Irrational Use Of Antibiotics Research Articles

Antibiotic Prescribing Practices in a Tertiary Care Teaching Hospital: A Retrospective Cross-Sectional Analysis.

Background Antibiotics are among the most frequently prescribed medications in hospitals, yet a significant portion of their use is inappropriate, contributing to the growing global threat of antimicrobial resistance (AMR). In Pakistan, AMR has reached alarming levels with the rise of multi- and extensively drug-resistant bacteria. This study evaluates antibiotic prescribing practices and the use of culture sensitivity (CS) testing to assess the appropriateness of antibiotic therapy. Methods This cross-sectional retrospective study was conducted in a 500-bed tertiary care teaching hospital in Islamabad, Pakistan, analyzing inpatient records from 2020 to 2022. From over 5000 patient files, 1012 met the inclusion criteria and were reviewed. The study assessed the rationality of antibiotic prescriptions based on the evidence of infection (EoI), clinical parameters, and the presence or absence of CS testing. Statistical analyses, including Chi-square tests, logistic regression, and Cox proportional hazards regression, were applied to determine the association between antibiotic use and patient outcomes. Results Among the 1,012 patients analyzed, 91.8% (n = 929) received one or more antibiotics. However, 30% (n = 274) of these prescriptions were issued without any documented EoI.Only 17.5% of patients underwent CS testing. Patients exposed to five or more antibiotics had a 2.5-fold increased risk of ICU mortality (HR = 2.50, p < 0.001). A positive correlation (r = 0.42, p < 0.001) was found between the number of antibiotics prescribed and the length of hospitalization. Conclusion The findings of this study reveal a high rate of inappropriate antibiotics prescribed without EoI and CS testing. The results emphasize the urgent need for comprehensive Antibiotic Stewardship Programs (ASPs) in hospital settings, particularly focusing on mandatory CStesting protocols. By reducing irrational antibiotic use, these initiatives can significantly mitigate the rise of AMRglobally, especially in resource-limited settings. Implementing ASPs not only optimizes antibiotic use but also aligns with the WHO recommendations, demonstrating the effectiveness of multifaceted interventions in minimizing resistance and improving patient outcomes.

Empowering Thai community pharmacists in combating antimicrobial resistance: Qualitative insight and sentiment analysis

BackgroundAntimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR. ObjectivesThis study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level. MethodsThis study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings. ResultsInterviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies. ConclusionThis study underscores the necessity of public awareness, pharmacist–patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use.

Cross-sectional assessment of perception and attitude of pharmacy students towards pharmaceutical promotion: a study from developing country, Pakistan

BackgroundThe pharmaceutical promotion is “all informational and persuasive activities by manufacturers and distributors, the effect of which is to induce the prescription, supply, purchase and/or use of medicinal drugs. These promotional activities affect the dispensing behavior of physicians and pharmacists and influence begins from educational institutes.ObjectiveOur study’s main aim was to evaluate opinion and attitude of pharmacy students towards pharmaceutical promotion.Materials and methodsA cross-sectional online survey was conducted among 3rd, 4th and final year pharmacy students of 3 public and 3 private sector universities in Punjab Pakistan. A modified version of pre available questionnaire was used to collect data from students between June 2020 and December 2020. The tool was made available through a Google Form, assessable to students via provided link. We utilized the snowball sampling technique. Descriptive statistics were used to evaluate the demographics, while Chi-square and t-test were used to analyze associations between demographics and items. Data were analyzed using SPSS version 21.0.ResultsA total of 1,195 students participated in the survey with an average age of 22.2 ± 1.2 years. Nearly 2/3rd of the students were males (62.2%) and a significant proportion (87.3%) of pharmacy students had never taken part in any training provided by pharmaceutical company. Among all, 51.9% confirmed that pharmacists who frequently interact with medical representatives tend to dispense more antibiotics. Additionally, 42.1% indicated they may dispense antibiotics under the influence of promotion. Pharmacy students in senior college years and those with lower parental exhibited significantly more perception and attitude scores (p &amp;lt; 0.001).ConclusionA significant number of students concurred with the notion that promotional activities could impact dispensing practices and they also believed that such activities contribute to the growing issue of irrational antibiotic use. This study underscores the necessity for a heightened emphasis on the educational needs of pharmacy students.

Antimicrobial Potential of Scorpion-Venom-Derived Peptides.

The frequent and irrational use of antibiotics by humans has led to the escalating rise of antimicrobial resistance (AMR) with a high rate of morbidity-mortality worldwide, which poses a challenge to the development of effective treatments. A large number of host defense peptides from different organisms have gained interest due to their broad antibacterial spectrum, rapid action, and low target resistance, implying that these natural sources might be a new alternative to antimicrobial drugs. As important effectors of prey capture, defense against other animal attacks, and competitor deterrence, scorpion venoms have been developed as important candidate sources for modern drug development. With the rapid progress of bioanalytical and high throughput sequencing techniques, more and more scorpion-venom-derived peptides, including disulfide-bridged peptides (DBPs) and non-disulfide-bridged peptides (NDBPs), have been recently identified as having massive pharmacological activities in channelopathies, pathogen infections, and cancer treatments. In this review, we summarize the molecular diversity and corresponding structural classification of scorpion venom peptides with antibacterial, antifungal, and/or antiparasitic activity. We also aim to improve the understanding of the underlying mechanisms by which scorpion-venom-derived peptides exert these antimicrobial functions, and finally highlight their key aspects and prospects for antimicrobial therapeutic or pharmaceutical application.

Multi-layered factors contribute to irrational use of antibiotics among pediatric patients in Tanzania: ADDO dispensers perspective

BackgroundAntimicrobial resistance (AMR) is a major public health problem affecting both current and future generations. Development of resistance to the commonly available antibiotics has been directly linked to their irrational use. The World Health Organization (WHO) has clearly stated on the Global Strategy on AMR, judicious antibiotic use as well as adequate knowledge and awareness about AMR, as important tools in curbing the existing problem. Therefore, this study aimed to explore the level of knowledge among accredited drug dispensing outlet (ADDO) dispensers on factors contributing to irrational use of antibiotics among Tanzanian pediatric patients.MethodsA qualitative study employing focused group discussions was conducted among 6–10 ADDO dispensers with at least 6 months dispensing experience in 14 regions between July and August 2020. Thematic analysis was used to analyze the data.ResultsFindings from this study indicate that the ADDO dispensers have adequate knowledge on antimicrobial resistance. Participants were aware of the general meaning and the use of antimicrobials. They were aware that antimicrobials are used for treating infections caused by microbes such as bacteria, fungi, and viruses. Participants knew AMR increases health related costs and that the increasing burden of AMR is not an outcome of a specific group of people such as health care providers or patients, rather a contribution of many factors that bring change in microorganism behavior. Despite this knowledge, participants felt that most of the private health care facilities are profit-oriented; they practice polypharmacy to maximize profit rather than focusing on providing quality health services. Participants revealed that dose shortage after symptomatic relief strongly contributes to AMR. Lastly, the ADDO dispensers expressed that continuous medical education and community education to patients is necessary in the efforts to fight against AMR.ConclusionsTo mitigate the increasing AMR burden in our society, integrated interventions must include both communities, ADDOs as first point of contact and other healthcare providers. Periodic refresher training with an emphasis on proper practices is crucial to help the dispensers transform their knowledge into action. Responsible authorities should ensure that ADDOs and other private health care facilities adhere to regulations.

Detection of antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant Eschericia coli isolates in a tertiary care hospital

Background: Clinical significance of Eschericia coli is due to its capacity to develop resistance against many antibiotics specially carbapenem by producing carbapenemase which limits treatment options. blaNDM and blaVIM genes are responsible for this multi-drug-resistance. This is an alarming condition for society as well as clinician because they are very difficult to treat due to limited options of antibiotics and its high virulence. Aims and Objectives: The study was conducted to detect antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant E. coli isolates in a tertiary care hospital. Our study will also help to identify molecular basis of Carbapenem resistance including treatment guideline. Materials and Methods: Cross-sectional study was performed during January’2021 to June’2022 time period. Identification of E. coli was followed by standard protocol and antibiotic sensitivity was done by Kirby-Bauer disk-diffusion method following CLSI guideline, using VITEK-2D-SYSTEM. Detection of genes was done by polymerase chain reaction (PCR). Results: Out of 1867 samples, 161 isolates were identified as E. coli, among which 90 were resistant to carbapenem. Among those, 50 (31%) were resistant to all three carbapenems. Among those, 100% were resistant to ampicillin, amoxycillin-clavulanic acid, cefuroxime, cefuroxime-axetil, cefoperazone-sulbactam, ceftriaxone, cefepime, piperacillin-tazobactam, nalidixic acid, ciprofloxacin; 52% were resistant to amikacin; 54% were resistant to gentamicin; 86% were resistant to cotrimoxazole; 22% were resistant to nitrofurantoin and 96% were sensitive to tigecycline; 100% were intermediate sensitive to colistin. blaNDM gene is detected in 17 (34%) isolates and blaVIM gene is detected in 2 (4%) isolates by PCR. Conclusion: E. coli leads to common clinical presentations such as urinary tract infection, blood stream infection, pneumonia, and wound infection. High burden of carbapenem resistant E. coli was associated with urinary indoor samples. Rising incidence of multi-drug-resistance occurs due to lack of infection control measures, irrational use of antibiotics. Continuous surveillance will prevent development of multi-drug-resistance and help to improve treatment guideline.

Natural History and Microbiological Profiles of Patients With Acute Pancreatitis With Suspected Infected Pancreatic Necrosis.

Acute pancreatitis (AP) is a prevalent emergency. The clinical spectrum of the condition is varied, ranging from a mild to a malignant course with higher mortality rates. Infection of pancreatic/peri necrosis, extrapancreatic infections, and organ failure are significant complications in AP. In the recent era, microbiological composition has shifted more towards multi-drug-resistant organisms due to irrational antibiotic use. This study aims to understand the natural history of patients with suspected infected pancreatic necrosis (IPN), the prevalence of multi-drug-resistant organisms (MDROs), and their antibiotic susceptibility patterns. This prospective, observational study was performed on 130 cases of acute necrotizing pancreatitis (ANP) with suspected IPN that were evaluated during their period of admission in the department of gastroenterology, emergency medicine, or surgery ward of thePostgraduate Institute of Medical Education and Research, Chandigarh, India, a tertiary hospital. The details of outcomes were recorded. The organisms in cases with IPN and antibiotic resistance patterns of various organisms were studied. The most prevalent site of necrosis was combined pancreatic and peripancreatic tissues in 111 (85.4%) patients. The computed tomography severity index (CTSI) had a mean of 8.72±1.43. Of all participants, 36 (27.7%) patients had <30% necrosis, 47 (36.2%) had 30%-50% necrosis, and 47 (36.2%) had >50% necrosis. Overall, 80 (61.5%) patients had organ failure, with acute lung injury (ALI) being the most common. Rates of complications were markedly greater in cases with higher pancreatic necrosis and with infected necrosis (p<0.05). The most common organism isolated from necrotic tissue was Escherichia coli (E. coli) in 17 (32.07%) cases, followed by Acinetobacter baumannii (A. baumannii) in 12 (22.64%) cases. The most common extrapancreatic infection site was respiratory tract infections. Pseudomonas aeruginosa (P. aeruginosa) and A. baumannii revealed maximum resistance to most of the drugs. Conclusion: Infected pancreatic necrosis is linked to high rates of morbidity and mortality. Our study suggests that irrational usage of antibiotics increases the incidence of combined infection, especially with higher rates of multi-drug-resistant infections.

KAJIAN RASIONALITAS PENGGUNAAN ANTIBIOTIK PADA ANAK DENGAN INFEKSI SALURAN KEMIH DI RSUD Dr. MOEWARDI SURAKARTA

Urinary tract infection (UTI) is the second highest infectious disease among children in Indonesia. Management of UTI requires antibiotic therapy, but the irrational use of antibiotics makes this disease one of the contributors to the high rate of antibiotic resistance. Therefore, there is a need for a study to measure the rationality of antibiotic use in children with UTI. This study is a descriptive observational study with a cross sectional design. Data were collected retrospectively using a purposive sampling technique based on medical record data of pediatric patients at Dr. Moewardi Surakarta Hospital in 2021-2023. The results showed that out of 100 medical records of pediatric patients with UTI, 68.00% were women and 32.00% were men. Based on age, the highest incidence of UTI occurred in the age range of 10-18 years as much as 52.00%. The most common antibiotic use was ampicillin 68.00%. The results of the rationality study showed 69.00% in category 0 (rational use of antibiotics). Irrationality occurred in category IIA (antibiotic use is not the right dose) 17.00%, IIIA (antibiotic use with too long duration) 1.00%, IIIB (antibiotic use with too short duration) 4.00%, IIA &amp; IIIB (antibiotic use is not the right dose &amp; duration is too short) 2.00%, IVA (there are other more effective antibiotic options) 4.00%, IIIB &amp; IVA (antibiotic use is too short duration &amp; there are other more effective antibiotic options) 3.00%. It can be concluded that the rational use of antibiotics needs to be improved.

Potential of ZnO nanoparticles for multi-drug resistant Escherichia coli having CRISPR-Cas from poultry market in Lahore

Background and objectivesApart from known factors such as irrational use of antibiotics and horizontal gene transfer, it is now reported that clustered regularly interspaced short palindromic repeats (CRISPR) are also associated with increased antimicrobial resistance. Hence, it is critical to explore alternatives to antibiotics to control economic losses. Therefore, the present study aimed to determine not only the association of CRISPR-Cas system with antibiotic resistance but also the potential of Zinc Oxide nanoparticles (ZnO-NPs) for avian pathogenic Escherichia coli (APEC) isolated from poultry market Lahore. Materials and methodsSamples (n = 100) were collected from live bird markets of Lahore, and isolates were confirmed as Escherichia coli (E. coli) using the Remel One fast kit, and APEC was identified using PCR. The antibiotic resistance pattern in APEC was determined using the minimum inhibitory concentration (MIC), followed by genotypic confirmation of antibiotic-resistant genes using the PCR. The CRISPR-Cas system was also identified in multidrug-resistant (MDR) isolates, and its association with antibiotics was determined using qRT-PCR. The potential of ZnO-NPs was evaluated for multidrug-resistant (MDR) isolates by MIC.ResultsAll isolates of APEC were resistant to nalidixic acid, whereas 95% were resistant to chloramphenicol and 89% were resistant to streptomycin. Nineteen MDR APEC were found in the present study and the CRISPR-Cas system was detected in all of these MDR isolates. In addition, an increased expression of CRISPR-related genes was observed in the standard strain and MDR isolates of APEC. ZnO-NPs inhibited the growth of resistant isolates.ConclusionsThe findings showed the presence of the CRISPR-Cas system in MDR strains of APEC, along with the potential of ZnO-NPs for a possible solution to proceed. This highlights the importance of regulating antimicrobial resistance in poultry to reduce potential health consequences.

Awareness of Antimicrobial Resistance and Antimicrobial Drugs Prescription Pattern in Small Animal Clinical Practice in Ogun State, Nigeria

Antimicrobial resistance (AMR) is a global health challenge in veterinary and human health, leading to monitoring of resistance and promotion of responsible antimicrobial use. This survey assessed the use of antimicrobials among government veterinarians in Ogun state, Nigeria. Clinicians were requested to fill questionnaires designed to extract information on the frequency of antibiotics use, antibiotic prescription patterns and evaluation of perception on AMR and use of antibiotics with compromised efficacy in veterinary practice in the last three years. Fifty-two (52) questionnaires were administered and duly completed upon return. Data analysis showed 100% awareness of AMR with 80.8% (42/52) agreeing to have encountered AMR in the course of managing small animal cases. The tetracycline class of antibiotics 49(94.2%) was the most prescribed, followed by aminoglycosides 40(76.9%) and fluoroquinolones 35(67.3%). Empirical therapy (34/52) 65.4% is the most common treatment option among clinicians while 18 (34.6%) out of 52 clinicians performed antibiotic susceptibility testing along with laboratory diagnosis as treatment guide. Furthermore, 75.0% of the respondents affirmed administering antibiotics formulated for human use in small animal treatment. Thirty-three (63.5%) respondents administered human antimicrobials in animals according to the recommended dosage in humans. This survey identified that AMR was common in small animals in the state studied and this may be due to the irrational use of antibiotics. Promoting antimicrobial stewardship in small animal medicine therefore is paramount to mitigating antimicrobial resistance and data obtained from this study will contribute to developing evidence-based policy on the rational use of antibiotics in small animal practice in Nigeria.

Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

&lt;b&gt;Introduction:&lt;/b&gt; Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium &lt;i&gt;Fusobacterium necrophorum&lt;/i&gt; (&lt;i&gt;F. necrophorum&lt;/i&gt;). In recent years, there has been an increase in the incidence of Lemierre’s syndrome.&lt;b&gt;Case report:&lt;/b&gt; A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy).&lt;b&gt;Discussion:&lt;/b&gt; Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications.&lt;b&gt;Conclusions:&lt;/b&gt; Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.

Antibacterial activity of Cinnamomum cassia against multiple drug resistant Klebsiella pneumoniae

The irrational use of antibiotics in various fields like medicine, animal husbandry and industrial sectors is probably a major cause of the emergence of antibiotic resistance in pathogens and commensal organisms. It is a big challenge to modern clinical practices, as it could lead to therapeutic failures, financial losses, and the creation of a gene pool that could be passed on to humans. The use of medicinal plants can be considered as an alternative, with a consequent impact on microbial resistance. Spices and hearbs have been traditionally used as coloring agents, flavoring agents, preservatives, food additives and medicine in India. The present work aimed to find out the antimicrobial activity of Cinnamomum cassiaon multi-drug resistant Klebsiella pneumoniae isolated from tap water. Natural spices might have anti-bacterial activity against other MDR bacteria and could be used for prevention of diseases.

Knowledge, Attitude and Practices Regarding Antimicrobial Resistance among Undergraduate Students

Background: Antimicrobial resistance (AMR) poses a significant global health threat, driven by factors such as irrational antibiotic use and limited healthcare infrastructure. Addressing knowledge gaps and promoting responsible antibiotic use among medical professionals is crucial to combat this growing problem. Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antibiotics and antimicrobial resistance among medical students at a medical college in North India. Methods: A cross-sectional study was conducted between October to December 2023, involving 201 medical students. Data was collected through a self-administered questionnaire covering demographic details, knowledge about antibiotics and antimicrobial resistance, attitudes toward antimicrobial resistance, and practices related to antibiotic use. Statistical analysis was performed using SPSS 20.0. Results: Participants demonstrated a mean knowledge score of 7.9±1.3, with 131 students exhibiting poor knowledge and 70 showing good knowledge regarding antibiotics and AMR. While positive attitudes towards prudent antibiotic use were prevalent, some risky behaviours such as keeping leftover antibiotics and self-medication were observed. Practices varied, with most participants completing full treatment courses but some discontinuing prematurely. Conclusion: The KAP assessment highlighted mixed findings among medical students regarding antibiotic use and AMR. While positive attitudes and practices were evident, knowledge gaps and risky behaviours persisted.

Evaluation of antibacterial susceptibility profile in pregnant women with asymptomatic bacteriuria in Kadapa

: The bacterial urinary tract infection in pregnancy may be symptomatic (cystitis, pyelonephritis) or asymptomatic (bacteriuria without symptoms). Empirical antimicrobial therapy may be affected by resistance of uropathogens due to the irrational use of antibiotics. This prevalence of resistance is rising and varies across the globe due to different treatment recommendations which may be determined by taking into account frequently occurring infections, susceptibility patterns, evidence, physician acceptance, antimicrobial stewardship norms, availability of formularies, and antimicrobial prices. So the current research was carried out. : A cross-sectional study was conducted among pregnant women with UTI attending antenatal care (ANC) by excluding pregnant women who had taken antibiotics within the two weeks prior to their ANC follow-up and symptomatic UTI pregnant women. The antibiotic sensitivity of the uropathogens and their identification were evaluated by conventional culture, microbiological techniques and sensitivity tests. The results were analysed by SPSS software for descriptive statistics. : 377 pregnant women with UTI participated in the present study. The results demonstrated that most of the participants who lived in urban areas (64%) were affected. The results also suggest that 42% of participants who had secondary education as the highest level of education, 45% of participants belonged to an upper middle-class family and, 40% of working professionals in the study were affected. Out of 103 isolates, 79 isolates were gram negative &amp; 24 were Gram positive. Out of seventy-nine gram negative isolates, the major contribution was by (36), . (26). Among 24 gram positive isolates, the major contribution was by Coagulase Negative Staphylococci (CONS) (12). The uropathogens were shown diverse antibiotic sensitivity for the study test drugs. : This study concludes that the antibacterial susceptibility and resistance of uropathogens may vary in different geographical areas based on antibiotic usage and circumstances. This study also demonstrated the imperative prerequisite of periodic assessments.

Investigation of Knowledge and Attitude Levels Regarding Irrational Antibiotic Use among Students in the Faculty of Health Sciences

Investigation of Knowledge and Attitude Levels Regarding Irrational Antibiotic Use among Students in the Faculty of Health Sciences

Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study

IntroductionAntimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone.MethodsThis was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children’s Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22.ResultsBoth ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% – 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription.ConclusionThe non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

Literature Review: Potential of Chinese Ketepeng Leaves (Cassia alata L.) as an Antibacterial Agent

Infectious diseases are diseases caused by bacteria. Several bacterial infectious diseases include bacteria that cause skin infections such as Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes and Streptococcus pyogene, nosocomial pneumonia infections of the urinary tract by Pseudomonas aeruginosa and Klebsiella pneumoniae that cause Healthcare-Acquired Infections (HAIs). The drugs usually used to treat bacterial infections are antibiotics. Along with the increase in cases of infection, there is also an increase in the use of antibiotics. Widespread or irrational use of antibiotics can cause resistance, so alternatives are needed to overcome them. One plant that has potential as an antibacterial agent is the leaves of Chinese Ketepeng (Cassia alata L.). Chinese ketepeng leaves contain phytochemical compounds, namely flavonoids, saponins, tannins, alkaloids and phenols. Therefore, this literature review aims to determine the potential of Chinese Ketepeng (Cassia alata L.) leaf extract as an antibacterial agent. The method used is the Systematic Literature Review method by collecting data through databases such as Publish or Perish, PubMed, and Google Scholar. The search method uses the keywords "Chinese Ketepeng Plant", "Skin infection", "Antibacterial", "Disc diffusion", "Well diffusion", "Staphylococcus aureus", "Staphylococcus epidermidis", "Klebsiella pneumonia", "Shigella dysentriae", ”Propionibacterium acnes”, “Streptococcus sobrinus”, and “Pseudomonas aerugenosa”. The results of this review article show that ke tepeng china leaf extract is proven to have potential as an antibacterial agent which is characterized by the presence of an inhibition zone formed. The phytochemical content in Chinese ketepeng leaves such as flavonoids, saponins, tannins, alkaloids and phenols are thought to be antimicrobial. The difference in the diameter of the inhibition zone formed is influenced by the concentration of the extract, the type of solvent and the type of test microorganisms used. The types of solvents used are ethanol and methanol which are extracted by sonication and maceration.

A review on the crisis of antibiotic resistance and the strategies to combat resistance

Abstract The discovery of antibiotics has caused a huge impact on the history of the entire health-care system. The irrational and excessive use of antibiotics has become futile and has given rise to another serious issue known as antibiotic resistance, which is now a threat to the health-care sector. Due to this, millions of deaths are occurring worldwide every year as infections are becoming difficult to treat as a result of resistance to the antibiotics that are used to treat them. Thus, the confidence of the global health-care system is ruined. The WHO has recognized antibiotic resistance as a serious issue that needs to be addressed and has declared tackling it a high priority. Even though complete eradication of antibiotic resistance is not possible, the spread and the incidence of resistance can be reduced by taking adequate measures. Combating antimicrobial resistance is, therefore, a prime need of the and various strategies have been adopted globally. This article primarily focuses on the phenomenon of antibiotic resistance, the mechanisms of resistance, various reasons that contribute to it, and the strategies adopted to combat the global crisis. Here, we have reviewed articles on antibiotic resistance from scientific websites such as PubMed Central, NCBI, Science Direct, and Google Scholar, and the strategies have been taken from the official website of the WHO, Indian Council of Medical Research, and the guidelines issued on this by the Ministry of Health and Family Welfare Government of India and Government of Kerala.

A Systematic Review of Antibiotic Use in Humans in Nigeria and Its Potential Contribution to Rising Antimicrobial Resistance

INTRODUCTION: The value of medicines is lost when these resources are not used rationally. Out of 12 developing countries, Nigeria has the third highest percentage of antibiotic prescriptions, at 48%. Antibiotic misuse results in limited efficacy, which can lead to the emergence of antimicrobial resistance. We conducted a systematic review to synthesise the evidence on antibiotic use in humans in Nigeria. METHODS: We conducted a systematic review of medicine use behaviour by patients and prescription behaviour by health workers, which were searched for in articles published in English from 2000 to 2017. Data was entered into purpose-built templates. Key quantitative indicators were extracted and summarised as frequencies and proportions, while free-text responses were synthesised. RESULTS: The systematic review determined that the median prevalence of persons using antibiotics without prescription is 46.7%. The drivers of irrational antibiotic use included poor regulation of medicines and premises, a chaotic medicine distribution system, limited licensed medicine prescribers, over-the-counter (OTC) sales of antibiotics, patients’ demand for antibiotics, and access to health insurance. DISCUSSION: Irrational antibiotic use is widespread in humans and animals. We recommend that the government enforce regulations on antibiotic sales to humans and animals and increase awareness of irrational antibiotic use and AMR in Nigerian communities through a whole-of-society approach. The collated information was used to develop a National Action Plan on AMR in 2017.

Multifunctional MXene Nanosheets and Their Applications in Antibacterial Therapy

Bacterial infections are a great threat to human health, and the irrational use of antibiotics has largely compromised the efficacy of antibiotic therapy due to the emergence of drug‐resistant pathogens. It is known that synthesizing new antibiotics is difficult and time‐consuming. In this case, developing antibiotics‐independent antibacterial approaches is of great importance and significance. In the past decade, various functional nanomaterials have shown great potentials in the treatment of bacterial infections. Among these nanomaterials, transition metal carbides or nitrides, namely MXene, have attracted much attention. As the novel 2D nanosheets, MXene can serve either as a direct antibacterial agent due to its intrinsic antibacterial activity and photothermal effect, or as an efficient carrier to load photosensitizers and photocatalysts for photodynamic and photocatalytic therapy. In recent few years, the number of literatures regarding MXene‐based antibacterial therapy has increased rapidly. Thus, it is the time to systematically summarize the applications of MXene in the treatment of bacteria, especially those with drug resistance. Herein, it is aimed to summarize the preparation methods for MXene and provide a comprehensive understanding of its properties and applications in antibacterial therapy. Also, its use for bacterial detection and the challenges for practical use are discussed.