Inappropriate Use Of Antimicrobial Agents Research Articles

The use of small group based educational interventions in General Practice to improve antimicrobial prescribing behaviours: a mixed methods systematic review protocol

Background Inappropriate use of antimicrobial agents in healthcare settings is one area that has received attention as a possible route to mitigate the threat of antimicrobial resistance. Globally, the highest consumption of antimicrobials in human healthcare originates from prescriptions in Primary Care. Strategies to increase appropriate antibiotic prescribing, which can mean not prescribing an antibiotic e.g. cases of viral infection, have been developed and evaluated. This systematic review aims to review the literature of studies of group based in person educational interventions designed to increase appropriate antibiotic prescribing behaviours in General Practice settings. Methods EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE and PsycINFO will be systematically searched from inception until February 2024 for primary studies of group based educational interventions designed to improve the antimicrobial prescribing behaviours in General Practice. Qualitative, quantitative and mixed methods studies that report on the phenomenon of interest will be included. All identified articles will be double screened at title and abstract level. One reviewer will then screen all included studies at full text level, extract the data, code the intervention and perform risk of bias assessment with a second reviewer performing verification of a randomly selected 20% of the articles. We will use an integrated approach to mixed method systematic reviews and will perform a narrative, or if possible quantitative, synthesis. Discussion The review will identify and assess the efficacy and / or effectiveness of small group based educational interventions designed to improve the antibiotic prescribing behaviours of General Practitioners. By using a mixed methods approach we aim to identify the salient content of the included interventions and the perspectives of participants on the content and delivery of the included interventions. We will use the findings to inform the design and content of a small group educational intervention for GP registrars.

Need for standardization and compliance to treatment protocols for COVID-19 within the African Region of the World Health Organization

COVID-19 pandemic changed the face of global health and brought about new issues in global health security and economy. The World Health Organization published guidelines for clinical management of COVID-19 four months after declaration of COVID-19 as a pandemic. Scholarly reviews and studies from member states within WHO AFRO reveals significant deviation from the WHO published protocols on COVID-19. Assessment of national treatment protocols of 30 of 47 WHO AFRO member states showed widespread inappropriate use of antimicrobial agents for patients, which may worsen the global and concerning threat of antimicrobial resistance. There is need for adopting interventions that optimize antimicrobial use in the context of pre- and post-pandemic preparedness to ensure long-term effectiveness and sustainability for antimicrobials. Treatment guidelines are to be adopted or adapted depending on best clinical evidence available. Non-compliance with guidelines might lead to mismanagement of infectious diseases with attendant negative consequences including antimicrobial resistance and misdirection of critical resources and supplies amongst others.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Antimicrobial veterinary drug sale pattern incorrelation with critically important antimicrobials for human use: A five-year studyin Montenegro.

Antimicrobial resistance (AMR) poses a significant threat in veterinary medicine due to the excessive and inappropriate use of antimicrobial agents, compromising the effectiveness of these drugs. To combat AMR, the collection of data on the consumption of antibiotics is paramount, as there is a well-established connection between antibiotic use and AMR in both humans and food-producing animals. Hence, the current study aimed to generate measurable data concerning the sales patterns of antimicrobial drugs used in animal treatment in Montenegro over a five-year period (from 2017 to 2021). Furthermore, the study aimed to compare these sales figures with the overall sales of antimicrobial veterinary medicine products (AMVMPs) during the same period, with particular emphasis on the utilization of critically important antimicrobials (CIAs) for human use. Data on AMVMPs consumption from 2017 to 2021 were expressed in euros and were sourced from the Institute for Medicines and Medical Devices of Montenegro (CInMED) annual reports, complying with the regulatory framework of the Law on Medicines in this country. Research results indicate that the sales of AMVMPs increased from 2017 to peak in 2019, followedby a stable decline of 21.79% in 2021. However, the portion of selected CIAs AMVMPs in total sales experienced a minor decline from 2017 to 2019, followed by a noticeable 6.11% increase from 2019 to 2021. In order to address AMR challenges, these findings emphasize the importance of enhancing surveillance and monitoring of veterinary antimicrobial use, as well as CIAs for human use.

Urinary Tract Infection, Bacteriological Profile and its Antibiotic Susceptibility in Tertiary Center

Introduction: Urinary tract infection is one of the common bacterial infections seeking treatment in clinical practice. A variety of organisms are associated with UTI and the most common organisms are Escherichia coli and other coliforms. Bacteriological investigations of UTI are not complete without an antibiotic sensitivity test of the isolate. The extensive and inappropriate use of antimicrobial agents has invariably resulted in the development of antibiotic resistance which, in recent years, has become a major problem worldwide. This study aims to determine the bacteriological profile and antibiotic sensitivity patterns and their disease association in a tertiary center. Methods: This study was conducted in the Department of Urology, College of Medical Sciences and Teaching Hospital, Chitwan, Nepal over a period of one year (January 2021 to December 2021). All cases of suspected UTI were sent for urine culture and sensitivity tests were evaluated in this study. Disease associated with UTI, bacteriological profile, and antibiotic sensitivity patterns were evaluated. Results: A total of 1987 cases were sent for urine culture and sensitivity test. The total culture-positive cases were 404 (20.3%). The most common age group for the culture-positive test was 60-70 years (17.3%) followed by 70- 80 years (17.1%). Prevalence was higher in females (56.9%) compared to males (43.1%). Escherichia coli (59.8%) was the most common pathogen isolated followed by Klebsiella species (10.6%) and Pseudomonas aeruginosa (4.4%). Most of the isolates showed susceptibility to amikacin (90.61%), gentamicin (83.76%), and imipenem (73.91%). Conclusions: The increasing trend of resistant strains depicts the random use of antibiotics and requires continuous monitoring of their resistance. Antibiotic susceptibility patterns must be continuously and periodically evaluated to select the appropriate regimen to treat UTI

Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children's Hospitals in Punjab, Pakistan.

Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics.

Epidemiological Cut-Off Values and Multidrug Resistance of Escherichia coli Isolated from Domesticated Poultry and Pigs Reared in Mwanza, Tanzania: A Cross-Section Study.

Simple SummaryThe objectives of this study were to determine the prevalence of multidrug resistance phenotypes and the distribution of Escherichia coli among poultry and pigs. Laboratory procedures were conducted according to standard operating procedures and international guidelines. Our findings showed that poultry and pigs reared in Mwanza, Tanzania, are colonized with resistant bacterial phenotypes. Further, different populations of intestinal flora, E. coli, exist between poultry and pigs.Increasing antimicrobial resistance (AMR) colonizing domesticated animals is a global concern threatening food safety. This study aimed at determining the prevalence of multidrug resistance (MDR) and epidemiological cut-off values (ECVs) of E. coli isolated from poultry and pigs in Mwanza, Tanzania. This cross-sectional study was conducted between June and August 2021, involving 297 pigs, 191 broilers, and 203 layers. Rectal and cloacal swabs were collected and processed following standard guidelines. ECVs were determined using normalized resistance interpretation (NRI), a computer software, and descriptive analysis was performed using STATA version 13.0. The overall prevalence of MDR E. coli was 63.2%, whereas poultry (87.5% layers and 86.3% broilers) were more colonized than pigs (31.8%) (p < 0.001). Based on ECVs of antibiotics tested, E. coli from broilers, layers, and pigs exhibited different resistance patterns hence different populations. Exotic breed (p < 0.001) and recent antimicrobial use (p < 0.001) significantly predicted colonization with MDR E. coli. Veterinary officers should implement regulations that prohibit the inappropriate use of antimicrobial agents in livestock keeping.

Evaluating bacterial resistance to antimicrobials in isolated bacteria from food contact surfaces

Bacteria isolated from food contact surfaces, can transfer resistance factors when exposed to pressure exerted by inappropriate use of antimicrobial agents. This study aimed to evaluate bacterial resistance against antibiotics and disinfectants commonly used (NaOCl and CH3COOH) in bacteria isolated from food contact surfaces. Additionally, using PCR, the presence of tetracycline resistance genes was evaluated. Results showed that 47% of the isolates exhibit resistance against more than one antibiotic, being Tetracycline the antibiotic that most isolates were resistant to (35.3%). A PCR analysis found that the tet M gene is the most frequent of the genes tested. Likewise, it was evidenced that although NaOCl is effective as a surface disinfectant, Aerococcus urinae and Kocuria kristinae isolates could resist up to 10 min of exposure. Likewise, all isolates were resistant to CH3COOH, demonstrating the low inhibitory capacity of this disinfectant. Finally, the observed correlation between resistance to antibiotics and resistance to disinfectants is confirmed. An important factor that should be studied since the generalized use of disinfectants can increase the spectrum of antibiotic resistance.

ANTIBIOTIC RESISTANCE PATTERN OF PSEUDOMONAS AERUGINOSA ISOLATED FROM VARIOUS CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL, PUDUCHERRY

Objective: One of the most common bacteria known to cause nosocomial infection and found to be multidrug-resistant is Pseudomonas aeruginosa. The objective of the study was to know the prevalence of the P. aeruginosa isolates with varied clinical conditions and specimens and to assess the antimicrobial susceptibility patterns of P. aeruginosa as well as its magnitude of multidrug resistance (MDR). Methods: A total of 229 biochemically tested and confirmed isolates of P. aeruginosa from various clinical samples were studied. Antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion method. Results: Out of the 229 isolates of P. aeruginosa, majority (60.70%) were from pus sample. Resistance to amikacin and tobramycin was 23.6% and 20.1%, ciprofloxacin was 33.2%. Resistance to ceftazidime, cefoperazone and cefepime were 21.8%, 45.9%, and 25.7%. Imipenem and meropenem showed 26.2% and 20.5% resistance, respectively. Resistance to piperacillin was 18.3% while piperacillin-tazobactam was only 13.5%. The MDR was observed in 33.7% of the isolates. Conclusion: There is increased resistance to cephalosporins as compared to aminoglycosides, carbapenems and beta lactamase inhibitor. To restrict the inappropriate use of antimicrobial agents, the development of MDR, needs to be continuously monitored and documented.

A Strategy for Hospital Pharmacists to Control Antimicrobial Resistance (AMR) in Japan.

In Japan, there is concern regarding the relation between the inappropriate use of antibiotics and antibiotic resistance (AMR). Increased bacterial resistance is due in part to the inappropriate use of antimicrobial agents. The support of the pharmacist becomes important, and there is growing interest in antimicrobial stewardship to promote the appropriate and safe use of antimicrobials needed for the optimal selection of drugs, doses, durations of therapy, therapeutic drug monitoring (TDM), and implementations of cost containment strategies in Japan. Pharmacists should strive to disseminate the concept of “choosing wisely” in relation to all medicines, implement further interventions, and put them into practice. In this article, we present data for antimicrobial stewardship and Japan’s AMR action plan, focusing on how pharmacists should be involved in enabling physicians to choose antimicrobials wisely.

Gram positive uropathogens and their antibiogram: Data analysis at a tertiary care hospital in Karnataka

Gram positive uropathogens and their antibiogram: Data analysis at a tertiary care hospital in Karnataka - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/2394-5478.2018.0014, Indian Journal of Microbiology Research-Indian J Microbiol Res

Identifying opportunities for antimicrobial stewardship through a point prevalence survey in an Indian tertiary-care teaching hospital

ObjectivesUnregulated and inappropriate use of antimicrobial agents has been a major driver of antimicrobial resistance with a dangerous impact on health issues in developing nations. We report an audit of antimicrobial use patterns in a tertiary-care teaching hospital in order to identify opportunities for antimicrobial stewardship. MethodsA point prevalence survey was conducted to study the use of ten selected antibiotics in various adult inpatient facilities. Patient characteristics as well as indications and patterns of antibiotic prescription were recorded. ResultsA total of 188 patients received any one of the survey antibiotics, accounting for 43% of patients admitted under the study specialties. Of the 188 patients, 59% were admitted in non-intensive care unit settings. The median (interquartile range) duration of hospitalisation during the survey was 8 (4.75) days. Intra-abdominal infections (75; 40%) and respiratory infections (41; 22%) were the most common reasons for admission. Empirical antibiotic use was observed in 66% of patients. Antimicrobial use without any microbiological test was evidenced in 32 patients (17%). Significant differences were noted between medical and surgical specialties in choice of antibiotic, dosage and utilisation of microbiological tests. ConclusionsHigh empirical antibiotic use, poor transition from empirical to rational use, and underutilisation of microbiological tests were noted. The choice of antibiotics differed among specialties. Inappropriate dosing was greater in surgical specialties, especially with aminoglycosides. Adherence to local antibiotic policy, optimal dosing and audit of reserved antibiotic use can be useful approaches to strengthen antimicrobial stewardship programmes.

Role of the hospital pharmacist in an Italian antimicrobial stewardship programme

The inappropriate use of antimicrobial agents is contributing to an increasing phenomenon of bacterial resistance. For this reason, there is a growing interest in ‘antimicrobial stewardship’, a series of coordinated...

Identification of Enterococcus faecalis in a patient with urinary-tract infection based on metagenomic next-generation sequencing: a case report

BackgroundUrinary tract infection (UTI) caused by various pathogenic microorganisms is ubiquitous in the parts of the urinary system such as kidney, ureter, bladder, and urethra. Currently, clinical detection of UTI is mainly focused on urine culture; however, the diagnostic value of urine culture remains limited due to the time-consuming procedure and low detection rate, especially in patients who have used antibiotics. Generally, treatment for UTI relies on empirical medication rather than pathogen diagnosis, which leads to the inappropriate use of antimicrobial agents and a significant increase in resistant strains. Comparatively, metagenomic next-generation sequencing (mNGS) is capable of overcoming the disadvantages of clinical culture, and identifying pathogens for further treatment.Case presentationA 33-year-old male patient was admitted to hospital with a high fever and chills. None of his autoimmune disease or thyroid function related indicators were positive, and he had no risk of endocarditis. His white blood cell count, C-reactive protein, procalcitonin, interleukin 6, and neutrophil proportion were markedly elevated. He was initially diagnosed as having an infection of unknown etiology. Since empirical treatment of Sulperazon and Metronidazole did not relieve his symptoms, both the blood and urine specimens were examined using traditional culture, serological testing, and mNGS assay. Traditional culture and serological testing produced negative results, while the mNGS assay revealed the presence of a potential pathogen, Enterococcus faecalis, in the urine specimen, which was further confirmed by both Sanger sequencing and qPCR analysis. A CT scan of the patient’s whole abdomen showed stones in the right kidney. Once targeted antibiotic therapy was administered, the patient recovered quickly.ConclusionsOur case illustrated that mNGS, as a novel culture-independent approach, demonstrated the capability of rapid, sensitive, and accurate pathogen identification. Furthermore, this technology provides strong support for guiding clinicians to determine appropriate treatment.

Bacteriological profile and its antibiotic susceptibility in patients with urinary tract infection in tertiary care hospital

Introduction: Urinary tract infections (UTIs) are counted among the most common infections in humans. In spite of the availability and use of antimicrobial drugs, UTIs caused by bacteria have been showing increasing trends. The extensive and inappropriate use of antimicrobial agents has invariably resulted in the development of antibiotic resistance which, in recent years, has become a major problem worldwide. Materials and Methods: The study was conducted among the different ages of groups of both males and females attending KPC Medical College, Jadavpur, Kolkata during six months of the period included in this study. A total of 350 urine samples received from patients of the ICU and other wards of the medical college and hospital. All urine samples were processed within 1 hour after collection for aerobic bacterial culture. Results: Out of a total of 380 patients, isolates were detected in 350 (76.29%) samples. Out of these, 280 (80%) were female. The most common organism found positive was Escherichia Coli. E. coli was highly sensitive to Amikacin and Nitrofurantoin. Whereas, E.coli was highly resistant to Ampicillin and Nalidixic acid. The antibiotic sensitivity pattern of Klebsiella and Acinetobacter shows that they were also highly sensitive to Amikacin. Klebsiella and Acinetobacter were highly resistant to Ampicillin and Gentamicin. Conclusion: The pattern of resistance to commonly used antibiotics for treating UTI alerts us against indiscriminate usage of antibiotics.

Ornithobacterium rhinotracheale: An Update Review about An Emerging Poultry Pathogen.

Respiratory diseases in birds generate sanitary and economic impacts and may be related to the environment and climate. Mycoplasma gallisepticum, Ornithobacterium rhinotracheale (ORT), Pasteurella multocida, Avibacterium paragallinarum, Escherichia coli, Riemerella anatipestifer, and Bordetella avium are among the most important avian respiratory pathogens. ORT is responsible for causing ornitobacteriosis, a disease characterized by clinical signs ranging from mild to severe respiratory conditions, with high mortality rates, mainly affecting turkeys and chickens. The first report of ornitobacteriosis was in 1981 in Germany. Despite its importance, few studies on ORT have been published. In addition, the presence of this pathogen has been neglected in poultry farms, mainly due to the lack of appropriate diagnostic protocols. The lack of correct isolation and diagnostic protocols along with inappropriate use of antimicrobial agents have been contributing to treatment failure. Due to its economic importance to the poultry industry, ornitobacteriosis should be monitored and included in national programs for the prevention and control of avian respiratory diseases. This review aimed to update and discuss important issues related to ORT since this pathogen has great economic and sanitary implications for the chicken production chain.

Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran.

Background:Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate.Objective:The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran.Methods:In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated.Results:Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital.Conclusions:Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.

Retrospective study on susceptibility and resistance pattern of urinary pathogens in a tertiary care hospital

Background: Indiscriminate and inappropriate use of antimicrobial agents (AMA) resulted in rapid emergence of antimicrobial resistance. Institutional level surveillance program to be carried out to track AMA use. The study was conducted to evaluate the prevalence of uropathogens and their susceptibility and resistance pattern in a tertiary care hospital to revise empirical therapy.Methods: Urine samples received from the inpatients and outpatients Departments of Mahatma Gandhi memorial hospital for culture sensitivity between January 2018 to December 2018 were included in this study. Data collected from the Department of Microbiology register by using WHONET software. After identification, isolates were tested for antimicrobial susceptibility by the standard Kirby Bauers diffusion method. Descriptive analysis done and results were expressed as percentage.Results: Out of 3425 samples 68.5% showed no growth, 15.5% normal flora and only 15.9% reported as culture positive. In this study the highest isolate was Escherichia coli (59%) followed by Klebsiella pneumoniae (10.6%), Enterococcus sp. (7%), Staphylococcus aureus (5%), Candid (3.6%), Acinetobactor (3%) and Pseudomonas (2.9%). Uropathogens developed resistance against penicillins, cephalosporins, macrolides and cotrimaxazole.Conclusions: This study confirms, the frequently prescribed empirical therapy drugs were less susceptible and developed resistance than less frequently prescribed and costly drugs. The current antimicrobial resistance pattern alarms the irrational and excessive use of antimicrobial agents. Hence the treating physicians should revise empirical therapy periodically based on the institutional antibiogram and resistance pattern reported from the laboratory to preserve antimicrobial source for the future generation.

Utilization of antimicrobial agents in patients on ventilator in medical Intensive Care Unit at a tertiary care teaching hospital: A prospective study.

Background:The burden of bacterial infections is huge and grossly underrepresented in the current health-care system. Inappropriate use of antimicrobial agents (AMAs) poses a potential hazard to patients by causing antibiotic resistance. In addition, the field of antimicrobials is witnessing constant development and introduction of new drugs for which holistic utilization, effectiveness, and side-effects studies are the need of the hour. The current study aims at studying the prescription pattern of AMAs in patients on ventilator and focuses on their prescribing trends.Methodology:A prospective, observational study was conducted in Medical Intensive Care Unit (ICU) of a tertiary care hospital of Western India for 6 months. Prescription pattern of AMAs was analyzed using predesigned format.Statistical Analysis:Descriptive statistics was used being an observational studyResults:Five-hundred and twenty patients who were on ventilator and were prescribed one or more AMAs were enrolled in the study with a mean patient age of 40.7 years. The intended purpose of the use of AMAs was prophylactic in 59% of patients. Empirical therapy was given in 92% of patients. β-lactams group of AMAs along with metronidazole were most frequently used. 73% required concurrent use of two or more AMAs. 9% of the patients required addition or substitution of one or more other AMAs on the basis of culture and sensitivity report or inadequate clinical response and expert opinion. The outcome of therapy with AMAs showed infection was effectively prevented in 34% of the patients.Conclusion:This study provides a baseline data for improving the utilization of AMAs in ICU settings by rationalizing their use and also carrying out further studies on prescribing pattern of AMAs in a tertiary care unit.

A multifaceted approach to decrease inappropriate antibiotic use in a pediatric outpatient clinic.

BACKGROUND:Inappropriate use of antimicrobial agents is the major cause for the development of resistance. Thus, it is important to include outpatient clinics in the development of antibiotic stewardship program.METHODS:We report a multifaceted approach to decrease inappropriate antibiotic use in upper respiratory tract infections (URTIs) in an outpatient pediatric clinic. The interventions included educational grand round, academic detailing, and prospective audit and feedback and peer comparison.RESULTS:During the study period, a total of 3677 outpatient clinic visits for URTIs were evaluated. Of all the included patients, 12% were <1 year of age, 42% were 1–5 years, and 46% were >5 years of age. Of the total patients, 684 (17.6%) received appropriate antibiotics, 2812 (76.4%) appropriately did not receive antibiotics, and 217 (6%) inappropriately received antibiotics. The monthly rate of prescription of inappropriate antibiotics significantly decreased from 12.3% at the beginning of the study to 3.8% at the end of the study (P < 0.0001). Antibiotic prescription among those who had rapid streptococcal antigen test (RSAT) was 40% compared with 78% among those who did not have RSAT (P < 0.0001).CONCLUSIONS:The combination of education and academic detailing is important to improve antibiotic use.