Number Of Antibiotic Prescriptions Research Articles

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.

Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland.

BackgroundFollowing concerns about increased antibiotic use during the COVID-19 pandemic, trends in community antibiotic prescriptions in Scotland were evaluated.MethodsThe primary care prescription electronic messaging system used in GP practices with NHS contracts provided near real-time data analysis of national data. The main outcome measures were the weekly number of prescriptions for antibiotics generated by prescribers in GP practices in 2020 compared with 2019.ResultsAt end of Week 12 2020 (22 March), after a sharp increase, the number of prescriptions commonly used for respiratory infections was 44% higher than the corresponding week in 2019. The number of prescriptions for respiratory antibiotics reduced through April and May 2020, with 34% fewer prescriptions issued by end of Week 22 (31 May) than in the corresponding week in 2019. Reductions were pronounced in all age groups but particularly apparent for prescriptions for children aged 0–4 years. These data were compared with weekly prescriptions for a selection of non-respiratory antibiotics and no difference was seen between 2020 and 2019.ConclusionsTrends in antibiotic prescription data show that after an initial surge, and following ‘lockdown’ in Scotland, the total number of prescriptions for antibiotics commonly used for respiratory infections fell. We believe this is the first published national evaluation of the impact of COVID-19 on community use of antibiotics. Further analysis of national data is planned to provide a greater understanding of the reasons behind these trends.

The Decline in Outpatient Antibiotic Use.

A central component of the German antibiotic resistance strategy is to monitor the outpatient prescribing of systemic antibiotics nationwide, across all of the statutory health-insurance providers, in order to provide a basis for targeted quality-assurance measures. All outpatient drug prescription data from patients covered by the statutory health-insurance carriers in Germany in the age groups 0-14, 15-64, and ≥ 65 years were assessed. The chosen primary outcome measure under study was the prescription rate (number of antibiotic prescriptions per 1000 insurees per year) for the years 2010 to 2018. Over the period of the study, a 21% decline was seen in the use of systemic antibiotics in outpatients, from 562 to 446 prescriptions per 1000 insurees per year in 2010 and 2018, respectively. The most marked reduction in the prescription rate-by 41%-was seen among child and adolescent insurees (in other age groups: -17% among those aged 15-64, -12% among those aged 65 and older). A downward trend was seen in all regions of Germany, and for most of the active substance groups for which data were obtained. In 2018, the prescription rate varied by a factor of 1.8 among regions, with the highest rate in the Saarland (572 per 1000 insurees per year) and the lowest in Brandenburg (318 per 1000 insurees per year). The observed nationwide decline in the prescription of antibiotics to outpatients in all age groups may be a result of the numerous initiatives that have been put into action to reinforce the appropriate use of antibiotics in Germany. A change in pediatric prescribing practices is demonstrated by the marked reduction in this age group. The remaining major differences across German regions underscore the importance of regionally tailored programs for the promotion of rational antibiotic use.

The Association Between High and Unnecessary Antibiotic Prescribing: A Cohort Study Using Family Physician Electronic Medical Records.

Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing. This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing. There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate. We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.

Antibiotic use and the risk of breast cancer: A systematic review and dose-response meta-analysis

ObjectiveOral antibiotics are posed as a possible risk factor for breast cancer. Evidence is insufficient to determine whether the choice of antibiotic class could effect this potential association, and non-linearity has not been studied. We aimed to fill these important knowledge gaps. MethodsPubMed, Web of Science, Embase and a trial registry were searched from inception until January 2020, without any restrictions. Additionally, extensive manual searches were undertaken. Random-effects meta-analyses provided pooled risk estimates with 95 % confidence intervals (CI). Dose-response analyses modeling the relationship between number of antibiotic prescriptions and breast cancer risk were extended to non-linear models. Heterogeneity, publication bias and small-study effects were assessed. ResultsOf 7805 identified publications ten were eligible, including 3,719,383 individuals and 84,485 breast cancer cases. The pooled breast cancer risk was modestly increased among individuals who ever used antibiotics (relative risk RR = 1.18, 95 %CI 1.08–1.29), also after excluding the last year prior diagnosis. This excess risk was seen among penicillin (RR = 1.09, 95 %CI 1.01–1.18), tetracycline (RR = 1.13, 95 %CI 1.04–1.24) and nitrofuran users (RR = 1.26, 95 %CI 1.05–1.52), whilst nitroimidazole and metronidazole use (RR = 1.05, 95 %CI 1.00–1.11) indicated for marginal association. No apparent association was found for other antibiotics. Data suggested for a non-linear dose-dependent relationship, with a seemingly protective effect after at least 35 prescriptions. However, these findings might partly be explained by limited power of dose-response analyses. ConclusionsThe association of antibiotics with breast cancer risk appears to differ between the various antibiotic classes. Whether this association is causal remains unclear, requiring further clarification and mechanistic studies.

The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010-2017.

BackgroundInfluenza, which peaks seasonally, is an important driver for antibiotic prescribing. Although influenza vaccination has been shown to reduce severe illness, evidence of the population-level effects of vaccination coverage on rates of antibiotic prescribing in the United States is lacking.MethodsWe conducted a retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness. Using data from IQVIA’s Xponent database and the US Centers for Disease Control and Prevention’s FluVaxView, we employed fixed-effects regression analysis to analyze the relationship between influenza vaccine coverage rates and the number of antibiotic prescriptions per 1000 residents from January to March of each year.ResultsWe observed that, controlling for socioeconomic differences, access to health care, childcare centers, climate, vaccine effectiveness, and state-level differences, a 10–percentage point increase in the influenza vaccination rate was associated with a 6.5% decrease in antibiotic use, equivalent to 14.2 (95% CI, 6.0–22.4; P = .001) fewer antibiotic prescriptions per 1000 individuals. Increased vaccination coverage reduced prescribing rates the most in the pediatric population (0–18 years), by 15.2 (95% CI, 9.0–21.3; P < .001) or 6.0%, and the elderly (aged 65+), by 12.8 (95% CI, 6.5–19.2; P < .001) or 5.2%.ConclusionsIncreased influenza vaccination uptake at the population level is associated with state-level reductions in antibiotic use. Expanding influenza vaccination could be an important intervention to reduce unnecessary antibiotic prescribing.

Delivery of subcutaneous immunoglobulin by rapid \u201cpush\u201d infusion for primary immunodeficiency patients in Manitoba: a retrospective review

BackgroundBoth intravenous and subcutaneous human immune globin G (IgG) replacement (IVIG and SCIG, respectively) reduce severe infection and increase serum IgG levels in primary immune deficiency disorder (PIDD) patients who require replacement. SCIG can be administered either with the aid of an infusion pump, or by patients or caregivers themselves, using butterfly needles and a syringe (“SCIG push”). SCIG offers advantages over IVIG, including higher steady state IgG levels, improved patient quality of life indicators, and decreased cost to the healthcare system, and for these reasons, SCIG has been increasingly used in Manitoba starting in 2007. We sought to determine the effectiveness of SCIG push in our local adult PIDD population.MethodsWe conducted a retrospective chart review of all adult patients enrolled in the SCIG push program in Manitoba, Canada from its inception in November 2007 through September 2018. We included patients who were naïve to IgG replacement prior to SCIG, and those who had received IVIG immediately prior. We collected data regarding serum IgG levels, antibiotic prescriptions, hospital admissions, and adverse events during a pre-defined period prior to and following SCIG initiation. Statistical significance was determined via two-tailed t-test.Results62 patients met inclusion criteria, of whom 35 were on IVIG prior and 27 were IgG replacement naïve. SCIG push resulted in an increase in serum IgG levels in those naïve to IgG replacement, as well as in those who received IVIG prior. SCIG push also resulted in a statistically significant reduction in number of antibiotic prescriptions filled in the naïve subgroup, and no significant change in antibiotics filled in the IVIG prior group. 8/62 PIDD patients (12.9%) left the SCIG program during our review period for varying reasons, including side-effects.ConclusionsIn a real-life setting, in the Manitoba adult PIDD population, SCIG push is an effective method of preventing severe infections, with most patients preferring to continue this therapy once initiated.

Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study

ObjectivesTo identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness...

Knowledge and use of antibiotics in six ethnic groups: the HELIUS study

BackgroundThe increase of antimicrobial resistance, mainly due to increased antibiotic use, is worrying. Preliminary evidence suggests that antibiotic use differs across ethnic groups in the Netherlands, with higher use in people of non-Dutch origin. We aimed to determine whether appropriate knowledge and use of antibiotics differ by ethnicity and whether knowledge on antibiotics is associated with antibiotic use.MethodsWe performed a cross-sectional study analyzing baseline data (2011–2015) from a population-based cohort (HELIUS study), which were linked to data from a health insurance register. We included 21,617 HELIUS participants of South-Asian Surinamese, African-Surinamese, Turkish, Moroccan, Ghanaian, and Dutch origin. Fifteen thousand seven participants had available prescription data from the Achmea Health Data-base (AHD) in the year prior to their HELIUS study visit. Participants were asked five questions on antibiotic treatment during influenza-like illness, pneumonia, fever, sore throat and bronchitis, from which higher versus lower antibiotic knowledge level was determined. Number of antibiotic prescriptions in the year prior to the HELIUS study visit was used to determine antibiotic use.ResultsThe percentage of individuals with a higher level of antibiotic knowledge was lower among all ethnic minority groups (range 57 to 70%) compared to Dutch (80%). After correcting for baseline characteristics, including medical conditions, first-generation African Surinamese and Turkish migrants received a significantly lower number of antibiotic prescriptions compared to individuals of Dutch origin. Only second-generation Ghanaian participants received more prescriptions compared to Dutch participants (aIRR 2.09, 95%CI 1.06 to 4.12). Higher level of antibiotic knowledge was not significantly associated with the number of prescriptions (IRR 0.92, 95%CI 0.85 to 1.00).ConclusionsLevels of antibiotic knowledge varied between ethnic groups, but a lower level of antibiotic knowledge did not correspond with a higher number of antibiotic prescriptions.

Antibiotic Prescription Patterns among Children Younger than 5 Years in Nouna District, Burkina Faso.

Understanding antibiotic use may help predict emergence of antimicrobial resistance. We evaluated antibiotic prescription trends in rural Burkina Faso, where little is known about antibiotic consumption. Antibiotic prescription data for 20 communities were extracted through record review in six primary health-care facilities serving the communities. The number of antibiotic prescriptions per child-year was calculated using population-based census data from the communities. A total of 1,444 antibiotic prescriptions were made from March to June 2017 among 3,401 children in the communities. The frequency of antibiotic prescription was 1.70 prescriptions per child-year (95% CI: 1.61-1.79). Penicillins were the most common (1.04 prescriptions per child-year, 95% CI: 1.01-1.06), followed by sulfonamides (0.69 prescriptions per child-year, 95% CI: 0.67-0.71) and macrolides (0.38 prescriptions per child-year, 95% CI: 0.37-0.40). Continued monitoring of antibiotic consumption in diverse settings will be important to understand the potential for emergence of antibiotic resistance.

Herbal anti-edematous agents for certain cases of facial cellulitis of odontogenic origin. Clinical recommendation.

Literature from different parts of the world reported that antibiotic abuse is evident in dental practice. One aspect of this abuse is prescribing antibiotics for non-indicated orofacial infections. The use of some herbal anti-edematous agents has been recommended for reducing post-operative swelling/edema in certain oral and maxillofacial surgical procedures. In this review we describe the possible benefits of using these agents for certain cases of facial cellulitis in order to reduce the number of antibiotic prescriptions for this particular clinical situation.

Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016

ObjectiveTo determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative...

Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database

Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice.Design: Retrospective cohort register-based study including the Danish National Prescription Register.Setting: Population-based study of routine electronic antibiotic prescriptions from Danish general practice.Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013).Main outcome measures: Number of prescriptions per clinical indication. Number of antibiotic prescriptions per 1000 inhabitants by age and gender. Logistic regression analysis estimated the association between patient and provider factors and missing clinical indications on antibiotic prescriptions.Results: A total of 2.381.083 systemic antibiotic prescriptions were issued by Danish general practitioners in the study period. We identified three main clinical entities: urinary tract infections (n = 506.634), respiratory tract infections (n = 456.354) and unspecified infections (n = 416.354). Women were more exposed to antibiotics than men. Antibiotic use was high in children under 5 years and even higher in elderly people. In 32% of the issued prescriptions, the clinical indication was missing. This was mainly associated with antibiotic types. We found that a prescription for a urinary tract agent without a specific clinical indication was uncommon.Conclusion: Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable.

Antibiotic management of children with infectious diseases in Dutch Primary Care.

Childhood infections are common in general practice. Although clinical guidelines recommend restrictive antibiotic use for children, antibiotics are too often prescribed. The aim of this study was to obtain insight in antibiotic prescribing for children related to clinical diagnoses. This is pivotal to define improvement strategies in the antibiotic management. In this observational study, we used consultation data collected from 45 general practices in the Netherlands in 2012. Infectious disease episode incidences, the number of antibiotic prescriptions per 1000 person-years, the proportion of episodes with an antibiotic prescription and the choice of antibiotic subclass were analysed for the most relevant diagnoses over different ages. A total of 262 antibiotic courses were prescribed per 1000 person-years on average, with the highest number among children of 1 year (714/1000 person-years). Antibiotics were prescribed in 24% of infectious disease episodes. Acute upper respiratory tract infection (RTI) was the most common reason to visit the GP (173/1000 person-years), and the second most frequent indication to prescribe antibiotics. Antibiotics were most often prescribed for acute otitis media (58/1000 person-years). Amoxicillin dominated prescribing (55%), followed by macrolides (14%) and amoxicillin/clavulanate (10%), prescribing of narrow-spectrum antibiotics was low (10%). This detailed insight in antibiotic management of childhood infections shows targets for Dutch improvement strategies: (i) prevent antibiotic prescribing for acute upper RTI and bronchitis; (ii) stimulate the use of narrow-spectrum antibiotics; and (iii) reduce the use of macrolides and amoxicillin/clavulanate. Furthermore, this information is helpful to compare antibiotic policy between countries.

Antimicrobial stewardship in the Federal Bureau of Prisons: Approaches from the national and local levels

ObjectivesTo determine the impact of national and local antimicrobial stewardship measures on overall antibiotic prescribing in the Federal Bureau of Prisons (BOP). SettingCare was delivered to more than 160,000 inmates in 122 BOP facilities in the United States and Puerto Rico. Practice descriptionMedical centers and health services clinics staffed by in-house medical staff, consultants, and specialists. Staffs include a variety of disciplines, including physicians, pharmacists, dentists, nurses, infection control personnel, therapists, health services administrators, and institution executive staff. Practice innovationInnovations occurred on 2 levels: local components were used to reinforce national initiatives. Local institutions used a multidisciplinary team approach including education and focused evaluations of all antibiotic prescriptions before dispensing. National initiatives included the development of a closed formulary, clinical practice guidelines, an antimicrobial stewardship group led by pharmacy, development of tools and strategies for institutions, inclusion in the BOP strategic plan, and a drug utilization evaluation. EvaluationThis was a study of antimicrobial stewardship within BOP and the resultant impact on antibiotic prescriptions. In addition, one institution’s antimicrobial stewardship methods were reviewed to determine the impact on antibiotic prescribing practices. ResultsThe total number of antibiotic prescriptions in BOP-managed institutions in fiscal year (FY) 2010 (October 2009 to September 2010) was 142,907 and progressively decreased to 105,832 in FY2015. The number of antibiotic prescriptions per 1000 inmates correspondingly decreased from 829 in FY2010 to 625 in FY2015. The overall number of antibiotic prescriptions as a percentage of total prescriptions decreased from 7.64% in FY2010 to 5.84% in FY2015. ConclusionA robust multidisciplinary antimicrobial stewardship program has likely contributed to a decrease in both the total number and the rate of antibiotic prescriptions on a per-1000-patient basis in BOP.

Antimicrobial Stewardship Program Intervention Package for Increasing Appropriate Outpatient Antibiotic Usage: A Clinic-Feedback Based Approach

BackgroundThe National Action Plan for Combating Antibiotic-Resistant Bacteria issued in March 2015 advocates for the presence of Antimicrobial Stewardship Programs (ASPs) in all outpatient settings by 2020 with a 50% reduction in inappropriate outpatient antibiotics. The purpose of this initiative is to determine whether ASP intervention can reduce prescription of antibiotics commonly associated with UTI treatment.MethodsA prospective cohort quality improvement initiative at Ralph H. Johnson VAMC evaluated the number of prescriptions written by primary care providers in Clinic A and Clinic B for oral antibiotics commonly associated with UTI treatment. Historical control data were collected from October 2015 - December 2015 and active ASP intervention data from October 2016 - December 2016. ASP interventions included: routine face-to-face provider education, clinic-specific feedback in the form of monthly e-mailed report cards, UTI treatment order menu implementation, modification of in-clinic antibiotic availability, and provision of pocket antibiograms. E. coli isolates and susceptibilities were also assessed for both time periods.ResultsClinic A demonstrated a 34% reduction in the number of prescriptions for antibiotics commonly associated with UTI treatment when comparing historical control data to ASP intervention data (126 vs. 70 prescriptions, respectively); Clinic B had a 19% increase (106 vs. 132 prescriptions). Clinic A had a 46% reduction in prescriptions written for fluoroquinolones (70 vs. 38 prescriptions); Clinic B had a 15% reduction (53 vs. 45 prescriptions). Total number of E. coli isolates decreased (143 vs. 131 isolates). E. coli susceptibilities to locally recommended first-line antibiotics increased, including amoxicillin/clavulanate (78% to 85%) and sulfamethoxazole-trimethoprim susceptibilities (73% to 81%); susceptibilities to ciprofloxacin also increased (71% to 79%).ConclusionCombining multiple outpatient ASP interventions to improve antibiotic prescribing can successfully reduce the total number of antibiotic prescriptions commonly written for UTI treatment. An ASP outpatient UTI treatment intervention package was most effective at reducing the total number of prescriptions written for fluoroquinolones.Disclosures All authors: No reported disclosures.

RAPID DIAGNOSIS OF STREPTOCOCCAL TONSILLITIS IN EPIDEMIOLOGICAL PRACTICES

The aim of the study was to conduct clinical testing of the rapid diagnostic test system «Streptatest» (Dectra Pharm, France) and to evaluate its performance in accordance with its purpose in solving the functional problems of express diagnostics of Group A streptococci. In the work the evaluation of the performance characteristics of the test systems «Streptatest» with an assessment of the feasibility and acceptability of its use in the interests of practical public health have been studied. Materials and methods: Clinical approbation was carried out by examining 200 military personnel contracted for outpatient admission to a medical service with suspected acute tonsillitis for the carriage of Group A beta-hemolytic streptococcus using this test system. The following results were obtained during the study. Of 200 examined patients, the number of people with a positive test was 31 (15,5%), negative – 169 (84,5%), which corresponds to the literature data on the prevalence of acute tonsillitis caused by GAS. Before the application of «Streptatest» antibiotic therapy was prescribed in 80-90% of cases, after the start of the use of the test system, the number of antibiotic prescriptions was reduced to 16%, which led to a reduction in the costs of treatment of acute tonsillitis. Test system «Streptatest» is a highly effective and sufficiently reliable medical device, the ease of using test strips and a simple evaluation of the results of the study are its advantages. The indication for the application of the rapid diagnostic test system is the request for medical care of a patient with clinical signs of acute tonsillitis, tonsillopharyngitis, pharyngitis. The social significance lies in obtaining a reliable result with the simplicity and ease of working with the test system. Conclusions. Estimating the prevalence of streptococcal group A infections in organized groups, providing rapid differential diagnosis, primarily of tonsillitis and viral streptococcal etiology, allows timely and adequate appointment of the necessary treatment, reduce the risk of complications and reduce the severity of the disease, reduce the economic costs of medical care .

The Clinical and Economic Impact of Probiotics Consumption on Respiratory Tract Infections: Projections for Canada.

IntroductionThere is accumulating evidence supporting the use of probiotics, which are defined as “live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host”, as a preventive measure against respiratory tract infections (RTI). Two recent meta-analyses showed probiotic consumption (daily intake of 107 to 1010 CFU in any form for up to 3 months) significantly reduced RTI duration, frequency, antibiotic use and work absenteeism.ObjectivesThe aim of this study was to assess the impact of probiotic use in terms of number of RTI episodes and days averted, and the number of antibiotic prescriptions and missed workdays averted, in the general population of Canada. In addition, the corresponding economic impact from both a healthcare payer and a productivity perspective was estimated.MethodsA microsimulation model was developed to reproduce the Canadian population (sample rate of 1/1000 = 35 540 individuals) employing age and gender. RTI incidence was taken from FluWatch consultation rates for influenza-like illness (2013–14) and StatCan all-cause consultations statistics. The model was calibrated on a 2.1% RTI annual incidence in the general population (5.2 million RTI days) and included known risk factors (smoking status, shared living conditions and vaccination status). RTI-related antibiotic prescriptions and work absenteeism were obtained from the literature.ResultsThe results indicate that probiotic use saved 573 000–2.3 million RTI-days, according to the YHEC–Cochrane scenarios respectively. These reductions were associated with an avoidance of 52 000–84 000 antibiotic courses and 330 000–500 000 sick-leave days. A projection of corresponding costs reductions amounted to Can$1.3–8.9 million from the healthcare payer perspective and Can$61.2–99.7 million when adding productivity losses.ConclusionThe analysis shows that the potential of probiotics to reduce RTI-related events may have a substantial clinical and economic impact in Canada.

Parents’ socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0–6 years in the Capital Region of Denmark

Objective: To investigate the distribution of antibiotic prescriptions in primary health care among children aged 0–6 years and its association with socioeconomic factors.Design: A cross-sectional study describing antibiotic prescriptions and socioeconomic factors, using different population-based registers from Statistics Denmark.Setting: Antibiotic prescriptions in 2012 from primary health care in the Capital Region of Denmark.Subjects: The population of children aged 0–6 years (n = 139,398) in the Capital Region of Denmark.Main outcome measures: High use of antibiotics identified by number of antibiotic prescriptions (≥ 3 prescriptions per year) and defined daily doses (DDD). A multinomial logistic regression analysis estimating the association between high antibiotic use and parents’ education, employment status, income, child’s sex, and ethnic background.Results: Ten percent of children accounted for 25% of the total use DDD. There was a clear tendency that the risk for high antibiotic use increased as parental educational level decreased. The risk for high use was the highest among children of mothers and fathers with basic schooling ≤10 years (OR 1.60, 95% CI 1.29–1.98, and OR 1.60, 95% CI 1.34–1.91, respectively). Low income and unemployment were not associated with high antibiotic use.Conclusion: Socioeconomic factors can only partially explain differences in antibiotic use. Further research is needed to clarify the unequal distribution of antibiotic prescribing and the association between high antibiotic use and low educational level. This would provide valuable information in the planning of strategies to promote rational use of antibiotics among children.KEY POINTSThe Capital Region of Denmark has the highest rate of antibiotic prescribing in Denmark.Preschool children are among the age groups with the highest use.Ten percent of the children accounted for 25% of the total antibiotic use.Low parental educational level was associated with increased antibiotic use.Parents’ income or employment status was not found to be associated with high antibiotic use.

Reducing antibiotic prescriptions for respiratory tract infections in family practice: results of a cluster randomized controlled trial evaluating a multifaceted peer-group-based intervention.

Irrational antibiotic use for respiratory tract infections (RTI) is a major driver of bacterial resistance. The aim of this study was to evaluate the effect of a multifaceted peer-group based intervention aiming to reduce RTI-related antibiotic prescriptions in family practice. This was a cluster randomized controlled trial with pre- and follow-up measurement. The intervention was implemented through PharmacoTherapy Audit Meetings (PTAM) in which family physicians (FPs) and pharmacists collaborate. Four PTAM groups received the intervention consisting of: (1) FP communication skills training, including communication about delayed prescribing; (2) implementation of antibiotic prescribing agreements in FPs’ Electronic Prescribing Systems; (3) quarterly feedback figures for FPs. Four other PTAM groups were matched controls. Primary outcome measure was the number of RTI-related antibiotic prescriptions after the intervention, assessed with multilevel linear regression analyses. Total number and number of prescriptions stratified by age (under/over 12 years) were analysed. At baseline, the average total number of RTI-related antibiotic prescriptions per 1,000 patients was 207.9 and 176.7 in the intervention and control PTAM groups, respectively. At follow-up, FPs in both the intervention and control groups prescribed significantly less antibiotics. For adolescents and adults, the drop in number of antibiotic prescription was significantly larger in the intervention groups (−27.8 per 1,000 patients) than the control groups (−7.2 per 1,000 patients; P<0.05). This multifaceted peer-group-based intervention was effective in reducing the number of RTI-related antibiotic prescriptions for adolescents and adults. To affect antibiotic prescribing in children other methods are needed.