Irrational Antibiotic Prescribing Research Articles

Knowledge, Attitude, and Perception regarding antibiotic use and its associated resistance among the general public in Lahore, Pakistan.

BACKGROUND & OBJECTIVE: Increasing misuse and irrational prescribing of antibiotics by physicians has led to antimicrobial resistance (AMR) posing a major global threat. Furthermore, only a few studies have been conducted to evaluate this domain in Pakistan. The objective of this study is to assess the general public’s knowledge, attitude, and perception towards antibiotic use and its resistance, and to determine positive associations between the various socio-demographic variables. METHODOLOGY: A descriptive cross-sectional study was conducted from October 2022 to March 2023. A convenient sampling technique was employed, selecting participants ≥ 18 years of age (n= 339). Structured questionnaires were distributed on different study sites and random participants were asked to respond immediately. RESULTS: Results showed that assessing antibiotics use among these 342 participants in the last year, it was determined that the majority of them had only used antibiotics once 108(31.6%). A closer number of individuals had used antibiotics more than thrice 101(29.5%) shows no significant association between rural and urban with a p-value=0.941>0.05. The majority were also aware of fatal allergic reactions produced by some antibiotics and agreed to stop antibiotic use if any adverse reaction were to occur 277(81.0%)p-value=0.674>0.05. No significance was observed, although some near-significant values of importance were noted and discussed. CONCLUSION: Antibiotic usage is commonly observed among all individuals; however, views contain many deviations. Constraints, including sample bias, Lahore’s urban dominance, and the omission of doctor-prescribing evaluations, highlight the study's limitations and have further skewed our results.

Rationality of antibiotic prescribing in basic- and intermediate-level accredited primary health centres in Depok, Indonesia

Background: Previous research has identified a high irrationality of antibiotic usage among accredited primary health centres (PHCs). Implementing health system accreditation in Indonesia will encourage health facilities to rationalise antibiotic use. Objective: To evaluate antibiotics' prescribing pattern and rationality in basic and intermediate accredited PHCs after implementing health system accreditation. Method: A cross-sectional study was conducted at each of two basic- and intermediate-accredited PHCs in Depok, Indonesia. All antibiotic prescriptions from January to March 2020 were included in the prescribing pattern, while 384 prescriptions from each PHC were randomly sampled to evaluate the rationality using the PHCs clinical guidelines. Result: Amoxicillin was the most prescribed in the basic accredited PHCs (61%) and intermediate accredited PHCs (83.9%). Most of the antibiotics were used to treat respiratory tract (64.1%), teeth (12.0%), skin (7.8%), and other kind of infections. Irrational prescribing of antibiotics was found in basic and intermediate health centres in the form of duration of administration (75.7% and 79.3%), selection (18.6% and 14.2%), frequency (14.4% and 3.4%), and dosage (11.8% and 1.4%) respectively. Conclusion: After implementing the accreditation system, irrational use of antibiotics remains common, but PHCs with higher accreditation levels tend to show more rational antibiotic use.

Prescription of antibiotics during endodontic treatments: Survey of senegalese dentists

: Irrational antibiotic prescribing is a phenomenon common to several countries, including Senegal.The aim of this study was to assess the level of antibiotic prescribing among Senegalese dental surgeons during the management of pulpal and periapical pathologies. This descriptive, analytical, cross-sectional study involved 132 dentists regularly registered with the Senegalese Dental Surgeons' Association.Data were collected and analyzed using SPSS version 17.0 software (SPSS, Inc., Chicago, IL, USA).The results of X2 tests showed a statistically significant difference between the private and public sectors for the management of root resorption (P≤0.005).: In patients with penicillin allergy, clindamycin was the first-line treatment (31.1%), followed by metronidazole combined with spiramycin (25%) and azithromycin 500mg (22.7%).: As with previous studies carried out in other countries, this study shows that very few practitioners make appropriate use of antibiotics for pulpal and periapical pathologies.

Досвід застосування засобу «Біоплазмікс спрей для горла» в комплексному лікуванні гострих вірусних фарингітів у дітей з атопічним фоном

The problem of therapy of acute respiratory infections in children remains relevant. The most common infectious pathology of the upper respiratory tract in both children and adults is acute viral pharyngitis. Irrational prescribing of antibiotics leads to medication-induced side effects and the spread of resistance of microorganisms to antibiotics in society. Topical application of respiratory probiotics may be an important component in the supportive treatment of acute respiratory infections and reducing antibiotic dependence. The use of probiotics in children with an atopic background is of particular importance due to the possible occurrence of adverse reactions. Purpose - to assess the safety and effectiveness of the local application of Bioplasmix throat spray in the complex treatment of acute viral pharyngitis in children with an atopic background. Materials and methods. 45 children aged 6-18 years with acute viral pharyngitis took part in the study. 2 research groups were formed: the Group I - main (n=25) - received protocol treatment + Bioplasmix throat spray locally and the Group II - comparison (n=20) - only protocol treatment. All patients were assessed for the severity of clinical symptoms (fever, headache, sore throat, scratching, cough) and oropharyngoscopy data (hyperemia, swelling of the mucous membrane of the oropharynx, granularity of the back wall of the pharynx) on the 1st, 2nd, 3rd, 4th, 5th and 7th days of using the product. Results. The use of the local application of Bioplasmix throat spray for acute pharyngitis in children ensures a faster reduction in the severity of the main clinical manifestations and signs of inflammation of the oropharynx. In the Group I, compared to the Group II, there were better indicators of a decrease in the severity of cough (1.2±0.91 points vs. 1.76±0.85 points), a scratching (1.12±0.92 points vs. 1.7±0.86 points), sore throat (1.6±0.81 points vs. 2.23±0.76 points) and hyperemia of the pharynx (1.4±0.7 points vs. 2.1±0.9 points) from the 3rd day, swelling of the pharynx (1.22±0.86 points vs. 1.8±1.04 points) from the 4th day. Adverse reactions were not noted during the use of the local application of Bioplasmix throat spray. Conclusions. Local probiotic therapy is an important component of the complex therapy of acute pharyngitis, the use of bacteria of the genus Bacillus in the form of Bioplasmix throat spray shows a positive effect on the course of acute viral pharyngitis in children, which manifests by a faster decrease in the severity of subjective symptoms of pharyngitis and inflammatory signs of the oropharynx. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Acute bronchitis: issues and options

Introduction. Acute bronchitis (AB) is a very common disease of viral etiology. In real-life practice, the treatment of AB is associated with widespread irrational antibiotic prescribing, which requires the overall implementation of patient management algorithms comprising the identification of biomarkers of inflammation, including C-reactive protein. Mucoactive therapy remains the mainstay of treatment for patients with AB, however the debate over the most effective treatments continues to this day. The emergence of new original drugs, in particular, Erdosteine, expands efficient therapeutic opportunities for AB.Aim. To analyse the clinical effectiveness of the use of the mucoactive agent Erdostein (Edomari) vs routine use of mucolytics in AB.Materials and methods. We reviewed the management of 60 patients with AB, 30 of which received Erdosteine (Group 1), the remaining 30 patients received standard mucoactive therapy (Acetylcysteine, Ambroxol, etc.). The following variables were assessed: the time required for reversal of all symptoms of the disease expressed as a total BSS scale score (Bronchitis Severity Score), the time required for reversal of productive cough that needs the use of mucolytics, the period of temporary disability, and levels of C-reactive protein.Results and discussion. The average CRP level at disease onset was 18.4 ± 8.2 mg/L. The average WBC count was 7.8 ± 3.5 (×109/l). In AB, the duration of productive cough in the Erdosteine group was 5.7 ± 1.4 days, while in group 2 (real-life practice) the duration of mucolytics therapy was 7.1 ± 1.3 days (p < 0.05). The total BSS scale score in group 1 on day 7 was 3.2 ± 0.9, in group 2 – 3.5 ± 0.9. The reversal of physical signs of AB required 5.3 ± 1.2 days in the Erdosteine group, and 5.7 ± 1.4 days in group 2. The period of temporary disability in group 1 was 8.7 ± 1.2 days, in group 2 – 9.1 ± 1.3 days.Conclusion. Thus, we collected objective data supporting the possibility of using C-reactive protein test in deciding the issue of antimicrobial therapy prescribing. The CRP level observed (18.4 ± 8.2 mg/l) indicated a viral etiology of AB. The use of original Erdosteine (Edomari) in the treatment of acute bronchitis is estimated as highly effective. The average duration of effective mucolytics therapy in AB is 5–7 days.

ASSESSMENT OF ANTIBIOTICS PRESCRIPTION PATTERN BY USING WHO PRESCRIBING INDICATORS IN GENERAL MEDICINE WARD OF A TERTIARY CARE HOSPITAL

Objective: Antibiotics encompass a great extent of the important cornerstone in clinical medicine. Antibiotics are being used more often for treatment, prophylaxis, and diagnosis as the diversity of infectious illnesses grows. Irrational prescribing of antibiotics leads to antibiotic resistance, ineffective treatment, polypharmacy, and an increase in treatment cost. This study is to assess prescribing pattern of antibiotics in the general medicine ward of a tertiary care hospital, Chitradurga.
 Methods: A prospective observational study was carried out for a period of six months. A self-designed data collection form was used to collect the data from the prescriptions. The collected data was entered and analysed using Microsoft Excel.
 Results: In 300 prescriptions, a total of 2,468 drugs were prescribed, with an average of 8.2 drugs per prescription. A total of 719 antibiotics were prescribed, with an average of 2.3 per prescription. Percentage of antibiotics prescribed by generic name was 6% and prescribed according to EDL was 74%. About 96% of prescriptions containing antibiotics are in injection form. Ceftriaxone (30.32%) was the most frequently prescribed antibiotic. Cephalosporins (44.51%) were the most frequently prescribed class of antibiotics.
 Conclusion: This study indicate that prescription pattern was not optimal compared to the recommended values of the WHO core prescribing indicators. The prescribing practices were not appropriate as they consisted of polypharmacy, lesser prescription by generic name, and parenteral route of administration more than the oral route. Hence, there is a need to implement the standards of antibiotic guidelines prescribed rational therapy.

Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications.

Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.

Susceptibility and resistance pattern of bacterial isolates and development of antibiogram in a tertiary care hospital of western India

The main issue in India and at a global level that led to antibiotic resistance is misuse, irrational prescribing of antibiotics, and lack of sufficient data on antibiotic resistance at a local, regional, and national level to develop antibiotic policy that guides all healthcare professional while prescribing antibiotics. The present study was carried out for 12 months in a tertiary care teaching hospital in western India to develop an antibiogram and to check antimicrobial resistance trends in the hospital. Out of 500 patients, 53.6% were male and 46.4% were female patients. A total of 17 bacterial species were identified throughout the study with gram-negative species infections being most common in hospitals. Escherichia coli was the most frequently isolated gram-negative species. Ceftriaxone was most prescribed frequently followed by amoxicillin and azithromycin, respectively. In the gram-positive organism, ceftriaxone and amoxicillin resistance rate was 65.35% and 35% respectively. Overall, in the study Cceftriaxone (58%) and amoxicillin-clavulanic acid (38.9%), Azithromycin (56%), and ciprofloxacin (53%) were found most resistant antibiotics, and Amikacin (72%), Clindamycin (18%) were most sensitive. Gram-negative infections were identified mostly and cephalosporine and fluoroquinolones antibiotics were showing high antibiotic resistance. An institutional hospital antibiogram was developed to check local antimicrobial agents for various bacteria.

Antibiotic Prescription Pattern, Appropriateness, and Associated Factors in Patients Admitted to Pediatric Wards of Tibebe Ghion Specialized Hospital, Bahir Dar, North West Ethiopia

Irrational prescribing of antibiotics leads to the emergence of resistant bacteria. Despite this fact, antimicrobial agents are commonly prescribed in the inpatient setting, especially in infants and children. The aim of this study was to assess the pattern of antibiotic prescription, appropriateness, and associated factors in pediatric wards of Tibebe Ghion Specialized Hospital (TGSH), Bahir Dar, North West Ethiopia, September 11th, 2021 to October 12th, 2021 GC (Gregorian Calendar). An institution-based cross-sectional study was conducted in the pediatric wards of TGSH from September, 2020 to August, 2021 GC. Data were collected using a structured checklist containing each patient's socio-demographic characteristics, clinical information, list of prescribed drugs, and reason for prescription. A systematic random sampling technique was used to select pediatric patients' medical records containing prescribed antibiotics. The collected data were entered and analyzed using SPSS version 25 software. A total of 279 pediatric patients' medical cards including at least one antibiotic were reviewed. The study revealed that antibiotics were prescribed for most of the patients (88.9%) for empiric treatment purposes. The main medical conditions for which antibiotics were prescribed were pneumonia (16.8%) and early-onset neonatal sepsis (14.0%). Ceftriaxone was the most widely used (84.9%) antibiotic among the monotherapeutic antibiotics, while ceftriaxone plus metronidazole (23.5%) was the most frequently used combination of antibiotics. A high proportion (30.8%) of the pediatric patients was exposed to inappropriate treatment. Residence in rural areas (P=0.046) and being 1 year old or younger (P<0.05) were found to be independent determinants of inappropriate drug use. Antibiotics were the most prescribed class of medications for pediatric patients in TGSH. Ceftriaxone and ampicillin were the most frequently prescribed antibiotics in the pediatric wards of TGSH. A high proportion of patients had been exposed to inappropriate antibiotic treatment. Early age and rural residence were found to be the factors that were significantly associated with inappropriate antibiotic utilization.

Negative impact of penicillin allergy labels on antibiotic use in hospitalized patients in Chinese Mainland

BackgroundPenicillin allergy labels have gained increasing global attention. However, to date, there are no data on the influence of penicillin allergy labels on patients in Chinese mainland. MethodsThis retrospective study reviewed the electronic health record (EHR) of hospitalized patients between June 1, 2018 and May 31, 2019. Patients with a penicillin allergy record were included in the allergy group. Every allergy patient was matched with 4 control patients by using propensity score-based matching to make sure the following were balanced: age, sex, date of admission, and the main diagnosis. We estimated the prevalence of penicillin allergy labels and compared the antibiotic prescription patterns and other clinical outcomes between the 2 groups. ResultsA total of 5691 patients and 22 585 patients were included in the allergy group and control group, respectively. The prevalence of penicillin allergy labels among the hospitalized patients in this study was 4.00%. Compared to the control group, significantly fewer patients in the allergy group were prescribed penicillins and most cephalosporins, while a larger proportion of allergy patients received clindamycin (10.02% vs 5.41%, p < 0.001) and some higher-class antibiotics, such as monobactams (1.81% vs 0.54%, p < 0.001), carbapenems (5.80% vs 4.98%, p = 0.014), macrolides (0.60% vs 0.25%, p < 0.001), and quinolones (17.62% vs 12.40%, p < 0.001). Allergy patients also had longer hospital stays and a greater need to consult infection specialists. ConclusionThe prevalence of penicillin allergy labels was 4.00% in Chinese hospitalized patients. Penicillin allergy labels could cause irrational antibiotic prescribing, prolonged hospital stays, and greater consultation needs.

Assessment of antibiotic prescribing patterns at dental and primary health care clinics according to WHO Access, Watch, Reserve (AWaRe) classification

BackgroundThe 2019 WHO Access, Watch, Reserve (AWaRe) antibiotic classification framework aims to prevent irrational prescribing of antibiotics used to treat widespread infections. This study explored antibiotic prescribing pattern for appropriate indications by family physicians and general dentists in primary health care practices. MethodsA retrospective review of patients’ electronic medical records was conducted over 6 months, from May 1, 2020, to November 30, 2020. The data were collected from 24 general family medicine and dental practices within the North West Armed Forces in Tabuk city. Antibiotic prescribing for systemic use (J01) was assessed by the number of prescriptions and the number defined daily doses (DDDs) and then analyzed according to the AWaRe classification. The prescribing of antibiotics for appropriate indications was assessed through comparing the prescription pattern with the recently published and relevant clinical guidelines. Multivariate logistic regression analysis was used to predict the association between the prescribing of AWaRe category and some demographic and disease-related factors. ResultsIn total, 752 prescriptions of antibiotics were collected. Watch-group antibiotics such as second-generation cephalosporin and macrolides were more likely prescribed (51.1%) based on the number of prescriptions and (52.2%) based on DDDs compared with Access-group antibiotics (48.9%) and (47.8%), respectively. The percentages of Watch group antibiotics for children and adults were 66.7% and 42.9%, respectively. Adherence to prescribing guidelines was poor for children (27.2%) and adults (64%). Being a child (adjusted odds ratio [OR]: 2.89; 95% confidence interval [CI] = 1.46-5.78), diagnosis with acute respiratory tract infection (adjusted OR, 2.62; 95% CI = 1.03-6.69), and urinary tract infection (adjusted OR, 4.69; 95% CI = 2.09-10.56) were associated with higher prescriptions of Watch-group antibiotics. Conclusionsa higher prescribing of Watch-group antibiotics and poor adherence to antibiotic guidelines were observed, especially for children. The findings of this study identified targets for further improvement and interventions needed to develop better antibiotic-prescribing practices.

ФАРМАКОЭКОНОМИЧЕСКИЙ АНАЛИЗ АНТИМИКРОБНОЙ ТЕРАПИИ COVID-19 У ГЕРИАТРИЧЕСКИХ БОЛЬНЫХ В УСЛОВИЯХ СТАЦИОНАРА

Abstract. A new coronavirus infection, like other infections of viral etiology, is not an indication for the use of antibiotics. The cause of lung damage in COVID-19 is immune mechanisms, in which macrophages are activated and a "cytokine storm" develops, which is not affected by antibiotics. Antibacterial therapy is prescribed only if there are convincing signs of bacterial infection adherence. Therefore, a competent and reasonable approach to prescribing antibacterial drugs during a pandemic new coronavirus infection is necessary. The aim of the study was to conduct a pharmacoeconomic analysis of COVID-19 antibiotic therapy and to identify cases of irrational prescribing of antibiotics. Case histories of 334 patients treated in a reassigned hospital infectious disease unit in October 2021 with a diagnosis of Covid-19 new coronavirus infection were analyzed. The study found that antibiotic therapy was prescribed in 52.5% of patients aged 60 years or older and 38.5% of those younger than 60 years. A single antibacterial was the most frequently prescribed antibiotic 66.4% in the elderly and 78% in the young. Levofloxacin was most frequently prescribed as a starting antibiotic (32.7% of all AB prescriptions in the elderly and 54% in the young). Ceftriaxone (17.8%), Cefotaxime (15.9%), and Cefotaxime + Sulbactam (13.1%) were also commonly prescribed in those over 60 years of age. The effectiveness of antibacterial agents in the treatment of NKI was calculated using a cost-effectiveness pharmacoeconomic analysis using the criteria of therapy duration, length of hospital stay, and prescription of a second antibiotic. The best cost-effectiveness ratio was observed for prescribing ciprofloxacin (5.5), ceftriaxone (13.2), and cefotaxime (32.1) to the elderly. Irrational prescribing of antibiotics was noted in 10.8% of all antibiotic prescriptions. Of all irrational prescriptions, levofloxacin accounted for the largest number (64.7%).

Prescribing Practices of Antibiotics for Acute Diarrhea in Children Aged Less than Five Years Old in Pakistan

Introduction: Childhood diarrhea accounts for 16% of child deaths in Pakistan. Irrational prescribing of antibiotics, prescribing of antibiotics for viral infections, self-medication using antibiotics, prescription sharing, and refilling are very common practices in Pakistan. The aim of this study was to evaluate the prescribing practices of antibiotics for acute diarrhea in children less than five years of age at a Secondary Healthcare Hospital of Pakistan and to assess the compliance of prescribers with authentic clinical guidelines of treatment for childhood acute diarrhea. Method: A cross-sectional study was conducted for a period of one year, from August 2020 to August 2021, at a Secondary Care Hospital of Karachi, Pakistan. It was based on the collection of outpatient clinic prescriptions of children aged less than five years and suffering from acute diarrhea. The regimens or suggested therapies by prescribers for acute diarrhea were assessed as per The National Institute of Care and Health Excellence and World Health Organization guidelines. A brief questionnaire was also distributed among prescribers, pharmacists, and caretakers of children to extract their opinions regarding antibiotic prescribing in acute diarrhea.Results: Antibiotics were inappropriately prescribed for acute diarrhea among children in Pakistan because p-value was less than 0.05 (p&lt;0.05) as calculated by descriptive statistical tools using Z-test. More than 90% prescriptions of acute diarrhea in children less than five years of age failed to comply with the authentic treatment guidelines.Discussion: Due to the limited knowledge of prescribers regarding treatment guidelines and compliance of parents with antibiotic prescribing for diseases in children, irrational prescribing of antibiotics for acute diarrhea in children less than five years of age is frequent in Pakistan. Healthcare professionals must be adequately trained to ensure the proper management of acute diarrhea by following authentic clinical guidelines. Conclusion: Antibiotics are irrationally prescribed for acute diarrhea in children less than five years of age in Pakistan and prescriptions do not comply with authentic clinical guidelines.

Community pharmacists’ perception and exposure to drug promotion in Pakistan: a cross-sectional study

ObjectiveDrug promotion is a factor that promotes the irrational use of drugs and sometimes negatively influences the prescribing/dispensing pattern. So there was a need to assess the views about accepting...

High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone.

Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone. We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software. Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%). We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis.

Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan.

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

Lung damage caused by COVID-19 and community-acquired pneumonia in children: Сomparative clinical and laboratory analysis

The study is devoted to the challenge of interpreting the lung damage associated with COVID-19 in children and the necessity for antimicrobial therapy in this disease. The aim of the research was a comparative analysis of clinical, radiological and laboratory signs in children with COVID-19 and community-acquired pneumonia (CAP). Methods. The observational comparative study included medical records of 53 children with the lung damage at the age of 1 year 4 months up to 17 years old, hospitalized for the period from June to August 2020. All children were tested for Severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR). 34 patients with SARS-CoV-2+ were diagnosed with COVID-19 and 19 children with SARS-CoV-2– were diagnosed with CAP. The assessment included medical history, clinical, laboratory and radiological changes. Results. Distinctive reliable clinical, laboratory, and X-ray signs of lung damage in COVID-19 compared to CAP were olfactory impairment (26%), bilateral lung damage (23%), erythrocytosis, leukopenia (20.6%), granulocyto- and monocytopenia, lower levels of reactive protein (CRP). Irrational prescribing of antibiotics (94%) was detected in the group of patients with COVID-19. Conclusion. We established the reliable clinical, laboratory and radiological features of COVID-19 in children, which indicate the viral nature of lung damage.

Pattern of antibiotic use for acute respiratory infections among out-patients in South Asian Region: Protocol for a systematic review.

Background:South Asian region has been experiencing the increasing burden of antimicrobial resistance (AMR) primarily due to over and irrational prescribing of antibiotics. Acute respiratory infections (ARIs) are the leading cause of out-patients’ visits in the region. Despite commonly known viral aetiology, ARI is the single largest reason for antibiotic prescriptions contributing the exponential growth of AMR in the region. Collated data on antibiotic consumption for ARI at outpatients and resistance pattern of respiratory pathogen are lacking in the region.Methods:MEDLINE, Cochrane, CINAHL Plus (EBSCO), and Web of Science will be searched for eligible papers. Titles and abstracts, and full texts of the relevant studies will be screened by 2 independent reviewers against the inclusion criteria. Data extraction and quality of the studies will be assessed by 2 reviewers independently using the JBI Critical Appraisal Tools. A third reviewer will resolve any disagreement at any point between 2 reviewers.Results:The review will assess proportions of ARI patients receiving antibiotic therapy and types of antibiotics prescribed among outpatients of all ages in South Asia. This review will also assess the pattern of antimicrobial resistance among respiratory pathogens causing ARI in the region.Conclusions:This systematic review will evaluate published literature, summarize the existing data on the antibiotic prescribing patterns for outpatients with ARI in South Asia. The holistic finding of the proportion of patients receiving antibiotic therapy for ARI, proportion of different types of antibiotic received, and resistance against respiratory pathogen might guide future research. This underscores a need for formulating regional and national policy for AMR mitigation strategy, and revising clinical practice guidelines for the clinician to ensure rational use of antibiotics for ARI.PROSPEROregistration no: CRD42018116658

Evidences on Irrational Anti-Microbial Prescribing and Consumption among COVID-19 Positive Patients and Possible Mitigation Strategies: A Descriptive Cross Sectional Study

Background: Increased antimicrobial consumption has increased the burden on worsening situation of antimicrobial resistance throughout the world. Objective: The purpose of this study was to assess the practice of irrational antibiotic prescribing and consumption among COVID-19 positive patients of Bangladesh and its possible impact on existing AMR. Methodology: This was a cross-sectional study conducted among SARS-CoV-2 positive patients from a tertiary COVID-19 PCR testing center in Dhaka between 10th July 2020 and 20th July 2020. A validated questionnaire was used to gather data. Ethical approval was obtained. A total of 100 participants through random sampling was selected. Results: A total of 100 COVID-19 RT-PCR positive patients were participated in this study: 96% had mild symptoms, fever (81.0%) was the most common presenting symptoms, 45.0% patients did not consult with physicians even after knowing their positive test results and reported self medicating with antibiotics, and 36.0% were treated with multiple antibiotics and antiviral at a time. Azithromycin (46.0%), Ivermectin (22.0%) and doxycycline (21.0%) were the antibiotics most used, which were mainly obtained from local retail pharmacies. Conclusion: Practice of irrational antibiotic prescribing and self medication is relatively high among COVID-19 positive participants. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S3-S7

Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter.

Antibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection. However, infectious diseases remain the leading cause of death in the world. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR.