Number Of Antibiotic Prescriptions Research Articles

Effects of a prophylactic treatment with horseradish root and nasturtium herb on urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction - a retrospective cohort study.

Recurrent urinary tract infections (UTIs) are common in individuals with neurogenic lower urinary tract dysfunction (NLUTD) and greatly affect their quality of life. There is currently no established prophylactic measure based on evidence. We have therefore evaluated the effects of a horseradish root and nasturtium herb product on the frequency of UTIs in a retrospective cohort. Clinical data of patients with chronic NLUTD who were receiving the phytotherapeuticum for at least 12 months were analyzed. The number of UTIs was categorized as no UTIs, sporadic UTIs (1-2/year) and recurrent UTIs (≥3/year). The change in the annual number of patient-reported symptomatic UTIs and antibiotic prescriptions was investigated. Data of 43 individuals (mean age 49±13 years, median NLUTD duration 17.9 years) were analyzed. The proportion of individuals with recurrent UTIs decreased significantly (p<0.0001) from 58.1% (42.1-73.0%) to 23.3% (11.8-38.6%) during phytotherapy, whereas the proportion of individuals without UTIs increased significantly (p=0.001) from 14.0% (5.3-27.9%) to 39.5% (25.0-55.6%). In addition, there was a significant (p=0.008) decrease in the number of antibiotic prescriptions. Prophylactic treatment with horseradish root and nasturtium herb seems to be a promising option for the prevention of UTIs.

Outpatient antibiotic prescribing during the first two years of the COVID-19 pandemic: A nationwide register-based time series analysis.

The COVID-19 pandemic has imposed an enormous burden on health care systems around the world. Simultaneously, many countries have reported a decrease in the incidence of other infectious diseases, such as acute respiratory infections, leading to a decline in outpatient antibiotic use. The aim of this study is to assess the impact of the COVID-19 pandemic on outpatient antibiotic prescribing in Finland during the first 2 years of the pandemic. We used nationwide register data, applied descriptive methods, and conducted an interrupted time series analysis (ITSA) using ARIMA modelling. Results from the ARIMA modelling showed that at the baseline, before the pandemic, the level of monthly number of antibiotic prescriptions was 248,560 (95% CI: 224,261 to 272,856; p<0.001) and there was a decreasing trend of 1,202 in monthly number of prescriptions (95% CI: -2,107 to -262; p<0.01). After the COVID-19 pandemic began, there was a statistically significant decline of 48,470 (95% CI: -76,404 to -20,535, p<0.001) prescriptions (-19.5% from the baseline level). The greatest decrease in antibiotic prescribing was observed among children aged 0-17 years. While antibiotic prescribing declined in all antibiotic groups associated with respiratory tract infections, the decrease from 2019 to 2020 was the largest with azithromycin (52.6%), amoxicillin (44.8%), and doxycycline (43.8%). Future studies should continue exploring antibiotic prescribing trends during the COVID-19 pandemic and beyond.

1369. Effect of COVID-19 on Antibiotic Consumption: An Analysis of the COVID-19 Community Research Partnership

Abstract Background The COVID-19 Community Research Partnership (CCRP) is a multisite healthcare system-based study of the COVID pandemic. Community residents in this study provided consent for electronic health record (EHR) access allowing for analysis of antibiotic prescribing. Methods We conducted a retrospective, self-controlled cohort study to determine antibiotic consumption in the CCRP pre-COVID (Jan 2018 - Dec 2019) and post-COVID (Jan 2020 - Jan 2022). Participants were ≥18 years with an EHR record in the pre-COVID period. The primary outcome was the number of antibiotic prescriptions (AP) per 1000 patient care encounters in each time period. Secondary outcomes included the AP location of care, analysis of antibiotic classes, and COVID attributable antibiotic consumption, defined as an AP written ≤14 days before or after an EHR documented or self-reported positive SARS-CoV-2 test or COVID diagnosis. Results 34,234 participants were included representing 2,775,711 encounters. Median age was 53 years with 70% female and 88% white. 41% lived in a rural or suburban area. There were 26,121 APs among 25,433 participants. Mean rate of AP per 1000 encounters was 12.1 and 7.6 pre vs post-COVID (p&amp;lt; 0.001). A decline in AP occurred at onset of the pandemic persisting through the post-COVID period (Fig 1). The prescribing rate for all antibiotics, except linezolid, decreased during the pandemic (p&amp;lt; 0.001, Fig 2). The largest declines were seen with antibiotics typically prescribed for respiratory illnesses. The decline in antibiotic consumption was driven by outpatient encounters (Fig 3). 6,341 participants were diagnosed with COVID and 333 APs were COVID attributable. These participants were more likely to receive a macrolide (45% vs. 22%, p&amp;lt; 0.001), live in a rural area (31% vs. 20%, p&amp;lt; 0.001), and receive care in an emergency department (12% vs. 6.1%, p&amp;lt; 0.001). Figure 1. Antibiotic Prescriptions During The Study Time Period Figure 2. Analysis Of Antibiotic Classes Figure 3. Location of Antibiotic Prescribing Conclusion The COVID pandemic was associated with a broad decline in antibiotic consumption. These results may be due to declines in other respiratory viruses, anchoring bias for COVID during the pandemic, improved antibiotic stewardship practices, or social isolation. Antibiotics for respiratory illnesses declined the most, suggesting this may be a target for outpatient stewardship efforts. Disclosures All Authors: No reported disclosures

Association between influenza vaccination and antibiotic prescription in pediatric population

Abstract Introduction A major cause of antimicrobial resistance (AMR) is inappropriate antibiotic consumption in humans. The scientific literature is discordant on the impact of the indirect effect that influenza vaccination in the pediatric population in counteracting AMR. This study aims to evaluate the impact of influenza vaccination on antibiotic prescriptions in the pediatric population in Tuscany (Italy) for the 2019-20 influenza season. Methods A retrospective cohort study was performed from current data obtained from the Tuscany Regional Health Authority. We recruited all the children between 6 months-6 years old who underwent influenza vaccination between September 2019 and April 2020. Each vaccinated child was matched with an unvaccinated by Propensity Score Matching for sex, age, area of residence, exemptions, previous hospitalization, and deprivation index. The consumption of beta-lactam antibiotics and macrolides (main drugs used for pediatric respiratory infections) between 15 days after vaccination and the end of the study period was measured for each child. The outcome is the number of antibiotic prescriptions per 100 weeks at risk. The association between influenza vaccination and antibiotic consumption was measured by estimating relative risk from a Poisson regression model. Results The study population consisted of 23,034 vaccinated children. Antibiotic prescriptions were 2.27 per 100 weeks at risk in the unvaccinated and 3.01 per 100 weeks in the vaccinated. Antibiotic prescribing in vaccinated children was higher than in the unvaccinated, with a relative risk of 1.33 [CI 95% 1.29-1.35; p &amp;lt; 0.00001]. Conclusions The results show a higher prescription of beta-lactams and macrolides in children vaccinated with influenza vaccine than in unvaccinated children during the study period. This result may depend on factors that cannot be measured with the available data, such as the number of visits to the pediatrician and the medical's propensity to prescribe antibiotics. Key messages • The results of this study showed that vaccinated children had a higher rate of antibiotic prescriptions than unvaccinated children. • Factors not measured, such as the frequency of pediatrician visits and medical prescribing habits, may have influenced the higher rate of antibiotic prescriptions in vaccinated children.

Prescribing Patterns of Oral Antibiotics and Isotretinoin for Acne in a Colorado Hospital System: Retrospective Cohort Study.

Guidelines established by the American Academy of Dermatology recommend oral antibiotics as first-line therapy for mild, moderate, and severe acne. However, it is recommended to minimize the duration of oral antibiotic use, and there is increasing support for other systemic agents for acne. We sought to characterize the use of oral antibiotics and isotretinoin for the treatment of acne in the pediatric and young adult population aged 10 through 20 years and the adult population aged 21 to 45 years from 2011 to 2019. We conducted a retrospective, observational cohort study using electronic data from the enterprise data warehouse of the University of Colorado Anschutz Medical Campus and its affiliates, with data in the format of the Observational Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership (OMOP) common data model. Categorical values (sex, race, and ethnicity) were compared using chi-square tests, and continuous variables (age) were compared using 2-tailed t tests. Our cohort of 15,704 patients was composed of mostly White (12,776/15,704, 81.4%), non-Hispanic or Latino (13,307/15,704, 84.7%), and female (11,093/15,704, 70.6%) patients. Among the 4605 male patients in the eligible cohort, 1810 (39%) received an oral antibiotic treatment, in comparison to 3109 (28%) of the 11,093 eligible women (P<.001). Among the 4605 men who were eligible for treatment with isotretinoin in this population, 988 (21.5%) received a course of isotretinoin, compared to only 10.4% (1159/11,093) eligible women (P<.001). Male patients were 1.67 times more likely to have received an antibiotic prescription(odds ratio [OR] 1.67, 95% CI 1.55-1.79) and over twice as likely to have received an isotretinoin prescription (OR 2.34, 95% CI 2.13-2.57) than female patients. Minocycline was the most frequently prescribed antibiotic for the treatment of acne in this study cohort. From 2015 to 2019, there was no significant change in the number of antibiotic prescriptions over time. Men were significantly more likely to receive both oral antibiotics and isotretinoin than female patients. Multiple factors could be contributing to this discrepancy, including the burden of iPLEDGE, additional systemic treatment options for female patients, and the difference in acne severity across sexes. We could not determine the difference in severity of acne between male and female patients in our cohort, and further research is needed to ascertain the variation across sexes.

Variability in changes in physician outpatient antibiotic prescribing from 2019 to 2021 during the COVID-19 pandemic in Ontario, Canada.

To evaluate inter-physician variability and predictors of changes in antibiotic prescribing before (2019) and during (2020/2021) the coronavirus disease 2019 (COVID-19) pandemic. We conducted a retrospective cohort analysis of physicians in Ontario, Canada prescribing oral antibiotics in the outpatient setting between January 1, 2019 and December 31, 2021 using the IQVIA Xponent data set. The primary outcome was the change in the number of antibiotic prescriptions between the prepandemic and pandemic period. Secondary outcomes were changes in the selection of broad-spectrum agents and long-duration (>7 d) antibiotic use. We used multivariable linear regression models to evaluate predictors of change. There were 17,288 physicians included in the study with substantial inter-physician variability in changes in antibiotic prescribing (median change of -43.5 antibiotics per physician, interquartile range -136.5 to -5.0). In the multivariable model, later career stage (adjusted mean difference [aMD] -45.3, 95% confidence interval [CI] -52.9 to -37.8, p < .001), family medicine (aMD -46.0, 95% CI -62.5 to -29.4, p < .001), male patient sex (aMD -52.4, 95% CI -71.1 to -33.7, p < .001), low patient comorbidity (aMD -42.5, 95% CI -50.3 to -34.8, p < .001), and high prescribing to new patients (aMD -216.5, 95% CI -223.5 to -209.5, p < .001) were associated with decreases in antibiotic initiation. Family medicine and high prescribing to new patients were associated with a decrease in selection of broad-spectrum agents and prolonged antibiotic use. Antibiotic prescribing changed throughout the COVID-19 pandemic with overall decreases in antibiotic initiation, broad-spectrum agents, and prolonged antibiotic courses with inter-physician variability. These findings present opportunities for community antibiotic stewardship interventions.

Impact of COVID-19 on antibiotic prescriptions for Brazilian children

The COVID-19 brought a new model of sanitary behavior (social distancing, etc.) that may have reduced the transmissibility of respiratory diseases, reflecting in the number of antibiotic prescriptions. This study evaluated antibiotic prescriptions for children throughout Brazil, between 2014 and 2021. An interrupted time series was conducted to assess variations in antibiotic consumption by the 1–12-year-old children. Joinpoint regression was used to assess the monthly variations. 86 million prescriptions were evaluated. On average, there was a 54% reduction in prescriptions during the pandemic. Amoxicillin showed a reduction of 65%. Joinpoint regression showed that the pandemic altered the prescription growth curve, changing the trend to a 22% drop per month. The new sanitary behavior showed us that it is possible, decreasing the use of antibiotics, to control the children’s respiratory health.

Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.

The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based metrics and days-supplied-based metrics. Outpatient antibiotic consumption metrics should incorporate the duration of therapy.

Private Practice Dentists Improve Antibiotic Use After Dental Antibiotic Stewardship Education From Infectious Diseases Experts.

BackgroundPrivate practice dentists represent 72% of United States dentists. We conducted a prospective cohort study of private practice dentists comparing antibiotic use before and after dental antibiotic stewardship education by infectious diseases (ID) antibiotic stewardship experts.MethodsStudy phases were as follows: phase 1 (preeducation), 3 months of retrospective antibiotic data and a presurvey assessed baseline antibiotic knowledge; phase 2 (education), dentists attended 3 evening Zoom sessions; phase 3, (posteducation/interventions), 3 months of prospective audits with weekly feedback; phase 4, postsurvey and recommendations to reach more dentists.ResultsFifteen dentists participated. Ten had practiced >20 years. Presurvey, 14 were unfamiliar with dental stewardship. The number of antibiotic prescriptions pre/post decreased from 2124 to 1816 (P < .00001), whereas procedures increased from 8526 to 9063. Overall, appropriate use (prophylaxis and treatment) increased from 19% pre to 87.9% post (P < .0001). Appropriate prophylaxis was 46.6% pre and 76.7% post (P < .0001). Joint implant prophylaxis decreased from 164 pre to 78 post (P < .0001). Appropriate treatment antibiotics pre/post improved 5-fold from 15% to 90.2% (P = .0001). Antibiotic duration pre/post decreased from 7.7 days (standard deviation [SD], 2.2 days) to 5.1 days (SD, 1.6 days) (P < .0001). Clindamycin use decreased 90% from 183 pre to 18 post (P < .0001). Postsurvey responses recommended making antibiotic stewardship a required annual continuing education. Study participants invited ID antibiotic stewardship experts to teach an additional 2125 dentists via dental study clubs.ConclusionsAfter learning dental antibiotic stewardship from ID antibiotic stewardship experts, dentists rapidly optimized antibiotic prescribing. Private practice dental study clubs are expanding dental antibiotic stewardship training to additional dentists, hygienists, and patients across the United States.

POLA PERESEPAN ANTIBIOTIK PADA MANAJEMEN FARINGITIS AKUT DEWASA DI PUSKEMAS

&#x0D; Acute pharyngitis is one of the most common diseases in primary health care, Bali. However, the best management to control the number of antibiotics prescribing in acute pharyngitis is not known. This study aims to determine the best management to control antibiotics prescribing in adult who has acute pharyngitis. This prospective cohort study involved 93 patients aged 12-45 years who had been diagnosed with acute pharyngitis by a physician. Measurements were made on the number of drugs per prescription, frequency antibiotic, quantity antibiotic and DDD antibiotics. Centor Criteria and RADT can reduce the number of antibiotic prescriptions than empirical management in primary health care district X, Bali. Decrease occurred on the the number of drugs per prescription, frequency antibiotic, quantity antibiotic and DDD antibiotics. Management centor criteria and RADT are the best strategies to reduce antibiotic prescription in primary health care distict X, Bali. &#x0D;

An Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes: A Cluster Randomized Controlled Trial.

To investigate whether an electronic health record (EHR)-integrated decision tool, combined with supportive interventions, results in more appropriate antibiotic prescribing in nursing home (NH) residents with suspected urinary tract infection (UTI), without negative consequences for residents. Cluster randomized controlled trial with NHs as the randomization unit; intervention group NHs received the EHR-integrated decision tool and supportive interventions, and control group NHs provided care as usual. 212 residents with suspected UTI, from 16 NHs in the Netherlands. Physicians collected data at index consultation (ie, UTI suspicion) and during a 21-day follow-up period (March 2019-March 2020). Overall antibiotic prescribing data at NH level, 12months prior to and during the study, was derived from the electronic prescribing system. The primary study outcome was the percentage of antibiotic prescriptions for suspected UTI that was appropriate, at index consultation. Secondary study outcomes included changes in treatment decision, complications, UTI-related hospitalization, and mortality during follow-up; and pre-post study changes in antibiotic prescribing at the NH level. 295 suspected UTIs were included (intervention group: 189; control group: 106). The between-group difference in appropriate antibiotic prescribing was 13% [intervention group: 62%, control group: 49%; adjusted odds ratio (OR) 1.43, 95% CI 0.57-3.62]. In both groups, complications (2% vs 3%), UTI-related hospitalization (2% vs 1%), and possible UTI-related mortality (2% vs 2%) were rare. The pre-post study difference in antibiotic prescriptions per 1000 resident-care days was-0.95 in the intervention group NHs and-0.05 in the control group NHs (P= .02). Although appropriate antibiotic prescribing improved in the intervention group, this does not provide sufficient evidence for our multidisciplinary intervention. Despite this inconclusive result, our intervention could potentially still be effective, because we established a large reduction in the number of antibiotic prescriptions in the intervention group.

Abstract P3-12-34: Antibiotic use and mortality from triple-negative breast cancer

Abstract Background: Gut-associated lymphoid tissue is the largest component of the body's immune system, as it influences both local and systemic immune responses. Gut microbiome dysbiosis related to antimicrobial exposure may be associated with decreased circulating and tumor-infiltrating lymphocytes and decreased immune repertoire, which may adversely impact survival in patients with triple-negative breast cancer (TNBC). We hypothesized that increasing antimicrobial exposure may lead to higher overall mortality (OM) and BC-specific mortality (BCM) in the presence of time-varying absolute lymphocyte count (ALC). Methods: Women with TNBC were identified in the Oncoshare database, a breast cancer registry that integrates data from the population-based SEER Registry and electronic medical records from two California healthcare systems (Stanford University and Sutter Health). We defined antibiotic use in three ways at each time point: (1) current use (“Antibiotic Use”), (2) total number of prescriptions (“Total Antibiotics”), and (3) total number of unique antibiotics prescribed (“Unique Antibiotics”) to study overall OM and BCM. We used marginal structural Cox proportional hazards multivariate models, with time-varying covariates (antibiotic use and ALC) to avoid immortal time bias. Results: 772 women were diagnosed with TNBC and treated from 2000-2014. The median overall follow-up time (including time to death) was 104 (IQR [61.66, 147.03]) months; the median follow-up time among those who were alive through the observation period was 121 (IQR [86.89, 160.93]) months. There were 654 (85%) patients who ever used antibiotics after TNBC diagnosis. There were 24/118 (20%) deaths among patients who never took antibiotics and 153/654 (23%) deaths in patients who ever took antibiotics during the study period. We previously showed that higher minimum ALC was associated with lower OM (HR 0.23, 95%CI (0.16, 0.35)) and BCM (HR 0.19, 95%CI (0.11, 0.34)) in TNBC patients from this cohort, with a significant association between higher peripheral lymphocyte count and tumor-infiltrating lymphocytes. Here, we found antibiotic use was associated with higher OM and BCM using definitions (2) and (3), but not definition (1). Model results are shown in the table and individual covariates are included for all definitions of antibiotic use. Conclusion: Higher number of antibiotic prescriptions and of unique antibiotics prescribed was associated with overall and breast cancer-specific mortality among women with TNBC. Future research on the role of the microbiome in mediating ALC and immune response may inform interventions to reduce TNBC mortality. Table. Overall and breast cancer-specific mortality among women with TNBC, Cox proportional hazards modelsOverall MortalityAntibiotic UseTotal AntibioticsUnique AntibioticsAntibiotic use1.54 (0.99, 2.39)Total number of antibiotics1.07* (1.04, 1.09)Number of unique antibiotics1.17* (1.12, 1.23)Age at diagnosis1.01* (1.00, 1.03)†1.01 (1.00, 1.02)1.01 (1.00, 1.03)Race/ethnicity (reference=White)Hispanic1.25 (0.70, 2.24)1.26 (0.70, 2.26)1.23 (0.69, 2.22)Non-Hispanic Asian Pacific Islander1.01 (0.64, 1.61)1.16 (0.74, 1.80)1.10 (0.69, 1.73)Non-Hispanic Black2.07* (1.12, 3.82)2.01* (1.10, 3.68)1.87* (1.03, 3.38)Neighborhood socioeconomic status quintile (reference=lowest)Second-lowest1.15 (0.49, 2.73)1.08 (0.47, 2.51)1.10 (0.49, 2.47)Middle1.22 (0.53, 2.81)1.05 (0.46, 2.40)1.06 (0.48, 2.35)Second-highest0.78 (0.34, 1.83)0.69 (0.30, 1.59)0.70 (0.31, 1.56)Highest0.96 (0.44, 2.11)0.82 (0.37, 1.78)0.80 (0.38, 1.70)Stage (reference=I)II1.72* (1.14, 2.59)1.61* (1.05, 2.45)1.71* (1.13, 2.57)III4.93* (3.08, 7.89)4.99* (3.10, 8.04)5.15* (3.20, 8.29)Grade (reference= 1)21.84 (0.66, 5.12)1.70 (0.61, 4.73)1.61 (0.57, 4.59)32.56 (0.95, 6.89)2.37 (0.88, 6.38)2.24 (0.82, 6.13)Received chemotherapy0.72 (0.45, 1.17)0.61 (0.37, 0.99)0.66 (0.41, 1.08)Received radiotherapy0.97 (0.70, 1.35)0.96 (0.69, 1.35)0.99 (0.71, 1.36)Used growth factors (e.g., filgrastim)1.38 (0.97, 1.97)1.31 (0.90, 1.93)1.15 (0.79, 1.67)† 95% CI lower bound is rounded from 1.001. * p &amp;lt; 0.05 Breast Cancer-Specific MortalityAntibiotic UseTotal AntibioticsUnique AntibioticsAntibiotic use1.50 (0.90, 2.47)Total number of antibiotics1.07* (1.04, 1.10)Number of unique antibiotics1.18* (1.12, 1.25)Age at diagnosis1.00 (0.98, 1.01)1.00 (0.98, 1.01)1.00 (0.98, 1.01)Race/ethnicity (reference=White)Hispanic1.36 (0.71, 2.61)1.36 (0.71, 2.60)1.34 (0.69, 2.58)Non-Hispanic Asian Pacific Islander1.41 (0.86, 2.31)1.48 (0.91, 2.40)1.47 (0.90, 2.40)Non-Hispanic Black1.69 (0.76, 3.76)1.66 (0.76, 3.60)1.55 (0.70, 3.43)Neighborhood socioeconomic status quintile (reference=lowest)Second-lowest1.54 (0.52, 4.52)1.71 (0.57, 5.17)1.59 (0.53, 4.79)Middle1.50 (0.53, 4.26)1.61 (0.55, 4.71)1.48 (0.51, 4.31)Second-highest1.15 (0.41, 3.27)1.17 (0.40, 3.41)1.12 (0.39, 3.26)Highest1.14 (0.42, 3.06)1.19 (0.43, 3.30)1.05 (0.38, 2.92)Stage (reference=I)II2.39* (1.37, 4.17)2.43* (1.39, 4.27)2.45* (1.40, 4.28)III7.96* (4.31, 14.70)8.35* (4.49, 15.53)8.48* (4.55, 15.80)Grade (reference= 1)21.12 (0.37, 3.36)1.01 (0.33, 3.05)0.91 (0.30, 2.81)31.67 (0.60, 4.68)1.52 (0.54, 4.26)1.42 (0.50, 4.04)Received chemotherapy0.64 (0.36, 1.14)0.61 (0.34, 1.10)0.60 (0.33, 1.09)Received radiotherapy0.95 (0.64, 1.39)0.91 (0.62, 1.33)0.95 (0.65, 1.38)Used growth factors (e.g., filgrastim)1.05 (0.70, 1.57)0.94 (0.63, 1.41)0.88 (0.58, 1.33)NOTE: * denotes p&amp;lt;0.05 Citation Format: Julia D Ransohoff, Karen Andrade, Natasha Purington, Vidhya Balasubramanian, Summer Han, Mina Liu, Jennifer Caswell-Jin, George Sledge, Ami Bhatt, Allison Kurian. Antibiotic use and mortality from triple-negative breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-34.

Effect of point-of-care influenza tests on antibiotic prescriptions by emergency physicians in a French hospital

Influenza is a public health issue worldwide. Although antibiotics should not be used to treat viral infections, they are often prescribed to patients with influenza-like illness (ILI). Such misuse promotes antibiotic resistance. The role of rapid point-of-care tests (POCTs) in preventing antibiotic misuse in adults with ILI symptoms remains relatively unexplored. To evaluate whether POCT implemented in 2018-2019 to detect influenza viruses led to a decrease in antibiotic prescriptions compared with laboratory-based influenza tests. Adult patients with ILI in one emergency department (ED) were retrospectively enrolled over three epidemic seasons (from 2016-2017 to 2018-2019). The primary outcome was the rate of antibiotic prescriptions, which was compared between the three seasons in bivariate and multivariate analyses. Prescriptions for ancillary laboratory tests, chest X-rays and oseltamivir were also compared, along with hospitalizations and length of stay (LOS) at the ED. Overall, 1849 patients were included. Median age was over 70 years throughout all three seasons. The number of antibiotic prescriptions was significantly different between the three periods in bivariate analysis (48.3% in 2016/2017, 44% in 2017/2018 and 31.1% in 2018/2019; P<0,0001) and in multivariate analysis (adjusted odds ratio (aOR)= 0.48, 95% confidence interval (CI)= 0.30-0.76 for 2018/2019 and aOR= 0.99, 95%CI= 0.67-1.46 for 2017/2018, compared with 2016/2017). There were significantly fewer prescriptions of ancillary laboratory tests, X-rays, hospitalizations and more oseltamivir prescriptions in 2018/2019, compared with the previous seasons. LOS was significantly lower in 2018/2019 only for influenza-positive patients. ED influenza POCT decreased antibiotic use and led to less ancillary testing, X-rays and hospitalizations among patients with ILI. However, medico-economic studies are necessary before formulating definite recommendations.

Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data.

Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections.

Elimination of Routine Urinalysis before Elective Orthopaedic Surgery Reduces Antibiotic Utilization without Impacting Catheter-associated Urinary Tract Infection or Surgical Site Infection Rates.

PurposeRoutine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines.Materials and MethodsA pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period.ResultsA total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05).ConclusionThe elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.

Effect of monthly vitamin D supplementation on antibiotic prescribing in older adults: a post hoc analysis of a randomized controlled trial

Observational studies have reported that low vitamin D status is associated with increased risk of antibiotic use. However, trials on the effect of vitamin D supplementation on antibiotics are limited and inconclusive. The main objective of this study was to determine the effect of monthly vitamin D supplementation on the proportion of adults with ≥1 prescriptions of antibiotics. The secondary outcomes were to determine the effect of monthly vitamin D supplementation on the number of antibiotic prescriptions and the number of days on antibiotics. This was a post hoc analysis of a randomized, double-blinded, placebo-controlled trial with community-based older adults who were randomly assigned to receive monthly 100,000 IU of vitamin D or identical placebo. All analyses were based on the principle of "intention to treat." RR from log-binomial models and the incidence rate ratio (IRR) from negative binomial models were estimated for primary and secondary outcomes after adjusting for age, sex, and ethnicity. A total of 5108 participants aged 50-84 y were randomly assigned to vitamin D supplementation (n=2558) or placebo (n=2550) groups. During a median follow-up of 3.3 y, 4211 (82%) participants were prescribed antibiotics. There was no difference in the proportion of participants prescribed antibiotics between vitamin D (82%) and placebo (83%) groups (adjusted RR: 0.99; 95% CI: 0.97, 1.01; P=0.42). Similarly, the number of antibiotic prescriptions per person-year did not differ between the 2 treatment groups (adjusted IRR: 0.98; 95% CI: 0.93, 1.04; P=0.58). However, the number of days on antibiotics per person-year was significantly lower in the vitamin D group (mean±SEM: 15±0.7) compared with the placebo group (mean±SEM: 17±0.8) (adjusted IRR: 0.90; 95% CI: 0.82, 0.98; P=0.01), especially for the tetracyclines (IRR: 0.65; 95% CI: 0.50, 0.85; P=0.002). Long-term, monthly, high-dose vitamin D3 supplementation did not prevent antibiotic prescribing in older adults, but the vitamin D group had fewer days per person-year on antibiotics. Further research is required to replicate these findings. This trial was registered at www.anzctr.org.au as ACTRN12611000402943.

Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice.

The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients’ daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient’s conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.

173. Identification of Inappropriate Antibiotic Orders During a Pharmacy-Supported Antimicrobial Stewardship Program in the Primary Care Setting: A Retrospective Analysis

BackgroundIn Florida, the number of antibiotic prescriptions has increased from 710–779 prescription/1000 population in 2012 to 748–839 prescription/1000 population in 2017. Antimicrobial stewardship in the outpatient setting is a suggested solution to combat antibiotics misuse in ambulatory practices.MethodsThis was a retrospective review of oral antimicrobial orders generated by primary care providers. The research protocol received approval from Memorial Healthcare System’s Institutional Review Board prior to any research related analysis being conducted. Orders from January 1-December 31, 2018 were reviewed for appropriateness by pharmacy based on IDSA guidelines. Appropriateness was assessed based on the need to prescribe the antibiotic for indication, selection, dose and duration of therapy. Descriptive statistics were used to analyze data.ResultsOf 2995 orders, 50.2% were inappropriate. The most common infections associated with inappropriate antibiotic use were upper/lower respiratory tract infections (URTIs (65%) and LRTIs (61%)), oral cavity infections (61%), and skin/soft tissue infections (SSTI (54%)). Inappropriately-prescribed antibiotics were penicillin (62%), cephalosporins (56%), quinolones (50%), macrolides (49%), and sulfamethoxazole/trimethoprim (46%). Penicillin use for URTIs were inappropriate (406 orders) for the following reasons: duration of therapy only 116/137 (85%); dose and duration 36/58 (62%), drug and dose 12/58 (21%) and all three (drug, dose, duration 85/93 (91%)).ConclusionImplementation of a pharmacist-driven antibiotic stewardship program in the primary care setting identified a significant proportion of orders that were inappropriate for type of antibiotic, dose, and duration of therapy in the management of patients with URTIs. These results serve as an avenue to implement the audit feedback process to promote appropriate use of antibiotics. A process improvement plan will include sharing of the findings, educating primary care physicians per IDSA guidelines and continuous review of prescribing trends. A programmatic evaluation will continue on an on-going basis to decrease the number of inappropriately prescribed antibiotics.Disclosures All Authors: No reported disclosures

Can Private Provision of Primary Care Contribute to the Spread of Antibiotic Resistance? A Study of Antibiotic Prescription in Sweden.

BackgroundGrowing rates of antibiotic resistance, caused by increasing antibiotic use, pose a threat by making antibiotics less effective in treating infections.ObjectiveWe aimed to study whether physicians working at privately and publicly owned health centres differed in the likelihood of prescribing antibiotics and choosing broad-spectrum over narrow-spectrum antibiotics.MethodsTo estimate the effect of ownership on the probability of a prescribed drug being an antibiotic, we analysed all 4.5 million prescriptions issued from 2011 to 2015 at primary health centres in Västerbotten, Sweden. We controlled for patient age, sex, number of prescriptions per patient, and month of prescription, and used a maximum likelihood logit estimator. We then analysed how ownership affected the likelihood of a prescribed antibiotic being broad spectrum. We also used aggregated data to estimate the impact of the number of private health centres on the number of antibiotic prescriptions per inhabitant and the proportion of broad-spectrum antibiotics.ResultsHolding other factors constant, private physicians were 6% more likely to prescribe antibiotics and 9% more likely to choose broad-spectrum antibiotics. An increase by one additional private health centre was positively associated with an increase in the number of antibiotic prescriptions per inhabitant and a higher proportion, although not significant, of broad-spectrum antibiotic prescriptions.ConclusionOur findings suggest that private physicians prescribe more antibiotics, especially broad-spectrum antibiotics, than public physicians. Therefore, it is crucial to provide health centres with incentives to follow guidelines for antibiotic prescription, especially when the level of private provision of primary healthcare is high.Electronic supplementary materialThe online version of this article (10.1007/s41669-020-00234-7) contains supplementary material, which is available to authorized users.

Shift in antibiotic prescription at a University Dental Clinic in Norway 2013-2017.

A considerable number of prescriptions for antibiotics are issued by dentists. Educational institutions have a special responsibility to promote informed attitudes among dental students towards prescribing antibiotics. The purpose of this study was to analyze the antibiotic prescriptions issued during a 5-year period (2013-2017) at a University Dental Clinic (UDC) in Norway. All patient records containing prescriptions for patients ≥18yr of age as of 2013-2017 were identified through an electronic search. In total, 6,014 patient record lines containing prescriptions were obtained, 1,047 (17.4%) of which were prescriptions for systemic antibiotics. These patient record lines were analysed to identify the specific antibiotic prescribed, the indication or diagnosis for which it was prescribed, and whether microbiological testing (to determine antibiotic sensitivity) had been carried out. Acute infections were the most common context for prescribing antibiotics. Surprisingly, prophylaxis was the second most frequent reason stated. Disease related to pulp necrosis (43%) and postoperative infections (26%) was the most common diagnosis for therapeutic antibiotic prescriptions. Antibiotic therapy was more commonly used to treat peri-implantitis than to treat periodontitis. Only 60% of the clindamycin prescriptions were issued to patients with penicillin allergy. Further studies are warranted concerning antibiotic use at UDC because this can probably be more restrictive, in particular concerning usage related to antibiotic prophylaxis. Microbiological testing should be performed before administration of antibiotic therapy for periodontitis and peri-implantitis. The reason for prescribing antibiotics should always be stated in the patient's record lines.