential implementation on a national scale. As part of the 'ANTIBIO-ciblés' interventional study (north-eastern France, August 2018-December 2019), we prospectively collected quantitative data on all resources dedicated by the laboratories of the intervention group to implement selective reporting of AST for Escherichia coli-positive urine cultures, and on the numbers and reasons of complete reporting of AST the prescribers requested to the laboratories. We also collected qualitative data using semi-structured interviews and focus groups of GPs and laboratory professionals. The implementation of selective reporting of AST required around 80 h and cost 23 000 euros. All interviewed professionals were favourable toward the principle of this tool. Most of them found it clear, simple and useful to improve the appropriateness of antibiotic prescriptions and reduce antibiotic resistance. Its major constraint was the necessity for GPs to call the laboratory to obtain the complete reporting of AST, but the number of requests was actually low (1.2% of all selective reporting of AST). Selective reporting of AST resulted in reasonable human and financial costs, and was well accepted by both GPs and laboratory professionals.

National Disparities in Antibiotic Prescribing by Race, Ethnicity, Age Group, and Sex in United States Ambulatory Care Visits, 2009 to 2016.

While efforts have been made in the United States (US) to optimize antimicrobial use, few studies have explored antibiotic prescribing disparities that may drive future interventions. The objective of this study was to evaluate disparities in antibiotic prescribing among US ambulatory care visits by patient subgroups. This was a retrospective, cross-sectional study utilizing the National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was described as antibiotic visits per 1000 total patient visits. The appropriateness of antibiotic prescribing was determined by ICD-9 or ICD-10 codes assigned during the visit. Subgroup analyses were conducted by patient race, ethnicity, age group, and sex. Over 7.0 billion patient visits were included; 11.3% included an antibiotic prescription. Overall and inappropriate antibiotic prescription rates were highest in Black (122.2 and 78.0 per 1000) and Hispanic patients (138.6 and 79.8 per 1000). Additionally, overall antibiotic prescription rates were highest in patients less than 18 years (169.6 per 1000) and female patients (114.1 per 1000), while inappropriate antibiotic prescription rates were highest in patients 18 to 64 years (66.0 per 1000) and in males (64.8 per 1000). In this nationally representative study, antibiotic prescribing disparities were found by patient race, ethnicity, age group, and sex.

873. Comparison of Antibiotic and Antiviral Use before and after Deployment of Rapid Influenza Testing in the Emergency Department

Abstract Background Influenza shares common symptoms with bacterial pneumonia, resulting in inappropriate prescribing of antibiotics that may lead to increased risk of adverse reactions, antimicrobial resistance, and healthcare costs. Rapid influenza polymerase chain reaction (PCR) tests have reduced turnaround times compared to multiplex PCR respiratory panels allowing for earlier diagnosis, which may improve antimicrobial stewardship outcomes in the emergency department (ED). This study aims to compare antibiotic and antiviral use before and after deployment of a rapid influenza PCR in the ED. Methods This single-center, retrospective, cohort study included pediatric and adult patients discharged from the ED with a positive influenza test with either the multiplex PCR respiratory panel (January 2017 – July 2019) or rapid PCR (July 2019 – February 2020). The primary endpoint was antibiotic use pre- and post-implementation of the rapid influenza PCR in the ED. Secondary endpoints included antiviral use, duration of antimicrobial therapy, test turnaround time, ED length of stay, 30-day readmission, and adverse events. A multivariable regression model evaluated patient factors associated with antimicrobial prescribing. Results A total of 620 positive influenza results were identified with 280 patients (multiplex PCR = 33; rapid PCR = 247) meeting inclusion criteria. Patients were less likely to be prescribed antibiotics (39.4% vs 8.9%, OR 0.15, 95% CI 0.067–0.34) and more likely to be prescribed antivirals (24.2% vs 61.1%, OR 4.92, 95% CI 2.13–11.34) with the rapid influenza PCR. Rapid influenza PCR significantly reduced ED length of stay (4.9 vs 3.4 hours, p &amp;lt; 0.01) and test turnaround time (27 hours vs 3.5 hours, p &amp;lt; 0.01). Patients at high risk for complications associated with influenza were more likely to be prescribed antiviral therapy (25% vs 77.7%, OR 5.27, 95% CI 3.02–9.17). Based on the regression analysis conducted, asthma, (OR 3.5, 95% CI 1.48–8.26), immunosuppression (OR 9.6, 95% CI 1.18–78.2), and age less than 5 years old (OR 3.1, 95% CI 1.80–5.45) are predictors of antiviral prescribing. Conclusion Implementation of a rapid influenza PCR in the ED reduced antibiotic use and optimized antiviral therapy for patients at higher risk of influenza with complications. Disclosures All Authors: No reported disclosures.

1751. Evaluation of Antimicrobial Stewardship Interventions in Primary Care Clinics

Abstract Background The goal of antimicrobial stewardship is to optimize antimicrobial therapy and clinical outcomes while minimizing the unintended consequences of antimicrobial use. With the majority of antibiotics prescribed in the outpatient setting, optimizing antimicrobial prescribing across the care continuum is necessary. We aimed to evaluate the effect of antimicrobial stewardship interventions on the rate of inappropriate antibiotic prescribing in three adult primary care clinics affiliated with a tertiary care hospital. Methods Antibiotic prescriptions were identified by filtering common antibiotics prescribed prior to and post intervention. Prescriptions were excluded if they were prescribed pre-procedure or if the patient had a recent hospitalization within 30 days of the outpatient visit. Appropriateness of antibiotics was determined by indication, agent, dose and duration. Institutional guidelines were created for most common infections treated in the pre-intervention period. Education to outpatient providers was completed in two in-person visits. Results A total of 258 prescriptions were reviewed between the pre- and post-intervention periods. The majority of patients were female (73-76%) and the median age was similar between both cohorts. The most common infection treated during the pre-intervention period was urinary tract infection, whereas skin and soft tissue infection was most common in the post-intervention period. During the baseline period, the inappropriate prescribing rate was 61%. After intervention, the rate was reduced to 55%. Conclusion The use of outpatient antimicrobial stewardship guidelines and provider education to reinforce knowledge demonstrated reductions in inappropriate antibiotic prescribing. Disclosures All Authors: No reported disclosures.

Penicillin Allergy label - the unmet needs - causes and potential solutions.

Background. Penicillin allergy is the most prevalent drug allergy. Its overdiagnosis has been associated with inappropriate antibiotic prescribing, increased antimicrobial resistance, worse clinical outcomes, and increased healthcare costs. Methods. 403 inpatients were audited against National Institute of Clinical Excellence (NICE) Clinical Guidance 183 (CG183) on diagnosis, investigations, documentation, and management of penicillin allergy. 50 junior doctors were surveyed to explore barriers to best practice, investigating their knowledge of, and confidence using the NICE CG183 guidelines. Their views on potential solutions were also explored. Results. The audit identified: 13% (54/403) of patients labelled penicillin allergic; 24% (13/54) fulfilled criteria for referral but none were referred to specialists. With regards to documentation: 33% (18/54) documented exact drug name; 72% (39/54) documented signs and symptoms; 20% (11/54) documented reaction severity; 2% (1/54) documented indication for the drug taken; 4% (2/54) documented number of doses taken or days before onset of the reaction and 0% documented route of administration. The survey revealed barriers including: 1- lack of awareness and confidence in applying the NICE CG183 on diagnosis and management; 2- tendency to err on the side of caution when de-labelling patients. All agreed that decision support tools would address barriers to best practice and appropriate penicillin allergy de-labelling Conclusions.The current practice of diagnosing, documenting, and managing penicillin allergies does not meet NICE CG183. A lack of awareness and confidence using NICE CG183 are the main contributing barriers to best practice. Decision support tools, including a drug allergy app, would help overcome these barriers.

Antibiotic Prescription Audits Among Pediatric Outpatients With Acute Ailments in a Secondary Care Hospital During the COVID-19 Omicron Wave in Northern India.

Background Antibiotics, as defined by the World Health Organization (WHO), are pharmaceuticals used to treat bacterial infections. There is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures. There are a few prescriptions audit studies from smaller cities in Northern India, especially those conducted during the COVID-19 pandemic whenthe unregulated private sector accounted for 90% of antibiotic sales and 75% of healthcare requirements. Thestudy objectiveswere to determine the rate of outpatient antibiotic prescription and adherence to WHO drug indicators in prescriptions to pediatric outpatients in private healthcare facilities in India. Methodology This cross-sectional survey was conducted over three months (January to March 2022) in the outpatient setting of a private pediatric hospital in Kanpur, a city having a population of nearly three million population located in the state of Uttar Pradesh in India. Prescriptions of children aged <10 years with a history of onset of complaint <14 days were included in this audit. Prescriptions were numbered;data were collected using a specially designed semistructured, pretested prescription audit checklist; and the recommended WHO indicators were also calculated. Data were entered using CSPro (U.S. Census Bureau, Washington, DC, USA) and analyzed using STATA 15 (StataCorp LLC, College Station, TX, USA). Results This study observed an antibiotic prescription rate of 65.75%, which was higher than the WHO-recommended value, which might indicate indiscriminate usage of antibiotics in the setting. Out of the 144 antibiotic medications prescribed, none were generic and all the antibiotics were prescribed presumptively. The most commonly prescribed medicines were cefpodoxime, azithromycin, and ofloxacin, which were primarily used to treat cough and stomach infections. Conclusions This antibiotic audit conducted in a private hospital outpatient setting in a city in Northern India during the Omicron wave of the COVID-19 pandemic found nongeneric, predominantly oral, presumptive antibiotic prescriptions in nearly two out of three young pediatric patients. Improvement in prescribing practices through regulation, monitoring, and antibiotic stewardship in low-resource settings is urgently warranted to curb the impending global pandemic of antimicrobial resistance.

Inappropriate antibiotic prescribing in primary healthcare facilities in China: a nationwide survey, 2017–2019

ObjectivesWe aimed to generate comprehensive estimates of the appropriateness of outpatient antibiotic prescriptions at primary healthcare facilities (PHFs) in China. MethodsBetween 2017 and 2019, we collected outpatient-visit prescriptions from 269 Chinese PHFs in 31 cities located in 6 provinces. Conditions that resulted in antibiotic use were classified into appropriate, potentially appropriate, and inappropriate using a well-established classification approach. We then assessed the magnitude, appropriateness, and costs of antibiotic prescribing, overall and by antibiotic classification group, diagnostic categories, and patient characteristics. ResultsOf all eligible 209 662 antibiotic prescriptions, 147 758 (70.5%) were inappropriate, which accounted for 66.8% (558.0/835.3 thousand US dollars) of costs for antibiotics. Upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis were responsible for 68.9% (101 744/147 758) of inappropriately antibiotic prescriptions. High inappropriate antibiotic prescribing rates were observed among children aged 0–5 years (78.5% (21 049/26 799)) and patients living in economically undeveloped areas (77.5% (38 430/49 587)). A total of 256 474 individual antibiotics were prescribed, of which 82.2% (210 885/256 474) were broad-spectrum antibiotics, with second-generation cephalosporins (15.1% (38 705/256 474)) and third-generation cephalosporins (14.6% (37 491/256 474)) being the most commonly prescribed subgroups. DiscussionOur findings highlight the excessive and inappropriate use of antibiotics in Chinese PHFs pending multidimensional efforts.

A Review of the use of Rational and Quality Antibiotics in a Nigerian Tertiary Institution

Purpose: The study reviewed the use of rational and quality antibiotics at the Federal Medical Centre, Yenagoa, Bayelsa State. Three objectives and three research questions were drafted for the study, respectively.&#x0D; Methodology: The study used a retrospective descriptive survey that lasted four months. The study relied on secondary data, which was gathered from the folders of 583 patients. From January 1, 2019 to April 30, 2019, all patients with complete information admitted to medical, surgical, and paediatric wards, as well as obstetrics and gynaecology wards, had their folders reviewed. A self-developed checklist was used to assess critical aspects of antibiotic utilisation and the use of generic names in antibiotic prescribing, a self-developed checklist was used. The data collected were collated, coded and analysed using descriptive statistics of frequency, percentage, charts, and tables.&#x0D; Findings: The findings showed that out of the total folders (n=583) reviewed, the socio-demographic information showed that majority of the patients (42.2%) who received prescribed antibiotics were adult female. On the age category, out of the total folders (n=583) reviewed, majority of the folders (114) showed that those within the ages of 21-30 years represents over 19.0%. The antibiotics prescribed from the four (4) different departments showed that 26.7% of antibiotics were prescribed and utilized in medical wards. The level of compliance with some standard practices, shows that pneumonia test conducted, was highest in surgery ward, this represents 82.8%, the sensitivity test conducted, was highest in paediatric ward (46.4%). Out of the total antibiotics prescribed (n=1164), generic names were used for 59.6% cases, while 73.2% of the antibiotic prescribed were in the EDL authorised list. The results revealed that cephalosporins were the most commonly prescribed class of antibiotics, 384 (34%) followed by the nitroimidazoles 346 (29.7%) and penicillin’s 138 (11.9%). Inappropriate antibiotic prescription was found to be 58.7% among the total prescribed antibiotics (n=1164). Based on the results and findings in the study, it is safe to conclude that the majority of antibiotics utilised were over prescribed, with high inappropriate use. The lack of generic use in antibiotic prescriptions and the overuse of antibiotics remain a problem in tertiary hospitals across Nigeria.&#x0D; Recommendation: This study recommend that prescriptions should be prescribed with slips duly signed by a doctor and approved by a pharmacist before the administration of such drugs. Also, all public hospitals in Nigeria should develop local treatment guidelines using national and international policy guidelines for local infectious disease.

Evaluation of Antibiotic Prescribing Pattern and Appropriateness among Hospitalized Pediatric Patients: Findings from a Malaysian Teaching Hospital.

Background: Antibiotics are commonly prescribed for hospitalized children. However, only a limited number of studies have evaluated antibiotic use in this population. The current work assessed the indication, prescribing pattern and appropriateness of antibiotics among pediatric inpatients. Methods: A retrospective cross-sectional study was conducted at the pediatric wards of a teaching hospital in Malaysia. Electronic charts of inpatients (≤12 years old) admitted in 2019 were reviewed. Antibiotic indication, selection, dosing regimen, route of administration and duration of treatment were evaluated using the national antibiotic guidelines (NAG). A binomial logistic regression was applied to test potential predictors of inappropriate antibiotic prescribing (IAP) incidence. Results: Out of 702 pediatric inpatients, 292 (41.6%) patients were given antibiotics and met the inclusion criteria. More than half of the patients (57.9%) were males, with a median age of 2.5 years. A total of 385 and 285 antibiotics were prescribed during hospitalization and at discharge, respectively. Azithromycin, co-amoxiclav and cefuroxime were the top three prescribed agents. Out of 670 prescriptions, IAP was identified in 187 (28%) prescriptions that were issued for 169 (57.9%) out of the 292 patients included in the study. Improper antibiotic selection, wrong dose and unnecessary antibiotic prescribing accounted for 41%, 34% and 10% of the identified IAP, respectively. Giving lower-than-recommended doses (28%) was more prevalent than prescribing higher doses (5%). The use of two antibiotics and treating upper respiratory tract infections were independent risk factors for IAP incidence. Conclusions: Prescribers did not adhere to the NAG in more than one quarter of the prescriptions. This may increase the risk of treatment failure, adverse drug reactions and the development of antibiotic resistance.

Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections.

Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type. Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31-6.41 and hazard ratio, 1.10; 95% confidence interval, 1.03-1.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18-$67) and variable (-$53 to $49) for viral infections. Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs.

Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing.

Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), -3 days, -7 days, -30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for -30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for -30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.

Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study

BackgroundAcute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients’ characteristics, care setting, preliminary diagnosis, and management.MethodsA prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium.ResultsIn this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5–29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13–113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10–58) compared to 7 mg/L (IQR < 5–19) when they were not prescribed.ConclusionA low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule.Trial registrationClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).