Irrational Use Of Antibiotics Research Articles

CATH-2-derived antimicrobial peptide inhibits multidrug-resistant Escherichia coli infection in chickens

Avian colibacillosis (AC), caused by infection with Escherichia coli (E. coli), is a major threat to poultry health, food safety and public health, and results in high mortality and significant economic losses. Currently, new drugs are urgently needed to replace antibiotics due to the continuous emergence and increasing resistance of multidrug-resistant (MDR) strains of E. coli caused by the irrational use of antibiotics in agriculture and animal husbandry. In recent years, antimicrobial peptides (AMPs), which uniquely evolved to protect the host, have emerged as a leading alternative to antibiotics in clinical settings. CATH-2, a member of the antimicrobial cathelicidin peptide family, has been reported to have antibacterial activity. To enhance the antimicrobial potency and reduce the adverse effects on animals, we designed five novel AMPs, named C2-1, C2-2, C2-3, C2-4 and C2-5, based on chicken CATH-2, the secondary structures of these AMPs were consistently α-helical and had an altered net charge and hydrophobicity compared to those of the CATH-2 (1-15) sequences. Subsequently, the antimicrobial activities of CATH-2 (1-15) and five designed peptides against MDR E. coli were evaluated in vitro. Specifically, C2-2 showed excellent antimicrobial activity against either the ATCC standard strain or veterinary clinical isolates of MDR E. coli, with concentrations ranging from 2-8 μg/mL. Furthermore, C2-2 maintained its strong antibacterial efficacy under high temperature and saline conditions, demonstrating significant stability. Similarly, C2-2 retained a high level of safety with no significant hemolytic activity on chicken mature red blood cells or cytotoxicity on chicken kidney cells over the concentration range of 0-64 μg/mL. Moreover, the administration of C2-2 improved the survival rate and reduced the bacterial load in the heart, liver and spleen during MDR E. coli infection in chickens. Additionally, pathological damage to the heart, liver and intestine was prevented when MDR E. coli infected chickens were treated with C2-2. Together, our study showed that C2-2 may be a promising novel therapeutic agent for the treatment of MDR E. coli infections and AC.

Assessment of antibiotic prescribing pattern and cost for hospitalized patients: A study from Palestine.

One of the largest problems facing the world today is the morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing pattern and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals, they were evaluated by some drug use indicators. The cost of antibiotics in these prescriptions was calculated based on the local cost. Descriptive statistics were performed using IBM-SPSS version 21. The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic.

Preparation of Bi4Ti3O12/TiO2 by flame spray pyrolysis for photoelectrocatalytic degradation of tetracycline

The negative effects of the irrational use of antibiotics have been increasing attention from the public, making it urgently needed to develop effective techniques for removing antibiotics from wastewater. Simultaneously, the construction of heterogeneous TiO2 photoanodes can be used to enhance photoelectrocatalytic performance. Herein, we used an advanced method, namely one-step flame spray pyrolysis (FSP) to in-situ prepare Bi4Ti3O12/TiO2 heterostructures. The ultra-high temperature characteristics of this method facilitated the high dispersion of Bi species on TiO2, leading to the formation of the Bi4Ti3O12 phase within milliseconds. Bi4Ti3O12 forms a "Z" type heterojunction with TiO2, improving charge separation and enhancing electron transfer efficiency. The photoeletrocatalytic degradation effect of Bi4Ti3O12/TiO2 on tetracycline is significantly improved. Under simulated sunlight irradiation for 75 min and 1V voltage, the removal of tetracycline can reach 99.7%. The recycling degradation experiments demonstrated the remarkable reusability and stability of Bi4Ti3O12/TiO2, while the evaluation of degradation intermediates and toxicity analysis of tetracycline were also conducted. Furthermore, free radical trapping experiments confirmed that hydroxyl radicals and holes play a significant role in the removal of tetracycline.

Microbiology of Klebsiella with extended-spectrum β-lactamases production

Extended-spectrum β-lactamases (ESBL) producing Klebsiella represents one of the greatest challenges in therapeutic management of the patients. Hence, the objective was to determine ESBL producing Klebsiella species and its molecular characterization in clinical samples of tertiary-care hospital. Klebsiella isolated from various samples were included and by using disc diffusion method ESBL detection amongst the Klebsiella isolates along with molecular detection of blaTEM, blaSHV, blaCTX-M genes which are associated with ESBL production was done. Results revealed that out of 3194 samples, 200 Klebsiella species were isolated. The ratio of Klebsiella species isolated from inpatient and outpatient departments was 75.5% and 24.5% respectively. The maximum isolates were obtained from men consisting of 57.50% and aged between 31-40 years with 26.50%. Majorly Klebsiella species were isolated from sputum including 30.5%, followed by urine consisting of 28% and pus samples with 19.5%. From the 200 isolates, 197 were Klebsiella pneumonia and 32.5% were ESBL producers with majorly having the blaTEM gene incorporated. Being Multidrug and Pan-drug resistant, Klebsiella with ESBL strains are a threat to mankind. This can be overcome by adhering to strict hospital policies to avoid irrational use of antibiotics, strictly following institutional and National antibiotic policies and by prescribing antibiotics according to the culture and sensitivity reports.

A Study of the Synergistic Effects of Essential Oils from Origanum compactum and Origanum elongatum with Commercial Antibiotics against Highly Prioritized Multidrug-Resistant Bacteria for the World Health Organization.

The irrational use of antibiotics has favored the emergence of resistant bacteria, posing a serious threat to global health. To counteract antibiotic resistance, this research seeks to identify novel antimicrobials derived from essential oils that operate through several mechanisms. It aims to evaluate the quality and composition of essential oils from Origanum compactum and Origanum elongatum; test their antimicrobial activity against various strains; explore their synergies with commercial antibiotics; predict the efficacy, toxicity, and stability of compounds; and understand their molecular interactions through docking and dynamic simulations. The essential oils were extracted via hydrodistillation from the flowering tops of oregano in the Middle Atlas Mountains in Morocco. Gas chromatography combined with mass spectrometry (GC-MS) was used to examine their composition. Nine common antibiotics were chosen and tested alone or in combination with essential oils to discover synergistic effects against clinically important and resistant bacterial strains. A comprehensive in silico study was conducted, involving molecular docking and molecular dynamics simulations (MD). O. elongatum oil includes borneol (8.58%), p-cymene (42.56%), thymol (28.43%), and carvacrol (30.89%), whereas O. compactum oil is mostly composed of γ-terpinene (22.89%), p-cymene (15.84%), thymol (10.21%), and (E)-caryophyllene (3.63%). With O. compactum proving to be the most potent, these essential oils showed antibacterial action against both Gram-positive and Gram-negative bacteria. Certain antibiotics, including ciprofloxacin, ceftriaxone, amoxicillin, and ampicillin, have been shown to elicit synergistic effects. To fight resistant bacteria, the essential oils of O. compactum and O. elongatum, particularly those high in thymol and (E)-caryophyllene, seem promising when combined with antibiotics. These synergistic effects could result from their ability to target the same bacterial proteins or facilitate access to target sites, as suggested by molecular docking simulations. Molecular dynamics simulations validated the stability of the examined protein-ligand complexes, emphasizing the propensity of substances like thymol and (E)-caryophyllene for particular target proteins, opening the door to potentially effective new therapeutic approaches against pathogens resistant to multiple drugs.

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.

QUALITATIVE ANALYSIS OF ANTIBIOTIC USE IN POSTOPERATIVE PATIENTS IN THE ICU (INTENSIVE CARE UNIT) ROOM OF HOSPITAL X IN ACEH IN 2022

The irrational use of antibiotics can lead to increased bacterial resistance to antibiotics in hospitals, which can complicate the treatment process. Potential problems with antibiotic use in the ICU arise from inappropriate use. A study mentioned that 30%-60% of antibiotic use in ICU is unnecessary, inappropriate, or suboptimal. Antimicrobial Resistance in Indonesia (AMRIN) research showed that 42% of antibiotic use indicated inappropriate in surgical patients. This study is an analytic descriptive study with a cross-sectional design using retrospective data with a qualitative approach to the Gyssens method. This study used retrospective secondary data in the form of medical records of postoperative patients in the ICU in 2022. 116 patient medical records met the inclusion criteria. The results of the Gyssens analysis showed a category 0 (rational) of 71.58% and an inappropriate category of 28.42% spread in several categories. The results of the chi-square test showed a difference in the quality of antibiotic use with the type of single or combined antibiotic use, and there was a difference in the quality of antibiotic use with the condition of the patient leaving the ICU.

Prevalence and Antibiogram of Methicillin Resistant Staphylococcus aureus Nasal Carriage among Apparently Healthy University Staff and Students in Kaduna, Nigeria

Methicillin Resistant Staphylococcus aureus (MRSA) has been frequently implicated in healthcare-associated infections. Hence, the objective of this paper was to investigate the prevalence and antibiogram of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage among apparently healthy University staff and students in Kaduna, Nigeria. A total of 250 nasal swab samples were collected alongside demographic data. Gram staining and biochemical tests were carried out to identify the Staphylococcus aureus. Methicillin-resistance was determined phenotypically using cefoxitin disc. Antibiotics susceptibility testing of the MRSA isolates was carried out using agar diffusion method and the multidrug resistance determined. Out of the 250 nasal samples collected, 41 (16.4%) were confirmed to be S. aureus, out of which 25(61.0%) were methicillin resistant. Students from Faculties of Science and Medicine harboured higher percentages of MRSA (69.2% and 60.0%, respectively) in their nasal cavity. Gentamicin (84%) and ciprofloxacin (72%) were the most active antibacterial agents against the MRSA isolates. High level of resistance was recorded amongst the MRSA isolates to amoxicillin (80.0%), cotrimoxazole (52.0%), erythromycin (32.0%) and streptomycin (32.0%).Multidrug resistance was recorded in 48% of the MRSA isolates. In conclusion, there was a high prevalence of MRSA (61.0%) among Staff and students of Kaduna State University. Irrational use of antibiotics especially in the community and without prescription might be responsible for this.

WHO AWaRe Method for Analysis of Clinical Practice of Antimicrobial Therapy in Children's Multidisciplinary Hospitals in Russia

The new AWaRe classification proposed by WHO for assessing the clinical practice of using antibiotics in adults in 2017 was adapted for children's hospitals in 2019, due to the update of the categorization of antimicrobials, and showed effec- tiveness for assessing the rationality of antimicrobials use in children's hospitals in WHO-participating countries in the observation protocol GARPEC. In this retrospective pharmacoepidemiological study, we assessed the rationality of antibiotic consumption in multidisciplinary hospitals in the subjects of the Russian Federation with a pediatric profile. An observational multicenter study of antibiotic consumption was carried out in the constituent entities of the Russian Federation (N=9). Consumption assessment was carried out using the AWaRe method, based on DDD analysis and the WHO list of essential antibiotics for children by groups: «Access» (green), «Watch» (yellow) and «Reserve»(red). The quantitative indicator «the number of days of therapy in the ATC group J01 Antibacterial drugs for systemic use» in the established standardized dose per 100 patient days in the pediatric profile in level III hospitals in 9 regions of Russia for 2021 was 214.93. On average, each of the hospitalized pediatric children received at least two antibiotics during the period of hospital treatment in 2021 in Russia. On average, in Russia, based on the results from 9 constituent entities of the Russian Federation, drugs in the «Admission» category were 44.24%, «Control» — 49.23%, «Reserve» — 0.88%. When categorizing according to WHO2019, negative characteristics were identified — either excessive use of cefazolin and amikacin in the «Access» category, or the predominance of drugs with antipseudomonas activity, ceftazidime and cefepime, in the «Watch» groups. A positive and more balanced version of the structure of antibiotic consumption in multidisciplinary children's hospitals was identified in Moscow («Access» — 37.3%, «Watch» — 59.29%, «Reserve» — 3.41%), in the Republic of Mari El («Access» — 30.28%, «Watch» — 69.42%, «Reserve» — 0.30%) and in the Republic of Khakassia («Access» — 30.95%, «Watch» — 67.39%, «Reserve» — 1.66%). Thus, «Access» (green), the main indicator of the assessment category of antibiotic consumption in children, did not reach 60% in 2021 in any of the multidisciplinary children's hospitals in Russia presented in this study, which was proposed as a target indicator for achieving rational consumption according to WHO. The results of this study showed the problems of irrational use of antibiotics: insufficient use of oral dosage forms in children, excessive use of aminoglycosides, unjustified switching to combination antimicrobial therapy with antibiotics of the «Reserve» group in multidisciplinary children's hospitals in Russia.

PATTERN OF PRESCRIPTION OF ANTIBIOTICS AMONG THE DENTAL PRACTITIONERS OF PESHAWAR, PAKISTAN

Objectives: To determine pattern of prescription of antibiotics among the dental practitioners of Peshawar, Pakistan.Materials and Methods: A cross-sectional online study was conducted in Peshawar over a period of 2 months using a convenient sampling technique. A total of 320 dental practitioners were included in the study. Data was collected through a reliable and validated questionnaire. Association between the variables was determined using the Chi-square test.Results: The mean age of study participants was 34.15±11.79years. Of the total 320, 183(57.2%) were female with a mean age of Most dentists prescribe a prophylactic antibiotic for root canal therapy i.e., 64(20.00%), and infi ltration injection with 31(9.68%), whereas for therapeutic purposes, the prescription of antibiotics was high in the case of acute peripheral abscesses with 157(49.06%) and chronic peripheral abscesses with 153(47.81%). Preferred antibiotics for different dental procedures were Metronidazole with 185 (57.8%) and Amoxicillin with 134(42%). A statistically significant association was observed between the use of diff erent antibiotics in anaphylactic and systematic situations with age, gender, and Higher-Qualifi cation (p&lt;0.05).Conclusion: Lack of uniformity is observed in the rational use of antibiotics among study participants. Concrete measures should be undertaken to prevent the irrational use of antibiotics in dental practice and to curb resistance.

Antibiotics Self-Medication Among Students at Faculty of Medical Technology, University of Tripoli

Background and aim. Antibiotics self-medication is a global phenomenon that is prevalent in developing countries due to inadequate monitoring controls. The current study conducted to assess the practice of self-medication among paramedical students at Faculty of Medical Technology. Methods. A pre-validated questionnaire was dispersed through google forms, and students were asked to report antibiotic use with or without prescription in the year 2022. The questions enclosed demographic characteristics, course completion, frequency of antibiotic use, condition for which it was used, and type of antibiotic used were all covered. Results. A total of 168 forms were completed. Prevalence of antibiotic use with and without a prescription was relatively high (42.9%). Among the survey students who utilized an antibiotic without a prescription, 17.4% they stopped the use of antibiotic without finishing the treatment course. The most frequently obtained antibiotic without prescription was Augmentin®. Tonsillitis, flu, upper respiratory tract infection, and urinary tract infection were the conditions for which antibiotics were used. Conclusion. Irrational use of antibiotics is common among university students and need effective interventions directed to increase students understanding of the problems associated with such practice.

Consumption and Informal Trade of Milk in the North of Antioquia (Colombia).

The excessive and irrational use of antibiotics to control bovine mastitis and the informal trade in milk with antibiotic residues are objects of great interest for public health, due to the problems associated with the consumption of milk with antibiotic residues on human, animal, and environmental health, and antibiotic resistance. The objective of this study was to understand the attitudes of dairy farmers towards the self-consumption of milk on the farm, the use of milk with antibiotic residues, and the formal and informal milk trade that generates risks for public health. Mixed methods: cross-sectional and grounded theory. Convergent triangulation design. The study was carried out in 9 dairy municipalities in the North of Antioquia, where 216 dairy farmers participated in the quantitative component; and 17 milk producers and 9 veterinarians took part in the qualitative component. A dairy farmer characterization survey was conducted, as well as a survey on the use and marketing of milk from cows with udder health problems and/or under antibiotic treatment. Semistructured interviews were conducted on the same subject. The variable "Intention to sell milk in the village when the dairy industry does not buy it due to high BTSCC" is associated with the BTSCC variable. The variable "Type of marketing reported" is associated with the CFU variable. 5 categories: self-consumption of milk, use of milk with antibiotics, informal milk trade, control of the dairy industry, and beliefs about the elimination of antibiotics in milk, were constructed to theorize about udder health and public health. Sociocultural, political, and economic factors affect decision making in dairy farmers regarding the use and marketing of milk from cows with mastitis and antibiotic residues. These attitudes and behaviors have public health implications.

Antimicrobial Susceptibility Pattern of Uropathogens Isolated at a Private Hospital in Khulna, Bangladesh

Background &amp; objectives: Urinary tract infection (UTI) is one of the most common infectious diseases affecting all age &amp; sex groups, causing significant morbidity &amp; mortality with a substantial economic burden. Due to the irrational empiric use of antibiotics, resistance is increasing at an alarming rate. Bacteria causing UTIs &amp; their antimicrobial susceptibility pattern varies among different areas &amp; changes frequently over time. This study aimed to identify microorganisms causing UTI at a private hospital in the southern part of Bangladesh &amp; to determine their sensitivity pattern towards commonly used antibiotics. Methods: A cross-sectional study was conducted in the clinical pathology &amp; microbiology laboratory at Islami Bank Hospital (IBH), Khulna during the period of January’2021 to July’2021. Clean catch midstream urine samples (MSU) from 221 clinically suspected UTI cases of all age &amp; sex groups were included in the study. Uropathogens were isolated &amp; identified by standard microbiological techniques &amp; susceptibility was determined by Kirby Kirby-Bauer disc diffusion method. Results: Among 221 suspected UTI cases, 108 (48.8%) were positive for urine culture, of which 103 (95.37%) showed antimicrobial growth. The majority 75 (69.4%) of the culture-positive cases were female. E. coli 50(44.24%) was the most predominant bacterial isolate, followed by Klebsiella 18(15.92%) &amp; Enterococcus 16(14.15%). All Isolated gram-positive cocci (GPC) showed very high sensitivity to Vancomycin (83.3% to 100%), Linezolid (87.5% to 100%) &amp; moderate sensitivity to Meropenem (66.7% to 75%). However, they showed relatively lower sensitivity to Ciprofloxacin, Doxycycline, Gentamicin, and Amoxiclav &amp; very poor sensitivity to Nitrofurantoin (31.3% to 50% only). Levofloxacin had relatively better sensitivity against GPC (S. aureus- 83.3% &amp; CONS- 75%), except Enterococcus. All gram-negative bacilli (GNB) showed a very good sensitivity towards Amikacin &amp; Meropenem, ranging from 77.8% to 100%. E. coli &amp; Pseudomonas were highly sensitive to Piperacillin-Tazobactam (90% &amp; 88.9% respectively). GNB were poorly sensitive to commonly used 3rd generation cephalosporins, Azithromycin, Amoxiclav &amp; Ciprofloxacin. Except for Pseudomonas &amp; Klebsiella, Levofloxacin showed relatively good sensitivity against other GNB. Nitrofurantoin showed lower sensitivity against GNB, except for Pseudomonas (66.7%) &amp; Enterobacter (75%). Conclusion: E. coli remains the most predominant uropathogen. Vancomycin, linezolid, Levofloxacin &amp; Meropenem were very effective against GPC whereas Amikacin, Piperacillin- tazobactam &amp; Meropenem showed good responses against GNB. Empiric antibiotics must be selected based on the current antibiogram of uropathogens in a particular area to prevent the increasing trends of antimicrobial resistance. Mediscope 2024;11(1): 01-12

The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households

BackgroundAntimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households. Study designA cross-sectional study of the Lebanese population was conducted between March and October 2022. MethodsThrough random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables. ResultsAmong selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33–3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14–4.56) had significantly higher odds of having LA. ConclusionLeftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

Pattern of Antibiotic Use Among Children With Acute Respiratory Infections in Saudi Arabia: Clinical Assessment.

This study aimed to evaluate the common clinical diagnoses and treatment management of acute respiratory infections (ARIs) in children and determine when antibiotics are recommended and prescribed. A retrospective review of medical charts was carried out at King Salman Bin Abdulaziz Medical City (KSAMC) Hospital to assess pediatric patients diagnosed with ARIs aged 0-14 years, excluding those requiring antibiotics for conditions other than ARIs. Data, including demographic diagnoses and treatment management, were extracted using consecutive sampling, and statistical analyses were conducted using Jamovi software. A total of 285 pediatric patients were included, with a median age of 3 (IQR = 1-6) years and a male predominance of 59.2%. Bronchopneumonia was the most common respiratory disease, diagnosed in 39.1% of participants. The median durations for illness and hospital admission were four and three days, respectively. Clinical evaluations showed an average respiratory rate of 28±10.5 breaths per minute and a mean oxygen saturation of 96.4±3.46% through pulse oximetry. The use of antibiotics was commonly prescribed in ARI patients only when accompanied by certain bacterial infections (46.32%). ARIs are a common viral health issue among children, emphasizing that not all ARIs in children are caused by bacteria and that antibiotics should only be used when there is a bacterial infection present. Enhanced diagnostic precision, patient awareness, and provider education are the global community's recommendations to prevent the presence of antibiotic resistance and the irrational use of antibiotics.

Characteristics of patients associated with antibiotic use among gastrointestinal surgery at the Academic Hospital, Universitas Gadjah Mada

Digestive surgery is a treatment for diseases of the parts of the body involved in digestion, which has a fairly high risk of infection. The study aimed to obtain a description of the types and specific characteristics of patients and the rationality of antibiotic use among digestive surgery patients. This study was conducted using observational analysis. Data on antibiotic use was collected prospectively from medical records of digestive surgery inpatients at the Academic Hospital Universitas Gadjah Mada (UGM) from January to March 2023. The Gyssens method was used to evaluate qualitatively the use of antibiotics. A total of 76 patients met the inclusion and exclusion criteria. No significant difference between the number of male and female patients was identified. The results showed that 24 (31.58%) acute appendicitis patients are the primary diagnosis most often encountered in patients undergoing digestive surgery. The most frequently used prophylactic antibiotics for digestive surgery patients were ceftriaxone (53.85%) and cefazolin (41.03%). Meanwhile, the most frequently used therapeutic antibiotics were ceftriaxone (41.94%) and levofloxacin (29.03%). The Gyssens analysis shows that large irrational use of antibiotics is still observed.

EVALUASI PENGGUNAAN ANTIBIOTIK PASIEN PNEUMONIA DENGAN METODE GYSSENS

The purpose of this study is to determine the rationality of using antibiotics in pneumonia patients with the gyssens method in the inpatient installation of Nene Mallomo Hospital, Sidrap Regency for the 2021 period. This type of research is descriptive research with a quantitative approach conducted retrospectively. The results of the evaluation of the use of antibiotics based on the gyssens method were obtained the use of appropriate / rational antibiotics (category 0) by 14% and irrational use of antibiotics by 86% which were divided into other antibiotics that were more effective (category IVa) by 67%, the use of antibiotics too long (category IIIa) by 5%, the use of antibiotics too short (category IIIb) by 13% and the use of antibiotics not right dose (category IIa) by 1%. In this study, it can be concluded from the category assessed that the use of antibiotics in pneumonia patients at Nene Mallomo Hospital, Sidrap Regency is irrational.

Assessing the Impact of Antimicrobial Stewardship on Antibiotic Rationality in a Tertiary Hospital Setting

Introduction: Irrational use of antibiotics can lead to antibiotics resistance, necessitating efforts for prevention. The implementation of an Antimicrobial Stewardship Program aims to mitigate inapproriate antimicrobial prescribing. This study aims to compare antibiotic rationality based on quantity, quality, and total cost of antimicrobial utilization following the Antimicrobial Stewardship Program in a tertiary hospital setting.Methods: This was a cross-sectional study. Data were obtained from the medical record of 120 patients hospitalized in the pediatrics ward and classified into two groups: post-program and control. The quantity of antibiotic utilization was measured using Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). Antibiotic rationality was assessed using Gyssens modified category. Normality was evaluated using the Kolmogorov-Smirnov test and analyzed with an independent t-test.Results: There was 10% increase of prudent antibiotic use and a 30.61% reduction in total cost in the post-program study group. However, there was no significant difference in the quantity of antimicrobial utilization in both groups (p=0.06).Conclusion: The program improves the rationality of prudent antibiotic prescription and reduces the total cost of antimicrobial utilization.

Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications

ABSTRACT Introduction Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). Methods Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. Results A total of 284 patients were included, most were male (66.9%), aged 30–50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the ‘Watch’ category (90.8%) followed by the ‘Reserve’ category (4.8%), similar to previous COVID-19 waves. Conclusion There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.

Antibacterial and biofilm disruptive nonribosomal lipopeptides from Streptomyces parvulus against multidrug-resistant bacterial infections

BackgroundIn recent years, new drugs for the treatment of various diseases, thereby the emergence of antimicrobial resistance tremendously increased because of the increased consumption rate of various drugs. However, the irrational use of antibiotics increases the microbial resistance along with that the frequency of mortality associated with infections is higher. Broad-spectrum antibiotics were effectively against various bacteria and the unrestricted application of antibiotics lead to the emergence of drug resistance. The present study was aimed to detect the antibacterial properties of lipopeptide novel drug producing Streptomyces parvulus. MethodsA lipopeptide-producing S. parvulus was isolated from the soil sample. The inhibitory effect of lipopeptide was detected against Gram-positive and Gram-negative bacteria. Bactericidal activity and minimum inhibitory concentration (MIC) were assayed. The IC50 value was analysed against ovarian and human melanoma cell lines. The experimental mouse model was infected withKlebsiella pneumoniae and treated with lipopeptide and bactericidal activity was determined. ResultsThe results indicated that the antibacterial activity of lipopeptide ranges from 13 ± 1 mm to 32 ± 2 mm against Gram-positive and Gram-negative strains. The lowest MIC value was noted as 1.5 ± 0.1 µg/mL against K. pneumoniae and the highest against E. aerogenes (7.5 ± 0.2 µg/mL). The IC50 value was considerably high for the ovarian cell lines and human melanoma cell lines (426 µg/mL and 503 µg/mL). At 25 µg/mL concentration of lipopeptide, only 16.4% inhibition was observed in the ovarian cell line whereas 20.2% inhibition was achieved at this concentration in the human melanoma cell line. Lipopeptide inhibited bacterial growth and was completely inhibited at a concentration of 20 µg/mL. Lipopeptide reduced bacterial load in experimental mice compared to control (p < 0.05). ConclusionLipopeptide activity and its non-toxic nature reveal that it may serve as a lead molecule in the development of a novel drug.