National Antibiotic Guidelines Research Articles

Pattern of Antimicrobial Resistance Amongst Pathogens Isolated from Children’s Blood at a Private Diagnostic Clinic in Sylhet District of Bangladesh

The incidence of antibiotic-resistant sepsis in children, particularly multidrug-resistant (MDR) sepsis, is increasing day by day. The aim of this study is to describe the pattern of antimicrobial resistance amongst pathogens isolated from blood sepsis of children. This descriptive type of cross-sectional study was carried out in the Microbiology Section of the Popular Diagnostic Centre, Sylhet from April to October 2021. Data were collected from the data record software at centre. All the blood culture positive reports of children of age 0-120 months were collected and antibiotic sensitivity tests were done to identify different organisms. Patients with incomplete data were excluded from this study. A total of 83 patient reports were appraised and data were analyzed by Statistical Package for Social Sciences (SPSS) software version 22. According to the reports majority of the children (59%) were male and male female ratio was 1.4:1. Mean age of the children was 16.54±26.4 months (Mean±SD). About one third (33%) of children were within 1 month, 60 % were between 31 to 60 days, and 7.2% within more than 60 days. Most frequent (72.3%) organisms were gram positive, among them nearly half (49.4%) of the organisms were Staphylococcus aureus. More than one fourth (27.7%) of the organisms were gram negative, among them E. Coli was common organism and found in 15.7% of the cultures specimen of children. Here we found Azithromycin, Ceftazidime, Ceftriaxone and Colistin were resistant in most of the gram-positive cases and in gram-negative cases most of the antibiotic were resistant, where Ceftazidime was resistant in all cases. Nearly two-third (64%) of the organisms were multidrug resistant (MDR), 6% were extensively drug-resistant (XDR) and none were pan-drug resistant. About 61% Staphylococcus spp, 77% of E. coli, 43% of Klebsiella were MDR. The majority of sepsis in children are MDR, with Staphylococcus spp. and E. coli being the most common organism. Anti-microbial resistance surveillance and farther large scale studies are now crucial to revise the National Antibiotic Guideline. Bangladesh Med J. 2022 May; 51(2): 30-36

699 Audit of Post-Splenectomy Patients in Primary Care

Abstract Aim To describe the demographics of a large general practices post-splenectomy patient population (including sex, age, and indication for splenectomy), and audit of cohort's care against national immunisation and antibiotic prophylaxis guidelines. Method All adult patients registered with the practice who had undergone surgical splenectomy were included. Included patients’ medical records were reviewed and data including sex; age; date and indication of splenectomy; immunisation history; and drug history were collected. Results Fifteen of approximately 13,000 registered patients were coded for having previously undergone surgical splenectomy. The main indications included trauma; haematological disease; major intra-abdominal resection. Patient cohort were of an older patient population (mean age 69) having undergone splenectomy several years previously (mean 39 years ago). Three patients had outstanding pneumococcal vaccine in the past five years, however there was 100% compliance with annual influenza vaccine. All patients had received a minimum of two COVID vaccinations. Variation in prescribed phenoxymethylpenicillin dose, with two patients on incorrect antibiotic prophylaxis, and four patients without antibiotic prophylaxis. Conclusions Despite our small patient cohort, this audit highlighted variation and deficiencies in patient care, and has led to a recall of patients with outstanding pneumococcal vaccination and review of antibiotic prophylaxis offered to patients. Additionally, there is no national recommendation that post-splenectomy patients should be offered an annual COVID booster. We recommend that this is reviewed urgently by public health officials due to an increased risk of secondary pneumococcal infection with COVID infection, which may be life-threatening.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Postoperative complications and antibiotic use in dogs with pyometra: a retrospective review of 140 cases (2019)

BackgroundPyometra is commonly seen in intact bitches and is usually treated by ovariohysterectomy. Few studies have reported the frequency of postoperative complications, particularly beyond the immediate postoperative period. Swedish national antibiotic prescription guideline provides suggestions about which antibiotics should be used and when in individuals undergoing surgery. Studies on how well clinicians adhere to these guidelines, and on the outcome for these patients, have not been evaluated for cases of canine pyometra. This retrospective study conducted at a private Swedish companion animal hospital assessed complications that developed within 30 days of pyometra surgery, and whether clinicians followed the current national guidelines in regard to antibiotic use. We also assessed whether antibiotic use affected the rate of postoperative complications seen in this cohort of dogs, where antibiotics were predominantly used in cases presenting with a more severely depressed general demeanour.ResultsThe final analysis included 140 cases, 27 of which developed complications. In total, 50 dogs were treated with antibiotics before or during surgery and in 90 cases, antibiotics were either not given at all or treatment was initiated postoperatively (9/90) due to a perceived risk of infection developing. Superficial surgical site infection was the most common complication, followed by an adverse reaction to the suture material. Three dogs died or were euthanised during the immediate postoperative period. Clinicians adhered to national antibiotic prescription guidelines on when antibiotics should be given in 90% of cases. SSI only developed in dogs that were not given pre- or intra-operative antibiotics, while suture reactions did not appear to be affected by antibiotic use. Ampicillin/ amoxicillin was used in 44/50 cases given antibiotics before or during surgery, including most cases showing signs of concurrent peritonitis.ConclusionSerious complications following the surgical treatment of pyometra were uncommon. Excellent adherence to national prescription guidelines was observed (90% of cases). SSI was relatively common and only seen in dogs that were not given antibiotics before or during surgery (10/90). Ampicillin/ amoxicillin was an effective first choice antimicrobial in cases requiring antibiotic treatment. Further studies are needed to identify cases benefiting from antibiotic treatment, as well as the duration of treatment needed to reduce the infection rate while also avoiding unnecessary preventive treatment.

Evaluation of Antibiotic Prescribing Pattern and Appropriateness among Hospitalized Pediatric Patients: Findings from a Malaysian Teaching Hospital.

Background: Antibiotics are commonly prescribed for hospitalized children. However, only a limited number of studies have evaluated antibiotic use in this population. The current work assessed the indication, prescribing pattern and appropriateness of antibiotics among pediatric inpatients. Methods: A retrospective cross-sectional study was conducted at the pediatric wards of a teaching hospital in Malaysia. Electronic charts of inpatients (≤12 years old) admitted in 2019 were reviewed. Antibiotic indication, selection, dosing regimen, route of administration and duration of treatment were evaluated using the national antibiotic guidelines (NAG). A binomial logistic regression was applied to test potential predictors of inappropriate antibiotic prescribing (IAP) incidence. Results: Out of 702 pediatric inpatients, 292 (41.6%) patients were given antibiotics and met the inclusion criteria. More than half of the patients (57.9%) were males, with a median age of 2.5 years. A total of 385 and 285 antibiotics were prescribed during hospitalization and at discharge, respectively. Azithromycin, co-amoxiclav and cefuroxime were the top three prescribed agents. Out of 670 prescriptions, IAP was identified in 187 (28%) prescriptions that were issued for 169 (57.9%) out of the 292 patients included in the study. Improper antibiotic selection, wrong dose and unnecessary antibiotic prescribing accounted for 41%, 34% and 10% of the identified IAP, respectively. Giving lower-than-recommended doses (28%) was more prevalent than prescribing higher doses (5%). The use of two antibiotics and treating upper respiratory tract infections were independent risk factors for IAP incidence. Conclusions: Prescribers did not adhere to the NAG in more than one quarter of the prescriptions. This may increase the risk of treatment failure, adverse drug reactions and the development of antibiotic resistance.

Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review the situation with respect to AMR in Brazil and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Brazil and to improve patient outcomes.MethodsNational initiatives to address AMR, antibiotic use and prescribing in Brazil, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infections (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, along with local antibiotic availability.ConclusionsIn Brazil there have been some initiatives addressing AMR such as the National Action Plan for AMR, established in 2018. Antibiotic consumption in Brazil is high but a ban on over-the-counter sales of antibiotics has led to a decrease in consumption. Local antibiotic susceptibility testing needs to be increased and the Survey of Antibiotic Resistance (SOAR) study in Brazil will provide useful data for pathogens causing CA-RTIs. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Brazil, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.

Country data on AMR in India in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review the current situation with respect to AMR in India and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize further rises in AMR and to improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing in India, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information.ConclusionsMany initiatives have been launched since AMR was recognized as a national priority and organizations such as the Indian Academy of Paediatrics and the Global Antibiotic Resistance Partnership have worked to build awareness. The Indian Ministry of Health and Family Welfare published a 5 year national action plan on AMR. However, the burden of infectious disease and consumption of antibiotics in India is high. There have been national surveillance studies generating local data along with international studies such as Survey of Antibiotic Resistance (SOAR) and Antimicrobial Testing Leadership and Surveillance (ATLAS). For common RTIs, clinicians use a range of international and national guidelines. However, a more standardized inclusive approach to developing local guidelines, using up-to-date local surveillance data from community-acquired infections, could make guidelines more locally relevant. This would encourage more appropriate antibiotic prescribing and improve adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

Country data on AMR in Pakistan in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review the current situation with respect to AMR in Pakistan and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR and improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing in Pakistan, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information.ConclusionsPakistan is active in developing initiatives to address AMR such as compiling a National Action Plan. However, antibiotic consumption is high and although there is legislation in place prohibiting over-the-counter purchase of antibiotics, this is still possible. Healthcare professionals use local and international antibiotic prescribing guidelines for CA-RTIs when managing patients. As highlighted by the clinical microbiologist’s expert comments, surveillance of AMR in locally prevalent microorganisms is lacking. A more standardized inclusive approach in developing local guidelines, using up-to-date local surveillance data of isolates from community-acquired infections, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.

Country data on AMR in Kuwait in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Kuwait and initiatives underway addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Kuwait and to improve patient outcomes.MethodsNational initiatives to address AMR, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from a clinician in Kuwait were sought to contextualize this information.ConclusionsIn Kuwait there have been some initiatives addressing AMR such as annual campaigns for proper use of antibiotics. Antibiotic use is high but there appears to be a low understanding in the general public about their appropriate use. However, there is legislation in place prohibiting over-the-counter purchase of antibiotics. Only international guidelines for CA-RTIs are used. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Kuwait, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical patient outcomes.

Country data on AMR in Mexico in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Mexico and initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rises in AMR and to improve patient outcomes.MethodsNational AMR initiatives in Mexico, antibiotic use and prescribing, and availability of susceptibility data, particularly the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used in Mexico for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, along with local antibiotic availability. Insights from a local clinician were sought to contextualize this information.ConclusionsThe Mexican national AMR strategy was published in 2018. This comprised similar objectives to the Global Action Plan from the World Health Assembly (2015) and was compulsory, requiring full compliance from members of the National Health System. Historically, antibiotic consumption in Mexico has been high, however, between 2000 and 2015, consumption fell, in sharp contrast to the majority of countries. Mexico lacks a national surveillance network for AMR, however there are several ongoing global surveillance studies providing local antibiotic susceptibility data. International and local antibiotic prescribing guidelines for CA-RTIs are used. A more standardized inclusive approach in developing local guidelines, using up-to-date local surveillance data of isolates from community-acquired infections, could make guideline use more locally relevant. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development in Mexico and improve patient outcomes.

Country data on AMR in Vietnam in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicines and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review the current situation with respect to AMR in Vietnam and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Vietnam and improve patient outcomes.MethodsNational initiatives to address AMR in Vietnam, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from clinicians in Vietnam were sought to contextualize this information.ConclusionsIn Vietnam there have been some initiatives addressing AMR; Vietnam was the first country in the Western Pacific Region to develop a national action plan to combat AMR, which according to the WHO is being implemented. Vietnam also has one of the highest rates of AMR in Asia due, in part, to the overuse of antimicrobial drugs, both in the animal health sector and in humans in both hospitals and the community. In addition, despite a 2005 law requiring antibiotic prescription, there is unrestricted access to over-the-counter antibiotics. Several global surveillance studies provide antibiotic susceptibility data for CA-RTI pathogens in Vietnam including Survey of Antibiotic Resistance (SOAR) and SENTRY (small isolate numbers only). For management of the common CA-RTIs in Vietnam there are several country-specific local antibiotic prescribing guidelines and in addition, there is a range of international guidelines referred to, but these may have been created based on pathogen resistance patterns that might be very different to those in Vietnam. Expert clinician opinion confirms the high resistance rates among common respiratory pathogens. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Vietnam, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.

Country data on AMR in Türkiye in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Türkiye and initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Türkiye and to improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media, acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and local clinical microbiologist were sought to contextualize this information.ConclusionsTürkiye developed an antibiotic stewardship programme, The Rational Drug Use National Action Plan 2014–2017, prioritizing appropriate antibiotic prescription in the community. Public campaigns discouraging inappropriate antibiotic use were also initiated. Türkiye has a high level of antibiotic resistance and a high level of consumption, however, in 2015 over-the-counter antibiotic sales were prohibited, resulting in a declining trend in overall consumption. There is still a need for physician education on current developments in antibiotic use. Several ongoing global surveillance studies provide antibiotic susceptibility data in Türkiye. Clinicians in Türkiye use several country-specific guidelines for common CA-RTIs plus a range of international guidelines. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data on isolates from community-acquired infections in Türkiye, could make guideline use more relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcome.

Country data on AMR in Saudi Arabia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Saudi Arabia and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize a further rise in AMR within Saudi Arabia and improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from a clinician in Saudi Arabia were sought to contextualize this information.ConclusionsVarious initiatives are underway in Saudi Arabia, including a National Action Plan for AMR, which was published in 2017. However, AMR is rising and knowledge about appropriate antibiotic use seems to be lacking among physicians and the general public. Various international guidelines are utilized by clinicians in Saudi Arabia, but a more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Saudi Arabia could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial reistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review AMR in Russia and any initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Russia and to improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and a local clinical microbiologist were sought to contextualize this information.ConclusionsRussia launched a national strategy in 2017 to prevent the spread of AMR and the WHO reports that as of 2020–21, it is being implemented and actively monitored. Reports suggest outpatient antibiotic use of antibiotics is high and that non-prescription access and self-medication are very common. Antibiotic susceptibility studies in Russia include PeHASus, a multicentre epidemiological study focusing on susceptibilities of community-acquired respiratory pathogens and international studies such as Survey of Antibiotic Resistance (SOAR), Antimicrobial Testing Leadership and Surveillance (ATLAS) and SENTRY Antimicrobial Surveillance Program. International guidelines are used to support the development of local guidelines in Russia, and for the common CA-RTIs Russian clinicians use of several country-specific local antibiotic prescribing guidelines. A standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Russia, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

A Prospective Study on Cephalosporin Utilization by Pattern in Pediatric Patients

Pediatric is the medicine specialization concerned with the health of infants, children, and adolescents. Worldwide, many infectious diseases were controlled in the 20th century by improving living standards, public health, and various antimicrobial agents. Antibiotics, in particular, cephalosporin, are amongst the most widely dispensed medications in Pediatric departments worldwide, especially in countries where there are no strict guidelines to regulate their use. A prospective cross-sectional study was conducted at 150 Bedded Pediatric ward of Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Shaheed Benazirabad to assess the utilization pattern of cephalosporin among all admitted in-patients. Patients' demographic details were recorded from the Patient's Bedside File (PBF). Data were analyzed by using Microsoft Excel and Microsoft SPSS 20. Among all admitted patients, 1285 patients met the inclusion criteria, and their PBF were evaluated for cephalosporin. A total of 2863 antibiotics were prescribed among 1932 patients. The most commonly prescribed class of antibiotics among the study population was Cephalosporin 1971 (68.83%), followed by Cefotaxime (20.39%). 76.20% of pediatric patients were prescribed antibiotics through the parenteral route and 23.8% through the oral route. The most common diagnosis was Pneumonia (23.4%), diarrhea (11.6%), and Bronchitis (11.2%), following other indications. Antibiotics were being prescribed without national antibiotic guidelines or institutionally approved protocols, which are currently unavailable. The study findings shall help the hospital administration and government design and implement official policies to promote rational utilization of antibiotics.

Retrospective Audit on Cloxacillin Prescription in Primary Health Care Facilities in Kuala Selangor, Malaysia

Introduction: Cloxacillin is the second most prescribed antibiotic for skin and soft tissue infection in Malaysia. A similar pattern was seen in Kuala Selangor, in which our district demonstrated that the Defined Daily Dose (DDD) of Cloxacillin is high (3.0-8.7) compared to the recommended value from World Health Organization (WHO). However, resistant patterns for Cloxacillin are alarming. This study focuses on appropriate use of Cloxacillin to prevent further antimicrobial resistance. Methodology: This is a retrospective cross-sectional audit, conducted in seven public health clinics in Kuala Selangor district from January 2020 to March 2020. All Cloxacillin prescriptions within this duration were selected. Audit format was adapted from the antimicrobial stewardship protocol (AMS). Appropriate Cloxacillin use is based on accuracy of diagnosis, indication of antibiotic, correct usage (pharmacological name, dose, frequency and duration). Results: A total of 259 prescriptions were collected. Majority were for age 40 years old, 48.6% (n=126) and male, 63.7% (n=165). Cloxacillin was prescribed most for infection of the skin and subcutaneous tissue 64.1% (n=166). Diagnosis was accurate in 63.7% (n=165). Those accurate diagnosis, had correct indication 79.4% (131/165); correct usage 51.5% (85/165); correct name 69.7% (115/165); correct frequency 55.2% (91/165); correct dose 55.8% (92/165), and correct duration 47.3% (78/165). Appropriate Cloxacillin use was 41.8% (69/165). Conclusion: Measures to improve appropriate Cloxacillin use and adherence to the National Antibiotic Guideline (NAG) and Antimicrobial Stewardship (AMS) protocol is crucial.
 Keywords: Cloxacillin, Skin and soft tissue infection, Malaysia, antimicrobial resistance

Antibiotic Prescribing Pattern in Primary Care Practice in Federal Territory Kuala Lumpur and Putrajaya, Malaysia

Introduction: The emerging of antibiotic resistance has become a challenge to global health and there is a strong association between antibiotic consumption and incidence of resistance. One of the tools to monitor and identify antibiotic prescribing pattern is Point Prevalence Survey (PPS). Objectives: To determine the pattern of antibiotic prescribing in Primary Health Clinics (PHC) in Federal Territory Kuala Lumpur and Putrajaya (FTKLP). Methods: A cross-sectional study was conducted at 17 PHCs in FTKLP using universal sampling. Data from prescriptions received were recorded in PPS-PC data collection form. The compliance of the antibiotics prescribed were determined via cross-referencing with the Malaysian National Antibiotic Guideline (NAG) 2014 and/or Clinical Pathway for Antimicrobial Stewardship Program in PHCs (CP) 2019. Results: A total of 338 prescriptions with antibiotics were received and the prescribing rate of antibiotics at the PHCs in FTKLP 2019 was 5.94%.Only 128 (37.9%) prescriptions with antibiotics prescribed were compliant with either the NAG or the CP while 33 (9.8%) prescriptions were found non-compliant with either guideline. Compliance of the remaining 177 prescriptions could not be determined due to non-specific diagnoses. The most commonly prescribed drug class was penicillin (n=198, 58.4%), followed by cephalosporins (n=80, 23.6%) and macrolides (n=41, 12%). Conclusion: This PPS study showed a low compliance of antibiotic prescribing to guidelines compared to recent studies and indicate the need for further action to be taken in order to improve antimicrobial prescribing in PHCs. KEYWORDS: Point prevalence survey, antibiotic, primary care

PRESCRIBING PATTERN OF INTRAVENOUS ANTIBIOTICS FOR HOSPITALIZED PATIENT IN HOSPITAL JERANTUT

Hospitalized patients are often prescribed with antibiotics and it can be a challenge for the prescriber. This study is conducted to review the prescribing pattern of intravenous antibiotics for hospitalized patients in Jerantut Hospital in accordance to the National Antibiotic Guideline and Antimicrobial Stewardship Program.

Studi Rasionalitas Penggunaan Antibiotika di RSUD DR. Murjani Sampit

Background Antibiotics are the most widely used type of drug due to the high incidence of infection in Indonesia. From the results of the preliminary study for 3 days prospectively, as many as 44 patients who received treatment, 37 patients (87%) received antibiotic therapy. There is the use of expensive antibiotics from the 3rd generation cephalosporin group, there are 4 trade names, 2 generation cephalosporins and 1 there are 6 trade names. Expensive sulbenicin and aminoglycoside derivatives are also found, Gentamicin and Kanamycin. The relatively cheap antibiotics are chloramphenicol, tetracycline, cotrimoxazole, but various brands of these products are popular with "me too drug" being used, of course with varying prices. Government Hospital type C should refer to the use of generic drugs and refer to the national antibiotic use guidelines. Therefore, researchers want to investigate further.
 Objective To study the patterns of antibiotic use at the Dr Murjani Sampit Regional Hospital before and after the Educational Information Communication on Guidelines for the Use of National Antibiotics.
 Method This study used a retospective and prospective descriptive observational study with pre-research intervention to medical personnel on the Guidelines for the Use of National Antibiotics and Rational Pharmacotherapy, to paramedics on the stability and method of administering injection dosage antibiotics. This retrospective study used medical documents for patients at 3 months intervals from inpatients for Surgery, Internal Medicine, Children and Gynecology. Prospective study of inpatients at the UPF Surgery, Internal Medicine, Children, and Gynecology for 1 week. Analysis of antibiotic prescribing patterns and the rationality of using antibiotics based on the National Antibiotic Guidelines and Use references. 
 Results The distribution pattern of antibiotic use from a retrospective study of 447 patients, there were 260 (58.1%) patients using antibiotics. Even in obstetrics UPF, 100% of the gynecologists used antibiotics. The results of a retrospective study on the rational category and the cost of using antibiotics found the rationality of the indications and patients only reached <50% of the 4 UPFs studied. The rationality of the dosage regimen was <20% and the dose regimen <10%. Average cost of antibiotics wasted Rp. 80,374 per patient. The highest wastage was at UPF Obstetrics and Gynecology of Rp. 145,223/patient, while the lowest was in UPF Children of Rp. 40,837,-/ patient. From the prospective study, there were 260 patients, 100% used antibiotics with the rationality of the indications and the patients <50%, the rationality of the drug selection was <20%, the rationality of the dosage regimen was <10%. The average wasted cost of antibiotics which became a burden for patients was Rp. 74,793,-/patient with the highest waste at the UPF Gynecology Rp. 119,272,-/patient and the lowest in UPF Children was Rp. 34,697,-/patient.
 Conclusion The pattern of antibiotic use in Dr Murjani Sampit Hospital in the 4 UPFs studied was 49.1 - 100%. There was an irrational use of antibiotics, the right indication was <43%, the right drug selection was <37.7%, the right dose regimen was <20.8%, there was a combination of antibiotic interactions <6.9% and there was a waste from the use of antibiotics Rp. 80,374,-/patient in retrospective and Rp. 74,793,-/patient in the prospective study.
 Keywords Rationality, Antibiotics

Impact of antibiotic consumption post-implementation of antimicrobial stewardship in Orthopaedic and Obstetrics & Gynaecology (O&G) Department

Background: Engagement of the surgical discipline into an active role in antimicrobial stewardship is a challenge. The usage of Ciprofloxacin and Cefoperazone/Sulbactam in the Orthopaedic and O&G, respectively, in Hospital Ampang was recorded to be the highest among Malaysian hospitals in 2017. Methods and materials: An antimicrobial stewardship team was established that consisted of leaders from the respective disciplines ie: Medical, Intensive Care Unit, Orthopaedics, Surgical, O&G. The objective of the team is to have ownership of antimicrobial issues regarding inappropriate usage of antibiotics or increase consumption in their own disciplines. The teams were given regular feedback regarding the antibiotic consumption and suggested personalised intervention for their departments by using the National Antibiotic Guideline 2014 as a guide. A dedicated pharmacist was also assigned to each department to carry out AMS activities. Results: There was a significant reduction in the Defined Daily Dose (DDD) of ciprofloxacin injection from 34.73 in 2017 to 0.92 in 2018 in the Orthopaedic Department (97.35% reduction). Marked decrement in cefoperazone/sulbactam usage in O&G was also seen, with DDD dropped from 6.67 in 2017 to 2.1 in 2018 (68.52% reduction). This achievement was resulted from changing the surgical prophylaxis antibiotic from cefoperazone/sulbactam to cefuroxime according to NAG. Conclusion: Engagement and ownership of AMS issues from the respective disciplines was the key step into making AMS implementation a priority and success in the Orthopaedic and O&G Department. This had led to a significant reduction in the usage of ciprofloxacin and cefoperazone/sulbactam in Hospital Ampang. Continued engagement is important to sustain this success.