Indications For Prescription Research Articles

Physicians’ experiences with indications and prescriptions of foot orthoses–A cross-sectional study in northern Germany

BackgroundFoot orthoses (FOs) are prescribed by general practitioners (GPs) and orthopedic surgeons for various complaints. As there are very limited medical guidelines and checklists, the prescription of FOs is often inconsistent. Therefore, our study to evaluate the general prescription behavior and indication experiences with FOs from the perspective of GPs and orthopedists. MethodsA survey was carried out using a questionnaire from October to December 2021. GPs and orthopedic surgeons in northern Germany were included. The focus of the survey was to examine which foot problems would lead GPs and orthopedic surgeons to prescribe FOs and to evaluate what factors these physicians included in their diagnostic analysis. Apart from descriptive analyses, a stepwise linear regression analysis was performed to explore potential associations of the primary outcome variable ‘specific effect on the prescription of FOs’, which was introduced to shed light upon the estimated added value of the prescription of FOs. ResultsOut of the 790 questionnaires distributed, 184 questionnaires were returned by GPs (n = 95) and orthopedic surgeons (n = 74) (response rate 23 %). FOs were most frequently prescribed for talipes valgus (96 %) and heel spur (54 %). Diagnostic analysis was mainly carried out clinically. Custom-made FOs (82 %) were prescribed more frequently than prefabricated FOs (6 %). Regular interaction within the prescription process was most commonly with orthopedic technicians (61 %). The estimation of the specific effect on FO prescription was assessed by a mean of 66 % of the participants, 82 % recommended self-exercises as an additional therapy. ConclusionsFOs are a specific and well-established aid prescribed by many GPs and orthopedic surgeons for a variety of foot complaints. Despite being one of the most frequently prescribed orthopedic devices, the utilization of FOs is predominantly explorative due to a growing but nevertheless still deficient body of well-researched evidence. There is a clear need for a uniform approach to the indication and prescription of FOs among physicians.

Epilepsy, Antiepileptic Drugs, and Adverse Pregnancy Outcomes, 1: Examination and Interpretation of Recent Research.

The age-standardized global prevalence of epilepsy is about 0.3% in women. Seizures are associated with morbidity and mortality risks; so, women with epilepsy (WWE) are usually advised antiepileptic drug (AED) treatment even during pregnancy. Women may also knowingly or unknowingly be exposed during pregnancy to AEDs advised for other on- or off-label indications. In this context, a meta-analysis of 35 adverse gestational outcomes examined in 76 observational studies found that WWE were at increased risk of most of the adverse outcomes, regardless of gestational exposure to AEDs. AEDs, especially in polytherapy, further increased at least a few of the gestational risks, including risks of congenital conditions, neonatal intensive care unit admission, small for gestational age, low birth weight, and neonatal/infant death (it is unclear whether the lack of statistical significance for the remaining risks was because AED exposure was truly limited to these risks or whether the nonsignificant analyses were underpowered). Reassuringly, the increases in risk were mostly in the small to modest range. This meta-analysis pooled unadjusted risks (which would probably be larger than adjusted risks), so readers are informed about expected findings in the population but not about cause-effect relationships that may be cautiously hypothesized from adjusted analyses. A take-home message is that, because of the wide range of outcomes for which risk is increased, WWE should be closely monitored and followed all through pregnancy, regardless of treatment with AEDs. This article also provides readers with suggestions on how to critically interpret literature with regard to 8 matters: confounding by indication and confounding by severity of indication, as specific to the indication for AED prescription; unadjusted and adjusted analyses; the base rate of an outcome in the population; the examination of multiple outcomes; the uniform direction of findings; the sample numbers; the timing of AED exposure; and self-fulfilling prophecies.

Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country—the impact of an antimicrobial stewardship program

BackgroundResistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital.MethodA point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis (http://www.global-pps.com).ResultsA total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%.ConclusionThe indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.

Les inhibiteurs de la pompe à protons à l’hôpital : prescription pertinente ou encore banalisée ?

Introduction: The increasing use of Proton Pump Inhibitors (PPIs) is associated with inappropriate indication and unjustified prolonged treatment. Yet, PPIs have side effects associated with long-term use and drug interactions. The aim of this study is to assess the relevance of hospital PPI prescriptionsMaterial and method: A clinical audit was performed on the PPI prescriptions of a university hospital over one month (October 2022). The main criteria assessed were indication, dosage, and duration of treatment, against the latest guidelines of the French Higher Health Authority (HAS), and the re-evaluation of PPI prescriptions at discharge.Results: One hundred PPIs prescriptions from various medical departments were analyzed. The average age of patients included was 68 years. The most common indication for PPI prescription was the concomitant use of antithrombotics in mono or dual therapy (n=68). Overall, only 11% of prescriptions are in accordance with the recommendations. Justification for the change was documented in the patients’ charts in only 24 % of cases. No discontinuation of PPI treatment was carried out during or after hospitalization whereas it would have been justified in 49% of patient.Discussion/Conclusion: Our study confirms the low relevance rate of PPIs prescriptions in hospital but also at discharge, highlighting the need to increase awareness about it among physicians and patients. Adaptation of PPIs prescriptions can be a way for pharmacist to limit misuse.

Patterns and Quality of Antibiotic Prescribing: Results from a Multicentre Point Prevalence Survey in Government Hospitals in Perak, Malaysia

A point prevalence survey (PPS) is used to collect data on antimicrobial prescribing and assess a set of quality indicators associated with antimicrobial use. This study aimed to describe patterns and quality indicators of antibiotic prescribing among government hospitals in Perak, Malaysia. Data was retrospectively reviewed data from a PPS conducted from 1st to 14th December 2021 in 5 specialist and 10 non-specialist hospitals. All hospitalised patients on the day of the survey formed the study population. Those who had received at least one active systemic antibiotic by 8.00 a.m. or surgical prophylaxis within 24 h of the survey day were eligible for PPS. Data on pattern and quality indicators of prescribing (documentation of indication, guideline compliance and appropriateness of surgical prophylaxis) were analysed with descriptive evaluation. Of 2,386 hospitalised patients, 40% were prescribed antibiotics, mainly from the ‘Access’ category (52.3%). Antibiotic prevalence was highest in the intensive care unit (ICU) (90.8%). The predominant antibiotic class was beta-lactam/ beta-lactamase inhibitor (32.6%), corresponding to community-acquired pneumonia (CAP) (19.8%) being the most common diagnosis. Intravenous administration was ordered in 79.4%, while empirical therapy constituted 84.5%. Documentation of indication within 24 h and guideline compliance were 88.2% and 69.8%, respectively. Inappropriate choice of antibiotics and improper dose/frequency were identified as important non-compliance issues. Of the surgical prophylaxis prescriptions, 35.6% were administered for more than 24 h. The findings have helped identify critical areas for antimicrobial stewardship interventions. Efforts are needed to reinforce compliance, documentation and improve surgical prophylaxis prescribing practices.

High incidence of inappropriate alarms due to artifact sensing and misclassification of episodes in patients with wearable cardioverter-defibrillators

Abstract Background The wearable cardioverter-defibrillator (WCD) has become a useful tool used for temporary protection from sudden cardiac death. However, since the WCD uses surface electrodes to detect arrhythmias, it is prone to inappropriate detection. Although shock conversion rates for the WCD are high for detected events, its efficacy in clinical practice tends to be degraded by patient noncompliance. Reasons include wear discomfort and frequent false alarms, that may interrupt sleep and generate anxiety. Data on the incidence of false alarms emitted by the WCD and their predictors are rare. Purpose The aim of our study was to assess both artifact and misclassification burden and wear compliance in patients with a WCD. Methods and Results We conducted a single-centre retrospective observational study analyzing patients with a WCD prescribed at our institution. In total, in 134 patients (mean age 51.7 ± 13.8 ys, 79.1% male) provided with a WCD, arrhythmia recordings were analyzed and categorized as either non-sustained ventricular tachycardia, sustained ventricular tachycardia / fibrillation, and artifact sensing or misclassified episodes. Indication for WCD prescription was both primary and secondary prophylactic. All patients received optimal medical therapy. Baseline evaluation in all patients included transthoracic echocardiography, 12-lead electrocardiogram, and baseline laboratory values. A total of 3019 false WCD alarms were documented in 134 patients (average number of false alarms 22.5 ± 130.4 episodes per patient) over a mean WCD wearing time of 71.5 ± 70.9 days (daily wearing time 20.2 ± 5.9 hs). In total, in 78 patients (58.2%), either artifact sensing (41.8%), misclassified episodes (3.7%) or both (9.7%) occurred. Misclassified episodes included sinus tachycardias, atrial flutter, atrial fibrillation, ventricular extrasystoles, and intermittent bundle branch block. At multivariate analysis, WCD wearing time (HR 1.02; 95% CI 1.01-1.02; P < 0.001) and loop diuretics (HR 0.16; 95% CI 0.06-0.44; P < 0.001) were identified as independent predictors of artifact episode occurrence. In terms of the frequency of artifact episodes, loop diuretics (HR -0.11; 95% CI interval -0.21-0.0001; P = 0.049), angiotensin receptor-neprilysin inhibitors (ARNIs) (HR -0.11; 95% CI -0.22-0.01; P = 0.03), and the R-amplitude (HR -0.17; 95% CI -0.27-0.07; P = 0.01) of the WCD baseline electrocardiogram (ECG) were independent predictors. In addition, WCD wearing time (HR 1.00; 95% CI 1.00-1.01; P = 0.04), atrial fibrillation (HR 4.03; 95% CI 1.15-14.11; P < 0.001), and ARNIs (HR 3.17; 95% CI 1.05-9.52; P < 0.001) were significantly associated with the occurrence of misdetected / misclassified episodes. Conclusions In conclusion, In WCD patients with a ZOLL LifeVest system, false alarms emitted by the device were frequent and most common caused by artefacts.

P018 A review of the use of anakinra in hyperinflammatory conditions at a large central London teaching hospital

Abstract Background/Aims The interleukin-1 receptor antagonist, anakinra, is increasingly used to treat inflammatory disorders. We recognized a need to provide patients with accurate information regarding the trajectory of their treatment. In this service evaluation project, we collected data on patients prescribed anakinra at a London teaching hospital over a 4-year period. Methods Patients included were started on anakinra to manage an inflammatory disorder between April 2019 and Feb 2023. Patients were identified by searching a high-cost drugs system. Data on indication for the drug, start and stop date(s) of treatment and any adverse effects were then collected using electronic patient records. Results 74 patients met inclusion criteria, 43 females and 31 males. Median age 38.5 years. 56 patients were treated for haemophagocytic lymphohisticytosis (HLH), 5 for Juvenile Idiopathic Arthritis (JIA) and 13 for Adult Onset Still’s Disease (AOSD). Median time on anakinra was 140.5 days (IQR 563.5), 1487.5 days (IQR 861) and 673 days (IQR 1017) for HLH, JIA and AOSD respectively. Of those treated for HLH, drivers and median duration of anakinra treatment for each respective driver were: infection (seven patients, 31 days), rheumatological (six patients, 785 days), haematological (26 patients, 36.5 days), iatrogenic (1 patient, 89 days), primary HLH (2 patients, 89 days), underlying rheumatological condition with infective/drug trigger (3 patients, 345 days), unknown (11 patients, 191 days). 9/56 patients with HLH remained on treatment at data collection - 4 with an unknown driver, two with AOSD, one with underlying Sjogren’s and a drug trigger, one with a haematological driver and one with primary HLH. 12/56 patients with HLH had died. Of those who died, eight had a haematological malignancy driving their condition, three had an infective driver and one an unknown driver. Five patients in our study had HLH driven by AOSD. Of these, 2/5 successfully stopped anakinra during the study period. Five patients (8.9%) with HLH required multiple courses of treatment with anakinra; three had lymphoma associated HLH, one primary HLH and one idiopathic HLH. Three patients were unable to continue with therapy due to side effects: neutropenia(1), rash (1), problems self-injecting (1). Conclusion From this data set we can begin to formulate answers to many commonly encountered questions regarding anakinra therapy. The length of time someone can expect to receive treatment with anakinra is significantly impacted by the indication for prescribing. Those with a haematological malignancy driving their HLH receive anakinra for the shortest time of all groups, usually while awaiting definitive treatment for their cancer, or before transition to palliative management. Some patients with AOSD driven HLH can safely stop treatment. Some patients may require multiple courses of treatment with anakinra for disease relapse. Adverse effects requiring treatment cessation are low in all groups. Disclosure I. Munro: None. R. Allen: None. A. Jones: None. J. Manson: None.

STOMP during COVID-19: use of psychotropic medication in intellectual disabilities community services – pilot QI project

PurposeA quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.Design/methodology/approachData was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.FindingsMost of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.Originality/valueTo the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

ANALYSIS OF DRUG UTILIZATION PATTERN IN CHRONIC KIDNEY DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL, SOUTH INDIA

Objective: The objective of the study is to assess the drug utilization pattern of various drugs prescribed in chronic kidney disease (CKD) patients in a tertiary care hospital. Methods: As a cross-sectional study 200 prescriptions were randomly selected from both the nephrology outpatient department and the inpatient ward. Patient demographics details, CKD staging, classes of drugs prescribed, and number of drugs prescribed were noted and data were analyzed with the World Health Organization core prescribing indicators. Results: Incidence of CKD is more common in the age group of 40–50 years (45%) with male predominance (70%). Hypertension, diabetes, and anemia are the common comorbid conditions seen with CKD. Anti-hypertensives, anti-anemic drugs, calcium supplements, and anti-diabetic drugs are the commonly prescribed drugs in CKD. Number of prescription contains that generic names are near optimal and drugs from the National List of Essential Medicine are optimal. Majority of the prescriptions contain on average 5 drugs. Conclusion: Diabetes and high blood pressure are the two most common causes of CKD with male dominance. Since polypharmacy is common in CKD patients , they should be monitored for drug – drug interaction and adverse drug reactions.

Low-value chronic prescription of acid reducing medication among Dutch general practitioners: impact of a patient education intervention

BackgroundDyspepsia is a commonly encountered clinical condition in Dutch general practice, which is often treated through the prescription of acid-reducing medication (ARM). However, recent studies indicate that the majority of chronic ARM users lack an indication for their use and that their long-term use is associated with adverse outcomes. We developed a patient-focussed educational intervention aiming to reduce low-value (chronic) use of ARM.MethodsWe conducted a randomized controlled study, and evaluated its effect on the low-value chronic prescription of ARM using data from a subset (n = 26) of practices from the Nivel Primary Care Database. The intervention involved distributing an educational waiting room posters and flyers informing both patients and general practitioners (GPs) regarding the appropriate indications for prescription of an ARM for dyspepsia, which also referred to an online decision aid. The interventions’ effect was evaluated through calculation of the odds ratio of a patient receiving a low-value chronic ARM prescription over the second half of 2021 and 2022 (i.e. pre-intervention vs. post-intervention).ResultsIn both the control and intervention groups, the proportion of patients receiving chronic low-value ARM prescriptions slightly increased. In the control group, it decreased from 50.3% in 2021 to 49.7% in 2022, and in the intervention group it increased from 51.3% in 2021 to 53.1% in 2022. Subsequent statistical analysis revealed no significant difference in low-value chronic prescriptions between the control and intervention groups (Odds ratio: 1.11 [0.84–1.47], p > 0.05).ConclusionOur educational intervention did not result in a change in the low-value chronic prescription of ARM; approximately half of the patients of the intervention and control still received low-value chronic ARM prescriptions. The absence of effect might be explained by selection bias of participating practices, awareness on the topic of chronic AMR prescriptions and the relative low proportion of low-value chronic ARM prescribing in the intervention as well as the control group compared to an assessment conducted two years prior.Trial registration10/31/2023 NCT06108817.

Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran.

The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities. Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis. In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions. In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from an Italian longitudinal study

IntroductionThe prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. In particular, baseline AP exposure in CHR-P individuals may be considered as a functional equivalent of the psychometric transition to psychosis, as already postulated in the original ‘Ultra High-Risk’ model.ObjectivesThe main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period.MethodsThis research was settled within the ‘Parma At-Risk Mental States’ program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. The acquisition of drug and outcome information was collected both at baseline and across the follow-up period. Finally, logistic regression analyses with dichotomized 1-year outcome parameters (previously showing statistically significant differences in inter-group comparisons) as dependent measures and sociodemographic and clinical characteristics as independent variables were also performed.ResultsHundred and seventy-eight CHR-P individuals (aged 12–25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals.ConclusionsThe current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic. Moreover, our findings confirm that baseline AP prescription appears to increase psychotic transition risk.Disclosure of InterestNone Declared

Commonly prescribed medicines, core prescribing indicators, and prescription errors in a tertiary healthcare setting in Sri Lanka: a descriptive cross-sectional study

Abstract Objectives To describe the commonly prescribed medicines, WHO/INRUD core prescribing indicators, and prescription errors from a tertiary healthcare setting in Sri Lanka. Methods This study was conducted at clinics and wards in a group of tertiary hospitals from Colombo, Sri Lanka. A total of 1600 prescriptions (800 in-ward [IW] and 800 out-patient clinic [OP]) were analysed and evaluated against WHO/INRUD core prescribing indicators. Prescription errors and medication interactions were also analysed. Key findings Number of medicines per encounter on average was 4.2 ± 2.9 (median: 4.0; range: 1–18) (IW vs. OP: 5.0 ± 3.1 vs. 3.4 ± 2.1; P < 0.001). Overall, the percentage of prescriptions with an antibiotic was 25.9% (n = 415) (IW vs. OP: 45.0% vs. 6.9%, P < 0.001). Percentage of encounters with an injection was 20.4% (n = 326) (IW vs. OP: 36.9% vs. 3.9%, P < 0.001) and percentage of medicine prescribed by generic name was 90.7% (IW 92.9% vs. OP 87.3%, P < 0.001). Prescribing from the essential medicines list (EML) was 76.9% (IW 77.7% vs. OP 75.7%, P-NS). Among IW prescriptions details regarding allergies were not mentioned in 643 (80.4%), while in paediatric prescriptions weight was not specified in 242 (75.6%). At least a single abbreviation was used in 638 prescriptions (39.9%). One or more medication interactions were identified in 744 (46.5%) prescriptions (major: 86 [5.4%]). Conclusions We identified a relatively high number of average medicines per encounter, indicating a degree of polypharmacy. In addition, generic prescribing and usage of EML medicines are areas recommended for further improvement. Prescription errors were common, and several commission/omission errors had potential for preventable patient harm.

Retrospective review of medicine utilization for noncommunicable diseases in three public sector pharmacies in Jamaica.

The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.

Comparing indicators of disease severity among patients presenting to hospital for urinary tract infections before and during the COVID-19 pandemic.

During the COVID-19 pandemic, patients may have delayed seeking healthcare for urinary tract infections (UTIs). This could have resulted in more severe presentation to hospital and different antibiotic usage. We explored evidence for such changes through existing national indicators of prescribing, and routine clinical data collected in the electronic health record (EHR). We carried out a retrospective cohort study of patients presenting to two UK hospitals for UTIs, comparing two indicators of disease severity on admission before and during the pandemic: intravenous (IV) antibiotic use, and National Early Warning Score 2 (NEWS2). We developed regression models to estimate the effect of the pandemic on each outcome, adjusting for age, sex, ethnicity and index of multiple deprivation. During the pandemic, patients were less likely to present to hospital for UTI with NEWS2 of 0 or 1 [adjusted odds ratio (aOR): 0.66; 95% confidence interval (CI): 0.52-0.85] compared with before, more likely to present with score 2 (aOR: 1.52; 95% CI: 1.18-1.94), whereas the likelihood of presenting with a NEWS2 of >2 remained the same (aOR: 1.06; 95% CI: 0.87-1.29). We did not find evidence that this limited increase in disease severity resulted in changes to IV antibiotic use on admission (adjusted risk ratio: 1.02; 95% CI: 0.91-1.15). There may have been a small increase in disease severity at hospital presentation for UTI during the pandemic, which can be detected using routine data and not through national indicators of prescribing. Further research is required to validate these findings and understand whether routine data could support a more nuanced understanding of local antimicrobial prescribing practices.

A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report.

Guidelines recommend treating asthma exacerbations (AAEs) with bronchodilators combined with inhaled and/or systemic corticosteroids. Indications for antibiotic prescriptions for AAEs are usually not incorporated although the literature shows antibiotics are frequently prescribed. To investigate the antibiotic prescription rates in AAEs and explore the possible determining factors of those practices. A digital survey was created to determine the antibiotic prescription rates in AAEs and the influencing factors for the prescription practices. The survey was distributed among European academy of allergy and clinical immunology (EAACI) members by mass emailing and through regional/national societies in the Netherlands, Italy, Greece, and Poland. Furthermore, we retrieved local antibiotic prescription rates. In total, 252 participants completed the survey. Respondents stated that there is a lack of guidelines to prescribe antibiotics in AAEs. The median antibiotic prescription rate in this study was 19% [IQR: 0%-40%] and was significantly different between 4 professions: paediatrics 0% [IQR: 0%-37%], pulmonologists 25% [IQR: 10%-50%], general practitioners 25% [IQR: 0%-50%], and allergologists 17% [IQR: 0%-33%]) (p=0.046). Additional diagnostic tests were performed in 71.4% of patients before prescription and the most common antibiotic classes prescribed were macrolides (46.0%) and penicillin (42.9%). Important clinical factors for health care providers to prescribe antibiotics were colorised/purulent sputum, abnormal lung sounds during auscultation, fever, and presence of comorbidities. In 19% of patients with AAEs, antibiotics were prescribed in various classes with a broad range among different subspecialities. This study stresses the urgency to compose evidence-based guidelines to aim for more rational antibiotic prescriptions for AAE.

Dalbavancin as an alternative to traditional outpatient parenteral antimicrobial therapy for deep gram-positive infections - an observational, retrospective review.

Treatment of invasive gram-positive infections in complex patient populations is challenging. Dalbavancin, approved for skin and soft tissue infections, offers advantages in this setting due to its long half-life and infrequent dosing. However, less is known about the outcomes of off-label dalbavancin for deeper infections. The objective of this study is to examine the feasibility and outcomes of patients with complex gram-positive infections treated with dalbavancin as an alternative to standard outpatient parenteral antimicrobial therapy (OPAT). We conducted a multicenter, retrospective review of adult patients managed within an OPAT program with intravenous dalbavancin for off-label indications. Adult patients were included if they had treatment details and follow-up documented between January 2020 and June 2023. Details of dalbavancin use including indications for prescription were captured. Outcomes of interest included 90-day infection recurrence, prosthesis retention rates, 90-day mortality, and adverse medication events. In all, 61 patients received dalbavancin, mostly as sequential therapy. Twenty-three percent received dalbavancin strictly in the outpatient setting. Dalbavancin was used primarily for hardware (fracture, spine, or joint), native bone or joint, and complicated soft tissue infections. The predominant pathogen was Staphylococcus aureus (61%). Dalbavancin was frequently prescribed as a two-dose 1500 mg regimen (49%) due to persistent infection (23%), difficult line access (30%), difficulty achieving therapeutic vancomycin levels (18%), or substance abuse history (18%). Overall, six patients (10%) had infection recurrence and no patients died during the follow-up period. Three of eight patients with hardware retention had infection recurrence. Adverse effects were minimal and mostly self-limiting. Dalbavancin is an efficacious and safe alternative to standard OPAT, especially in those with barriers to traditional long-term intravenous antibiotics. Improved outcomes may be achieved with hardware removal. Dalbavancin may facilitate early discharge or prevent hospitalizations. Comparative studies of standard OPAT regimens versus dalbavancin are needed.

Documenting the indication for antimicrobial prescribing: A retrospective observational study of long-term care homes.

Overuse of antimicrobials in residents of long-term care homes is common and can result in harm. Antimicrobial stewardship interventions are needed in the long-term care (LTC) homes setting to improve the appropriate use of antimicrobials. Previous literature has highlighted the importance of documenting antimicrobial indication as a strategy that contributes to improve antimicrobial use; however, there is a lack of evidence in LTC homes. This study examines the prevalence, clarity, and facility-level variability of antibiotic indication documentation in this setting. This is an observational retrospective study of oral antibiotic prescriptions dispensed to 218 homes between January 1, 2021 and December 31, 2022 in Ontario, Canada. Indication was obtained from reviewing antibiotic prescription data. Clarity was determined by comparing documented indication to the National Antimicrobial Prescribing Survey (NAPS). Descriptive analysis was performed to examine the prevalence and clarity of indication documentation. Funnel plots were generated to examine variability in prevalence of indication documentation and clarity at the home level. Overall, 22.9% (7998/34,867) of prescriptions had an indication documented. The proportion of indications that were clear was 37% (2984/7998). The most common indications were for urinary (45%), skin and soft tissue (19.9%) and respiratory infections (15.0%). At the home level, the median prevalence of indication was 19.6% (interquartile range [IQR]: 10.8%-31.4%) and median prevalence of clear indications was 35.1% (IQR: 23.8%-42.9%). Funnel plots revealed substantial variability in indication prevalence with 46.3% of homes falling outside of 99% limits but minimal variability in indication clarity between homes with only 8.7% of homes outside of 99% control limits. There is an opportunity to increase both the prevalence and clarity of antibiotic prescriptions in LTC homes. Future work should focus on determining how best to support prescription indication documentation in this setting with consideration being given to prescription workflow and most common antibiotic prescription indications.

Comparative Analysis of Outpatient Antibiotic Prescribing in Early Life: A Population-Based Study Across Birth Cohorts in Denmark and Germany.

Comparing antibiotic prescribing between countries can provide important insights into potential needs of improving antibiotic stewardship programs. We aimed to compare outpatient antibiotic prescribing in early life between children born in Denmark and Germany. Using the Danish nationwide healthcare registries and a German claims database (GePaRD, ~ 20% population coverage), we included children born between 2004 and 2016, and followed them regarding outpatient antibiotic prescriptions until end of enrollment or the end of 2018. We then determined the median time to first antibiotic prescription. Based on all prescriptions in the first 2years of life, we calculated the rate of antibiotic treatment episodes and for the children's first prescriptions in this period, we determined established quality indicators. All analyses were stratified by birth year and country. In the 2016 birth cohorts, the median time to first antibiotic prescription was ~ 21months in Denmark and ~ 28 in Germany; the rate of antibiotic treatment episodes per 1000 person-years was 537 in Denmark and 433 in Germany; the percentage of prescribed antibiotics with higher concerns regarding side effects and/or resistance potential was 6.2% in Denmark and 44.2% in Germany. In the 2016 birth cohorts, the age at first antibiotic prescription was 50-59% higher compared to the 2004 birth cohorts; the rate of antibiotic treatment episodes was 43-44% lower. Infants in Denmark received antibiotics markedly earlier and more frequently than in Germany, while quality indicators of antibiotic prescribing were more favorable in Denmark. Although both countries experienced positive changes towards more rational antibiotic prescribing in early life, our findings suggest potential for further improvement. This particularly applies to prescribing antibiotics with a lower potential for side effects and/or resistance in Germany.

2048 Antipsychotic medication prescription in elderly patients in Royal Gwent Hospital, Wales

Abstract Introduction he use of anti-psychotics is higher in older people than their younger adult counterparts due to high prevalence of dementia/delirium. Anti-psychotic drugs cause side effects which include cardiovascular, metabolic, extra pyramidal and risk of falls. So, we set out to do a QIP on antipsychotic medication prescription on our Geriatric wards comparing it with NICE guidelines. Method We had 2 approaches to use. Firstly, we prepared a check list for anti-psychotic medication monitoring according to NICE guidelines 2021 and we applied this retrospectively to our patients who had been initiated on anti-psychotics within the last year, the aim being to compare our practice with best practice. Secondly, we prepared a questionnaire for doctors to assess their knowledge about anti-psychotic NICE guidelines and distributed this to our junior doctors in RGH. Results • Main Indication for prescription was Behavioural and psychological symptoms of dementia (BPSD) - 94% of the time • Risperidone was the most commonly prescribed (64%) antipsychotic. • 83% of them had non-pharmacological methods tried before considering antipsychotic medications. • 82% had their baseline ECGs checked and falls risk assessments done • 35% had their lipids checked and 47% had their HbA1c checked • 52% of the doctors were aware about NICE guidelines on prescribing anti-psychotic medications • 70% of the doctors had knowledge about the side effects. Conclusions Our study showed the most commonly used antipsychotic drug was risperidone. We were good at documenting the indication, trying non-pharmacological methods and discussing side effects with patients/family. Hba1c, lipids and prolactin were not often checked, showing room to develop best practice. We are in the process of finalising stickers as a checklist when starting antipsychotics. To improve knowledge, we have presented the findings and aim to put up posters on wards and to do regular teachings.