Indications For Antibiotic Prescription Research Articles

Antibiotic Prescription for Treatment and Prevention of Odontogenic Infections: A Cross-Sectional Survey of Lithuanian Dentists.

Background and Objectives: The inappropriate use of antibiotics can lead to antimicrobial resistance. Overprescribing in dental practice has been reported. This study aimed to describe patterns of antibiotic prescription for treating and preventing odontogenic infections based on reports from Lithuanian dentists. Materials and Methods: Questionnaires were sent to all 4751 Lithuanian dentists registered in the database of the Lithuanian Dental Chamber who had consented to participate in surveys. The questionnaire addressed antibiotic prescription preferences for the treatment and prevention of various dental pathologies. The statistical analysis included chi-square tests and a factor analysis to evaluate prescription frequences in different clinical scenarios considering the respondents' specialty and age. Results: Of 647 responses, 497 were from general dentists, 35 from oral surgeons, 40 from endodontists, 20 from periodontists, and 35 from prosthodontists. Respondents were grouped by age: A (≤35 years, n = 207), B (36-50 years, n = 224), and C (≥51 years, n = 209). Amoxicillin was the first-choice antibiotic for 81.1% of respondents (group A more frequently than other groups, p = 0.001). A 7-day treatment duration was preferred by 60.8%, while 33.6% chose 5 days. For patients allergic to β-lactam antibiotics, 63% preferred clindamycin. Over 90% cited acute apical abscess with systematic involvement as an indication for antibiotic prescription. A factor analysis of 18 clinical scenarios revealed prescription differences among dental specialists, oral surgeons, and periodontists prescribing antibiotics more frequently than general dentists and endodontists. For prophylaxis, 87.5% recommended antibiotics for patients at risk of infectious endocarditis after a cardiologist's consultation (group C less frequently than other groups, p = 0.021). Conclusions: Lithuanian dentists generally prefer narrow-spectrum antibiotics for the treatment of odontogenic infections. There are notable differences in prescription patterns among dental specialists, with younger dentists showing a trend towards more rational antibiotic use.

A survey on systemic antibiotic prescription among dentists in Romandy.

Antimicrobial resistance (AMR) is a significant global health threat that arises from the excessive and incorrect use of antibiotics. As key players in the evolution of AMR, medical and dental practitioners are often questioned on their indications for antibiotic prescription during daily practice. The present survey aimed to evaluate self-reported practices regarding systemic antibiotic prescription among Swiss dentists in Romandy. An electronic questionnaire was sent to 331 dentists working in the French-speaking part of Switzerland and the responses were analyzed on a three-point Likert scale. The response rate was 28%. Results showed that the main indications for antibiotic use were abscesses with systemic symptoms (89%), cellulitis (81.5%), acute sinusitis (62%) and necrotizing periodontitis (52%). Surgical procedures most frequently combined with antibiotics were sinus floor elevation (59.8%) and implant placement (60.9%). Amoxicillin was the first-choice antibiotic, and clindamycin was mostly prescribed for patients with a penicillin allergy (87%). The majority of dentists recommended prophylaxis with 2g of amoxicillin, one hour before the procedure for patients with a high risk of endocarditis (82.6%), immunodeficiency / immunosuppression (50%), or joint replacement during the last year (47.8%). Most participants (76.1%) expressed the need for specific guidelines on the use of antibiotics in dentistry. The research findings suggested antibiotic prescriptions in dentistry could profit from stricter guidelines.

A survey on systemic antibiotic prescription among dentists in Romandy

Antimicrobial resistance (AMR) is a significant global health threat that arises from the excessive and incorrect use of antibiotics. As key players in the evolution of AMR, medical and dental practitioners are often questioned on their indications for antibiotic prescription during daily practice. The present survey aimed to evaluate self-reported practices regarding systemic antibiotic prescription among Swiss dentists in Romandy. An electronic questionnaire was sent to 331 dentists working in the French-speaking part of Switzerland and the responses were analyzed on a three-point Likert scale. The response rate was 28%. Results showed that the main indications for antibiotic use were abscesses with systemic symptoms (89%), cellulitis (81.5%), acute sinusitis (62%) and necrotizing periodontitis (52%). Surgical procedures most frequently combined with antibiotics were sinus floor elevation (59.8%) and implant placement (60.9%). Amoxicillin was the first-choice antibiotic, and clindamycin was mostly prescribed for patients with a penicillin allergy (87%). The majority of dentists recommended prophylaxis with 2g of amoxicillin, one hour before the procedure for patients with a high risk of endocarditis (82.6%), immunodeficiency / immunosuppression (50%), or joint replacement during the last year (47.8%). Most participants (76.1%) expressed the need for specific guidelines on the use of antibiotics in dentistry. The research findings suggested antibiotic prescriptions in dentistry could profit from stricter guidelines.
 Accepted for publication: July 11, 2023
 Published online: July 13, 2023

Gender-based analysis of antibiotic prescribing trends for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore

Respiratory tract infections (RTIs), caused by microorganisms such as bacteria and viruses, are a leading cause of morbidity and mortality in children worldwide. Antibiotic resistance is a serious concern, and proper prescribing practices are necessary to avoid life-threatening situations. Thus, this study aims to conduct a gender-based analysis and compare antibiotic prescribing patterns for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore. This comparative cross-sectional study was conducted at Children’s Hospital in Lahore, Pakistan, for three months and enrolled 250 pediatric patients who met the inclusion criteria, including 155 males and 95 females. Data were collected through face-to-face interviews and reviewing hospital records. The results of the study showed that the average number of drugs per prescription was 3.06 ± 1.29 (male) and 3.12 ± 1.5 (female), while the average number of antibiotics per prescription was 2.25 ± 0.60 (male) and 2.17 ± 0.58 (female). The most prevalent medical conditions were bronchopneumonia (53.55% males and 58.95% females), followed by respiratory distress (20.00% males) and pneumonia (16.13% males and 16.84% females). The most commonly prescribed drugs were J01DD04: Ceftriaxone (78.71% males and 71.58% females), J01CR02: Amoxicillin/Clavulanate (59.35% males and 56.84% females), and J01GB06: Amikacin (41.29% males and 45.26% females). A low percentage of prescriptions had major drug-drug interactions (8.39% males and 10.53% females), while most prescriptions had no drug-drug interactions (81.94% males and 84.21% females). There was no significant difference between male and female patients for caregiver, indications for antibiotic prescriptions, the class of active agent prescribed, and drug interactions. Our study findings indicate that most male and female patients admitted to the hospital with lower respiratory tract infections were prescribed antibiotics alongside analgesics and antipyretics. Furthermore, our analysis revealed minimal drug interactions among the prescribed medications. Importantly, we observed a similar antibiotic prescribing trend among male and female pediatric patients, highlighting the consistency in treatment approaches.

P14 The antibiotic resistance profile of bacteria causing acute respiratory tract infections in Khartoum, Sudan

BackgroundAcute respiratory tract infections (ARTIs) are the most common indication for antibiotic prescriptions. This is associated with irrational prescription and correlated with antimicrobial resistance especially in low-income countries including Sudan. This is a cross-sectional study aimed at identifying bacterial pathogens causing ARTIs and their susceptibility to the commonly prescribed antibiotics.MethodsBacterial pathogens (51 isolates) were obtained from 29 ARTI patients from two hospitals in Khartoum in the time period March 2021 to March 2022. Samples were collected from each patient using both nasopharyngeal and oropharyngeal swabs. They were then cultured using blood and chocolate agar. The isolated colonies were identified using Gram staining technique, biochemical test, and selective media. Antibiotic susceptibility tests (AST) were done using the Kirby–Bauer disc diffusion susceptibility test protocol. Susceptible strains were determined following CLSI guidelines. The susceptibility of isolates was determined for different antibiotics representing the important classes including co-amoxiclav, cefixime, penicillin G, oxacillin, ceftriaxone, erythromycin, levofloxacin, ciprofloxacin and meropenem.ResultsIsolates were found to be mostly (82.3%) Gram positive (Staphylococcus aureus and Streptococcus pyogenes). Pseudomonas aeruginosa was the most abundant (17.9%) Gram-negative bacteria. S. aureus isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and meropenem. S. aureus exhibited less susceptibility to ceftriaxone (75%), and the least susceptibility to co-amoxiclav (37.5%), cefixime (31.3%), oxacillin (18.8) and erythromycin (25%). S. pyogenes isolates were found to be completely susceptible (100%) to co-amoxiclav, levofloxacin, ciprofloxacin and ceftriaxone. S. pyogenes had less susceptibility to vancomycin (92%), and the least susceptibility to cefixime (38.5%) and erythromycin (26.9%). P. aeruginosa isolates were found to be 100% susceptible to levofloxacin, ciprofloxacin and ceftriaxone, with less susceptibility to ceftriaxone (66%) and the least susceptibility to co-amoxiclav (22.2%), cefixime (33.3%), erythromycin (11.1%), vancomycin (11.1%) and oxacillin.ConclusionsCo-amoxiclav is extensively used in Sudan empirically. The results show that S. aureus and P. aeruginosa are increasingly becoming resistant to this drug. However, S. pyogenes is still susceptible to it. Conversely resistance to erythromycin and cephalosporins is shown in all the different isolated species, however these drugs are still widely used without even culture and ASTs. Luckily, non-susceptibility to ciprofloxacin and levofloxacin was not detected here. Obviously, laboratory identification and ASTs are much needed along with surveillance programmes in hospitals. Together with rational use of antibiotics these measures will help to slow down the progress of the deadly AMR pandemic.

Oral antibiotic prescription patterns for dental conditions at two public sector hospitals in Pietermaritzburg, KwaZulu-Natal

Antibiotic resistance is a growing public health concern. Yet, there is a paucity of published data in KwaZulu-Natal on antibiotic prescription trends and patterns related to dental use. The objectives of this study were to identify the range of dental conditions for which oral antibiotics are prescribed at two public health settings (Institution A and B) in the Pietermaritzburg Complex, KwaZulu-Natal and to explore practitioner understanding of the indications for antibiotic prescription for dental conditions. The study used a two-phased approach and collected a combination of qualitative and quantitative data. Phase 1 comprised a retrospective clinical chart review (n=720), while phase 2 comprised a focus-group discussion with purposively selected health care practitioners at each institution. The results of the retrospective clinical chart review indicated that dental abscesses were the most common dental infections requiring oral antibiotic therapy (n= 479; 66%), followed by acute alveolar osteitis (dry socket) (n=110; 15%), dental impactions (n=78; 11%) and dental extractions (n=62; 9%). At Institution A, antibiotic therapy was prescribed for conditions such as trismus (n=13; 6%), soft palate swelling of unspecified origin (n=9; 4%), fibrous epulis (n=6; 3%) and acute herpes simplex (n=2; 1%). Interestingly, antibiotics were not prescribed at Institution B for the same dental conditions. Antibiotic therapy was also prescribed for eruption pain (n=4; 1%) and for cases when patients did not bring their inhaler for asthma treatment (pump) (n=3; 1%). The findings from the focus-group discussions suggested that there is a need to improve practitioner understanding of the indications for antibiotic prescriptions for dental conditions. This study showed some differences in antibiotic therapy prescription patterns at the two public health institutions, especially for dental conditions that did not require such management. This suggests a need for consensus building among health professionals and the provision of more dedicated guidance for antibiotic prescription in the management of dental conditions.

Evaluation and optimization of antibiotic usage in upper respiratory tract infections in children at a tertiary care outpatient department

INTRODUCTION:Inappropriate antibiotic (ab)use contributes to antimicrobial resistance. Upper respiratory tract infection (URTI) is the most common reason for antibiotic prescription in an outpatient department (OPD). Several factors influence the high and unjustified antibiotic use in a common ailment.MATERIALS AND METHODS:A clinical audit was performed to assess antibiotic prescription rate (APR) for URTI in the pediatric OPD against the available benchmark. The prescription pattern was assessed, and interventions were formulated to improve prescription behavior. Data of all children attending OPD and fulfilling the criteria for URTI group were collected from the online hospital management system and analyzed. Interventions, in the form of discussions, presentations, posters, and guidelines (Indian Ministry of Health Guidelines for URTI) regarding etiology of URTI, and indications for antibiotic prescription were implemented. Data were monitored and feedback to consultants was given.RESULTS:The baseline APR was 14.7%. There was wide variation in APR (4.1%–53.1%) among consultants. Three consultants had a rate of 53.1%, 29.7%, and 28.6%, which was very high. Postintervention, the average APR decreased to 8.7%, a reduction of 40.8%. There was a reduction in APR among consultants with high APR as well. There was reduction in the use of azithromycin, a drug recommended for patients with penicillin allergy, from 21.2% to 14.4% (32.1% reduction). Amoxycillin plus clavulanic acid combination and amoxicillin alone continued to be the most prescribed antibiotics.CONCLUSION:Interventions through clinical audit were useful in reducing APR. The APR of 8.7% achieved in this study postintervention can be used as a benchmark by other institutions to assess APR in children with URTI.

1592 An Audit on Prophylactic Prescribing for Third Molar Surgery

Abstract Introduction Over-prescription of antibiotics gives rise to problems including increased risk of adverse antimicrobial reaction and antimicrobial resistance. Despite this, the ‘routine’ prescription of prophylactic antibiotics following lower third molar removal (LTMR) remains common practice. The current body of evidence shows minimal to no statistically significant difference in the incidence of postoperative infection between prescribing and withholding prophylactic antibiotics for LTMR in healthy individuals. There is currently no published guidance on appropriate antibiotic usage following LTMR. Method A single centred, retrospective review of 100 successive patients undergoing LTMR. In the absence of current guidance, standards of specific criteria to justify antibiotic prophylaxis were formed. Primary outcome measures included appropriate prescription of prophylactic antibiotics, and record of clinical indication for antibiotic prescription. Following dissemination of results and implementation of suggested improvements, a 2nd audit cycle has commenced. Results Cycle 1 (n = 100) (Nov 2019 - April 2020) 52% of patients received prophylactic antibiotics following LTMR. Only 9% had a clear appropriate justification for use. 27% of antibiotics were not prescribed in accordance with BNF or SDCEP guidance. There were 0 postoperative infections within this cohort. Conclusions Over-prescription of antibiotic prophylaxis with inadequate documented justification for use is clear. All clinicians have a duty to consider the rising incidence of antimicrobial resistance and reflect this in their practice. The use of prophylactic systemic antibiotics in LTMR should be limited to cases where it may be deemed to show clinical benefit in patient best interest on both an individual and community scale.

Indication for Antibiotic Prescription Among Children Attending Primary Healthcare Services in Rural Burkina Faso

Of 61 355 visits by children <5 years old to 48 government-run primary healthcare facilities in Nouna District, Burkina Faso, 30 975 had an antibiotic prescribed (58% for pneumonia diagnoses). A minority of prescriptions were for diagnoses not requiring antibiotics, including malaria, nonbloody diarrhea, and cough without pneumonia.

Antibiotic prescription rate for upper respiratory tract infections in general practice - a Croatian study.

Aim Acute upper respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The frequency of antibiotics prescribed to patients with upper respiratory tract infections has been studied. Methods A cross-sectional survey has been conducted from October to December 2017 with participation of 17 General Practices in Croatia. Visits of patients with symptoms of upper respiratory tract infections made the survey framework. A specially structured questionnaire was a tool for the assessment of reasons for encounters, clinical statuses and practitioners' decisions. According to the registered clinical status, two independent doctors classified patients using Centor criteria, which were used to evaluate appropriate indication for antibiotic prescription. Results The survey analysed 709 patients' visits. Seventy three percent of general practice visits due to acute respiratory tract infection were initial. Antibiotics had been prescribed in the total of 32.6% of cases. Analysing upper respiratory tract infections with Centor score 1 and 2, antibiotics had been prescribed in 22.8% cases of the first visit and in 31.7% of the second visit, and with the Centor score 3 and 4 antibiotics had been prescribed in 85.1% of cases during the initial visit, and 66.7% of cases during the second visit. Logistic regression analysis about the contribution of nonclinical variables to antibiotic prescribing showed that most often antibiotics had been prescribed on Mondays. The most prescribed group of antibiotics was the penicillin group (74.8%), followed by macrolides (17.6%) and cephalosporins (4.0%). Conclusion General practitioners prescribe antibiotics for acute respiratory tract infections more than recommended by evidence based medicine and professional criteria.

Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand

IntroductionAntibiotic use in low-income and middle-income countries continues to rise despite the knowledge that antibiotic overuse can lead to antimicrobial resistance. There is a paucity of detailed data on the...

Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi.

We aimed to assess the impact of antibiotic optimization education along with understanding the antibiogram on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance and cost of antibiotics in a tertiary care hospital in New Delhi. We divided the study into 3 phases-before and after intervention and a phase of education in between. We collected data on demographics, indication for antibiotic prescription, appropriateness or reasons for inappropriate antibiotic uses, antibiotic consumption (i.e. the rate and duration of antibiotic use), bacterial resistance and antibiotic cost. Interventions included education, introduction of an antibiogram and use of antibiotic prescription forms. Similar data were collected for the post-interventional phase. The study was conducted at the Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. There was an improvement in the number of patients who underwent de-escalation of antibiotics, 21/100 v. 36/100 (p = 0.019); appropriate antibiotic usage, 25/ 100 v. 46/100 (p = 0.002); switching from intravenous to oral promptly, 16/52 v. 1 9/36 (p = 0.003) and decrease in expenditure, ₹24 207.5 v. ₹16 51 7.5 per patient (p = 0.001 ); in the post-interventional phase. Significant reductions in the incidence of infections due to Acinetobacter (60% v. 31%; p<0.001) and improvement in sensitivity pattern with cephalosporin sulbactam (80% v. 100%; p<0.001) were seen. Multivariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) score, hospital stay <10 days, ventilator-associated pneumonia and methicillin-resistant Staphylococcus aureus coverage were independent predictors of mortality with odds ratio of 1.14, 0.1, 9.7 and 1.14, respectively. Education and an antibiotic control programme constituted an effective and cost-saving strategy to optimise antibiotic use at a tertiary care centre.

Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications.

Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. Retrospective data from patients' records between January and December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/International Network for Rational Use of Drugs indicators were used to assess prescribing patterns in the study clinics. Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by International Non-proprietary Name and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics, respectively. Systemic antibiotics (JO1C) accounted for 45.4% of prescribed antibiotics of which amoxicillin accounted for 28.4% and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at Primary Health Care facilities should be designed and implemented, including developing robust quality indicators.

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

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

A review of urinary tract infection management for patients admitted to the emergency department: Assessment of adherence to guidelines and identification of hospitalization criteria

Background & objectives Community-acquired urinary tract infections (UTIs) are the second most common indication for antibiotic prescription in France. Previous studies on the adherence to guideline on antibiotic use reported a prevalence of inappropriate prescriptions varying from 20 to 50%, both in the community and hospital settings. The misuse of antibiotics not only have an important economic impact but can also lead to therapeutic impasses. This study aimed at establishing the current management of UTIs for patients admitted to the emergency department (ED) of our hospital. Methods This retrospective observational study was conducted in the European Hospital of Marseille January 2015 and May 2016. Consecutive patients admitted to the ED for a suspected UTI were included, including patients hospitalized ( n = 50) or discharged ( n = 50) after their ED admission. Assessment of adherence to guidelines for antibiotic prescription was conducted using the guidelines of the French-speaking society of infectious disease (SPILF). Results In the hospitalized group, 22 (44%) antibiotic prescriptions initiated at the ED did not comply with national guidelines. The two main causes for inappropriate prescriptions were the use of two antibiotics in patients with no severity criteria (15, 68%) and/or the use of a non-recommended drug (6, 27%). In this group, 17 (35%) antibiotic prescriptions ordered by the urologist on patients’ discharge did not comply with national guidelines. The two main causes of inappropriate prescriptions were the use of a non-recommended drug (9, 53%) and an inadequate duration of treatment (9, 53%). In the discharged group, 29 (60%) of the antibiotic prescriptions ordered at the ED did not comply with national guidelines. The two main causes of inappropriate prescriptions were an inadequate duration of treatment (23, 79%) and the use of a non-recommended drug (19, 66%). We could also identify discrepancies between reasons for hospitalization in our cohort compared to the criteria for hospitalization mentioned in the national guidelines. Discussion & conclusions This study has identified areas of improvement for the management of UTIs in our hospital. Our suggestions for optimization include educational materials and a decision tree displayed at the ED and specific therapeutic protocols in our computerized prescription system.

What should I do when a patient just wants antibiotics?

What should I do when a patient just wants antibiotics?

Antibiotic prescribing in dental practice in Belgium

To assess the types and frequency of antibiotic prescriptions by Belgian dentists, the indications for antibiotic prescription, and dentists' knowledge about recommended practice in antibiotic use. In this cross-sectional survey, dental practitioners were asked to record information about all antibiotics prescribed to their patients during a 2-week period. The dental practitioners were also asked to complete a self-administered questionnaire regarding demographic data, prescribing practices, and knowledge about antibiotic use. A random sample of 268 Belgian dentists participated in the survey. During the 2-week period, 24 421 patient encounters were recorded; 1033 patients were prescribed an antibiotic (4.2%). The median number of prescriptions per dentist for the 2 weeks was 3. Broad spectrum antibiotics were most commonly prescribed: 82% of all prescriptions were for amoxycillin, amoxycillin-clavulanic acid and clindamycin. Antibiotics were often prescribed in the absence of fever (92.2%) and without any local treatment (54.2%). The most frequent diagnosis for which antibiotics were prescribed was periapical abscess (51.9%). Antibiotics were prescribed to 63.3% of patients with periapical abscess and 4.3% of patients with pulpitis. Patterns of prescriptions were confirmed by the data from the self-reported practice. Discrepancies between observed and recommended practice support the need for educational initiatives to promote rational use of antibiotics in dentistry in Belgium.

ABS82: Symptom pattern and antibiotic prescription in patients with acute cough

Introduction:Acute cough is a common presentation in general practice. The indications for antibiotic prescription are debated.Methods:Prospective observational study of adults consulting General Practitioners with acute cough.Subjects:Over 26 months, 377 visits were made by the research nurse to 12 family practices in the UK using a randomised schedule. All consenting patients (17 yrs or older) seen with acute cough were recruited. A symptom questionnaire was obtained.Results:162 patients were recruited (64 male, median age 49.5 range 17–88 yrs). Co-morbidity with asthma was reported by 25%. Only 10% had a temperature of >37.0°C. Sputum production was reported by 90%. The median (range) duration of cough was 7 (1–14) days. The following symptoms were reported by patients: breathlessness (81%), wheeze (79%) sweating (51%), chest pain (48%) haemoptysis (8%). Antibiotics were prescribed to 63%. The age of those prescribed antibiotic was greater than that of those not (52.2 vs. 45.7 yrs, p = 0.04). Antibiotics were prescribed to a higher proportion of patients with breathlessness than without (69% vs. 38%, p =0.002), other symptoms were not predictive of antibiotics. There was a non-significant tendency for a higher prescribing rate in those with reporting productive cough (65% vs. 47%) p = 0.17, and to those reporting purulent sputum (67% vs. 50%) p = 0.15. Antibiotics were prescribed to a higher percentage of those with a fever (87%) than those without (59%), p = 0.04 The duration of cough, sex, smoking status and co-morbidity were not associated with an antibiotic prescription.Conclusions:Many patients presenting with acute cough are prescribed antibiotics; factors predicting the issue of a prescription include age, breathlessness and fever. Conflict of interest and funding Conflict of interest: None. Funding: Department of Health UK.

Effectiveness of Education and an Antibiotic-Control Program in a Tertiary Care Hospital in Thailand

We conducted a study to evaluate the impact of education and an antibiotic-control program on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance, and cost of antibiotics in a tertiary care hospital in Thailand. A study of the year before and the year after the intervention was performed. Inpatient antibiotic prescriptions were prospectively observed. Demographic characteristics, hospital unit, indication for antibiotic prescription, appropriateness of antibiotic use, reasons for inappropriate antibiotic use, antibiotic consumption (i.e., the rate of antibiotic use), bacterial resistance, and antibiotic cost data were collected. Interventions included education, introduction of an antibiogram, use of antibiotic prescription forms, and prescribing controls. After the intervention, there was a 24% reduction in the rate of antibiotic prescription (640 vs. 400 prescriptions/1000 admissions; P<.001). The incidence of inappropriate antibiotic use was significantly reduced (42% vs. 20%; P<.001). A sustained reduction in antibiotic use was observed (R2=0.692; P<.001). Rates of use of third-generation cephalosporins (31 vs. 18 defined daily doses [DDDs]/1000 patient-days; P<.001) and glycopeptides (3.2 vs. 2.4 DDDs/1000 patient-days; P=.002) were significantly reduced. Rates of use of cefazolin (3.5 vs. 8.2 DDDs/1000 patient-days; P<.001) and fluoroquinolones (0.68 vs. 1.15 DDDs/1000 patient-days; P<.001) increased. There were no significant changes for other antibiotic classes. Significant reductions in the incidence of infections due to methicillin-resistant Staphylococcus aureus (48% vs. 33.5%; P<.001), extended-spectrum beta -lactamase-producing Escherichia coli (33% vs. 21%; P<.001), extended-spectrum beta -lactamase-producing Klebsiella pneumoniae (30% vs. 20%; P<.001), and third-generation cephalosporin-resistant Acinetobacter baumanii (27% vs. 19%; P<.001) were also observed. Total costs saving were USD 32,231 during the study period. Education and an antibiotic-control program constituted an effective and cost-saving strategy to optimize antibiotic use in a tertiary care center in Thailand.