Percentage Of Antibiotics Research Articles

Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda.

Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators. This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators). The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners. The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.

PRESCRIBING PATTERN OF DRUGS IN OUTPATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL

Aim: The study was conducted to assess the prescribing behaviour for antimicrobials and various groups of drugs in tertiary care hospital in Puducherry. Prescription audit was done. Total 500 presc Method: riptions were analysed for sex wise distribution, no of patients for specic age group, antimicrobials prescribed in generic name, percentage of antibiotics, antacids, NSAIDs and multivitamins, among the prescribed drugs, groups of antibiotics, drugs prescribed from National List of Essential Medicines (2022), use ofxed drug combinations, injectable preparations if any. Results: Demographic analysis showed that out of 500 patients in OPD, most were female (53%) and in the age group between 41 to 60 years. In 500 number of prescriptions,9.96% of antibiotics were prescribed; uoroquinolones (5.42%) were prescribed more from antibiotics followed by extended spectrum penicillin (1.64%). 14.78%of antacids were prescribed; PPIs (11.28%) were prescribed more from antacids. 21.63% of NSAIDs were prescribed.11.66% were prescribed in generic names, 65.44% drugs were prescribed from National List of Essential Medicines (2022), 15.88% of FDCs were prescribed,6.13% of injectable preparations were prescribed. The rational use of antimicrobial agents is one of the main contribut Conclusion: ors to control worldwide emergence of bacterial resistance, side effects and reduced cost of the treatment

Antibiotics prescribing practice among patients with urinary tract infection at outpatient department, the case of Dilchora referral hospital, Eastern Ethiopia: an institutional retrospective cross-sectional study

BackgroundInappropriate prescription of antibiotics is a global public health challenge. Widespread use, misuse, or inappropriate prescribing has resulted in unnecessary expenditure on drugs, raised risk of adverse reactions, the development of antimicrobial resistance, and increment in health care costs. There is a limited practice in rational prescribing of antibiotics in the management of Urinary tract infection (UTI) in Ethiopia.ObjectiveTo assess antibiotic prescribing practice in the treatment of patients with UTI at outpatient department (OPD), Dilchora referral hospital, Eastern Ethiopia.MethodsA retrospective cross-sectional study was conducted from January 7 to March 14, 2021. Data were collected from 600 prescription papers using systematic random sampling method. World Health Organization’s standardized core prescribing indicators was used.ResultsA total of 600 prescriptions containing antibiotics prescribed for patients with UTIs were observed during the study period. Of these, 415 (69.19%) were females and 210 (35%) were in the age group of 31–44 years. The number of generic drugs and antibiotics prescribed per encounter was 1.60 and 1.28, respectively. The percentage of antibiotics per prescription was found to be 27.83%. About 88.40% of antibiotics were prescribed by generic names. Fluoroquinolones were the most frequently prescribed class of drugs for the treatment of patients with UTIs.ConclusionThe prescribing practice of antibiotics in patients with UTIs was found to be good as the drugs were prescribed in generic name.

Effectiveness of an enhanced antibiotic stewardship programme among paediatric patients in a tertiary hospital in Vietnam

In 2016, the Vietnamese Ministry of Health promoted development of antimicrobial stewardship for hospitals. To evaluate the effectiveness and safety of the enhanced antibiotic stewardship programme (ASP) compared to the original ASP among paediatric patients at a tertiary hospital for infectious diseases in Vietnam. An interrupted time-series analysis was conducted to examine antibiotic use in paediatric patients aged 0-17 years admitted to the Hospital for Tropical Diseases in Ho Chi Minh City from April 2016 to March 2020. Outcomes measured were defined daily doses (DDDs) per 1000 patient-days; antibiotic days of therapy (DOT) per 1000 patient-days; percentage of antibiotic use by the World Health Organization Access, Watch, and Reserve (AWaRe) system; Access-to-Watch ratio; and worse clinical outcomes at discharge. Of 60,172 admissions during the study period, 28,019 received at least one antibiotic (46.6%) during hospital stay. The Watch antibiotics were the most frequently prescribed (78.1% of total antibiotic courses). The enhanced ASP did not improve antibiotic prescribing by DDDs per 1000 patient-days (risk ratio: 1.05; 95% confidence interval: 0.94-1.17) and DOT per 1000 patient-days (1.11; 0.99-1.25) compared to the original ASP. However, the percentage of Access antibiotics prescribed, and the Access-to-Watch ratio increased after the enhanced ASP (1.73; 1.38-2.17). There was no significant difference in worse clinical outcomes at discharge between the original and enhanced ASP (1.25; 0.78-2.00). The enhanced ASP had modest impact on antibiotic consumption in the paediatric population despite the improvement of Access antibiotic use and the Access-to-Watch ratio.

АНТИБАКТЕРИАЛЬНОЕ ДЕЙСТВИЕ НАНОЧАСТИЦ СЕРЕБРА

Objective. To determine the minimum inhibitory concentration of Ag nanoparticles in relation to clinical pathogenic strains of microorganisms. Methods. The minimum inhibitory concentration of Ag nanoparticles, obtained by metal vapor synthesis was studied on six strains of pathogenic bacteria, including representatives of gram-positive and gram-negative groups. The microbiological analyzer Vitek 2 Compact was used to identify each strain and to determine the antibiogram. The metal nanoparticles used in the study were synthesized by the method of metalvapor synthesis. Ag nanoparticles were studied by transmission electron microscopy(TEM) and X-ray photoelectron spectroscopy (XPS) methods. Determination of the minimum inhibitory concentration was performed by the method of serial dilution using sterile 96-well plates with using the tests of positive and negative control. The concentration of microorganisms was controlled by the turbidity standard. Results. All pathogenic strains of bacteria used in the study were characterized by pronounced polyantibiotic resistance, and the percentage of antibiotics against which the strain was resistant ranged from 12.5 to 93.3%. The minimum inhibitory concentration of silver nanoparticles ranged from 7.81 to 31.25 μg/ml, depending on the type of microorganism. Gram-positive microorganisms, in contrast to gram-negative ones, were characterized by lower values of the minimum inhibitory concentration. The data of transmission electron and X-ray photoelectron spectroscopy showed that the size of the studied nanoparticles is in the range of 2-15 nm. Conclusion. Silver nanoparticles (2-15 nm in size) have antimicrobial action against clinically significant, polyantibiotic-resistant strains of microorganisms. The minimum inhibitory concentration of silver nanoparticles, depending on the strain of the microorganism, varies from 7.81 to 31.25 μg/ml. Silver nanoparticles have an inhibitory impact on microorganisms and to a greater extent inhibit the growth of gram-positive versus gram-negative. The obtained materials based on silver nanoparticles represent an effective alternative to the currently used antibacterial drugs. What this paper adds The quantitative indices of the antibacterial action of silver nanoparticles have been firstly studied on pathogenic polyantibioticresistant strains of microorganisms The impact of the antibacterial resistance of bacteria does not affect the degree of antimicrobial action of these nanoparticles has been demonstrated Determination of the minimum inhibitory concentration of silver nanoparticles is considered to be a significant step in the development of a scientifically based method of using this class of substances in surgery

Cluster randomised controlled trial to assess a tailored intervention to reduce antibiotic prescribing in rural China: study protocol

IntroductionUp to 80% of patients with respiratory tract infections (RTI) attending healthcare facilities in rural areas of China are prescribed antibiotics, many of which are unnecessary. Since 2009, China has...

Study on Antibiotic Prescribing Pattern in the In-Patient Surgery Department of Tertiary Care Teaching Hospital Using WHO Indicator

Aims: The evaluation of antibiotic agents conveyed is critical for guaranteeing that the quality and fittingness of therapy. The study's purpose was to assess the use of antibiotics on the basis of WHO indicator in surgery department.
 Study Design: A prospective observational study was carried out in the surgery inpatient department for a period of six months after the approval of the ethical committee in tertiary care hospital.
 Place and Duration of Study: Department of Surgery, National Institute of Medical Sciences (NIMS), Tertiary Care Teaching Hospital Jaipur, Rajasthan, between Feb 2019 and July 2019.
 Methodology: The information was gathered in a predesigned performa from the clinical case sheets, drug charts of patients. Descriptive statistics were applied to the gathered information and dissected utilizing Microsoft Excel programming.
 Results: A total of 190 prescriptions were collected of which 995 drugs were prescribed. The total number of antibiotics in prescription was found to be 263. The percentage of antibiotics was found to be 88.42% which was found to be higher on comparing with the WHO marker. Various class of antibiotics was prescribed in which cephalosporin with a total of 120 (45.62%) followed by penicillin 33 (12.54%), macrolide 1 (0.38%) fluoroquinolones 23 (8.75%), nitroimidazole 39 (14.82%), aminoglycoside 38 (14.44%) and other classes 9 (3.45%).
 Conclusion: The adequacy of anti-microbial is undermined by the worldwide ascent in bacterial resistance and antimicrobial resistance is currently perceived as a significant medical issue. The study shows that the pattern of antibiotics was found to diverge from the WHO recommendation and also practice was lacking in terms of selection of antibiotics as there was no culture sensitivity test was performed. There gives off an impression of being an urgent requirement for the improvement of recommending rules with regards to the use of antibiotic agents.

Drug used pattern by self-medication among the RT-PCR positive health workers in Dhaka city

Background: To date there is no effective treatment against COVID-19. Self-medication played one of the major modes of treatment among general population as well as the health workers during this pandemic. Studying the pattern of self-medication among the health care workers (HCWs) may indicate their knowledge and skills towards rational use of medicines. The aim of the study was to assess the pattern self-medication among the COVID-19 affected HCWs.Methods: This cross-sectional survey assessed the pattern of drug used by self-medication among the health workers who were RT-PCR positive in context to Bangladesh.Results: A total of 267 HCWs data were collected. Most of the HCWs were in middle age group between 31-40 years with the mean age of 32.2±5.2. Doctors (83.9%) enrolled five times more than the nurses (16.1%). Most of the HCWs (60.3%) commenced medications just after appearance of symptoms and 27.0% went for the RT-PCR testing. Only 3.7% went to health care facilities for treatment. More than sixty percent of the respondents took medication by themselves just after start the symptoms, 19 (33.7%) took advised from the specialists and attended at health facilities 2.6%. Most of the patients (42.7%) used azithromycin as antimicrobial agent. Paracetamol was the most used drug among the participants (78.65%) followed by antihistamines (67.79%). Average number of drugs used by patients 3.1% and percentage of antibiotics per patients 42.6%.Conclusions: The prescribing practice of antibiotics shows deviation from the standard recommendation. Awareness regarding essentials drug list should be needed.

Antibiotic Prescribing in Outpatient Before and After Implementation of the Urban Family Physician and Referral System

Background The Family Physician and Referral System was piloted in Mazandaran and Fars provinces, Iran in 2012. The goal of this program was to improve the provision of health services including medication prescription. Objective This study aimed to determine the trends in antibiotic prescribing in outpatient before and after implementation of the Family Physician and Referral System in Babol, Iran from 2010 to 2018. Methods In this retrospective study, all prescriptions of urban family physicians in Babol, which were registered in the database of the Health Services Insurance Organization of Mazandaran province, were included. The trends of average number of items per prescription, percentage of antibiotics per prescription, frequency of antibiotic groups, and cost of antibiotics were calculated using SQL Server and IBM SPSS version 22. Results The average number of items per prescription was found to be 3.4±1.82, and 2.8±1.60, and percentage of antibiotics per prescription was 49% and 32% in 2010 and 2018, respectively. The most prescribed antibiotic groups were penicillin (54.8%) and cephalosporin (39.9%). Amoxicillin 500mg capsules (13.1%), metronidazole 250 mg (10.2%), and ciprofloxacin 500 mg (8.2%) were the most prescribed antibiotics. Also, the mean cost of prescriptions containing antibiotics compared to the total prescriptions had decreased from 22% in 2010 to 5.5% in 2018. Conclusion The pattern of medication prescription especially antibiotics, improved after the implementation of the Family Physician and Referral System. Due to the positive impact of the Family Physician and Referral System on medication prescription by physicians, we recommend the implementation of this program in low and middle-income countries. Keywords: Antibiotic, medication prescribing, Health system reform plan, Family physician, Trend

PRESCRIPTION AUDITING BASED ON THE WORLD HEALTH ORGANIZATION (WHO) PRESCRIBING INDICATORS IN OUTPATIENT DEPARTMENT OF A TEACHING HOSPITAL IN KERALA

Objectives: The objectives of the study were to study the pattern of major drug groups prescribed, assess the Rational Prescription pattern by measuring the WHO Core Prescribing Indicators and to assess the quality of the prescriptions by assessing the legibility of prescription in the outpatient department of a tertiary care hospital.
 Methods: It was an analytical cross-sectional study done in hospital pharmacy for a period of 6 months. Approval from Institutional Research Committee and Institutional Ethics Committee was taken before starting the study. Sample size was taken as 1020.
 Results: One hundred and twenty prescriptions were analyzed. About 49% prescriptions were of males and 54% of females. Mean age of the patients were 46 years. A total of 3557 medicines were prescribed in 1020 prescriptions. Due to lack of legibility, we were unable to decode 122 medicines out of 3557 medicines prescribed. The dosage forms prescribed were; oral 87.4%, injections 1.4%, inhalational agents 0.4%, and topical agents 10.8%. Average number of medicines per prescription was 3.5. Percentage of medicines prescribed by generic name was 45%. Percentage of antibiotics per prescription was 24.8%. Percentage of injections per prescription was 4.8%. Percentage of medicines prescribed as per NATIONAL essential drugs list (EDL) was 3.2% and as per the WHO EDL was 2.6%. Percentage of fixed dose combinations (FDCs) was 6.5%.
 Conclusion: It was evident that polypharmacy was present as indicated by the average number of medicines prescribed. Medicines prescribed by generic name and from Essential Medicine List were less in number. Antibiotics and injections prescribed was in conformity with the WHO recommended values, which means that there was no irrational use of antibiotics and unwanted use of injectables. Percentage of FDCs was 6.5%. Most commonly prescribed drug was Ranitidine as per our study. Hence, as per this study, prescribers did not follow prescribing core indicators of the WHO closely, except for two indicators. The quality of prescriptions with respect to legibility and clarity was found to be optimal.

Evaluation of the Quality of Antibiotic Prescribing in Primary Care: A Multicenter Longitudinal Study From Shenzhen, China.

Background: Currently, there is no comprehensive evaluation of the quality of antibiotic prescribing in China’s primary care facilities based on longitudinal data. Methods: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the quality of antibiotic prescribing, we used six quality indicators for analysis, including number of antibiotics per 100 consultations, ratio between broad-spectrum and narrow-spectrum antibiotics (B/N ratio), percentage of first-line antibiotics recommended by guidelines, percentage of oral antibiotics with a duration exceeding the guideline recommendation, and new pediatric-specific indicators such as percentage of antibiotics with amoxicillin (A index) and ratio between amoxicillin and broad-spectrum antibiotics (A/B ratio). Results: During the study period, 571,362 outpatient consultations resulted in antibiotic prescriptions, which contained 706,411 antibiotics. The overall number of antibiotics per 100 consultations decreased significantly from 93.50 in 2010 to 19.98 in 2015 (p = 0.004), but the B/N ratio showed an upward trend over time (p = 0.009). In different populations and different common infections, the number of antibiotics used decreased to varying degrees, while the B/N ratio increased to varying degrees, with the most obvious change in children <5 years. The percentage of first-line antibiotics for common infections was not high, ranging from 3.45 to 44.25% during 2014–2015. The percentage of oral antibiotics with an exceeded duration ranged from 0.70 to 19.39%. Moreover, the A index and A/B ratio in children remained low for a long time, which was 0.76% and 0.01 in 2015. Conclusion: A review of antibiotic prescribing in Shenzhen, China, showed a substantial reduction in antibiotic use in primary care. However, problems such as widespread use of broad-spectrum antibiotics, insufficient use of first-line antibiotics and low use of amoxicillin were prevalent. Improving and optimizing the quality of antibiotic prescribing, particularly in children prescriptions, will be the focus of future antibiotic stewardship in China.

Prescription auditing based on the World Health Organization prescribing indicators in inpatient department of a tertiary care hospital in Kerala

Background: Irrational prescribing is rampant worldwide. Rational prescribing is the need of hour. Prescription or medication audit can foster rational prescribing and acts as benchmark for comparison with future audit. Core prescribing indicators are highly standardized and formulated to assess rational drug use. Aim and Objectives: The objectives of study were to study major drug groups prescribed, assess Rational Prescription pattern by measuring World Health Organization (WHO) Core Prescribing Indicators and assess quality of prescriptions at General Medicine Inpatient Department in a tertiary care hospital. Materials and Methods: It was an analytical cross-sectional study done in the department of general medicine, in a tertiary care hospital for a period of 6 months. Approval from Institutional Research Committee and Institutional Ethics Committee were taken before starting the study. A total of 779 prescriptions were analyzed. Results: 779 prescriptions were analyzed. About 56.5% prescriptions were of males and 43.5% of females. Mean age of the patients was 56 years. A total of 4370 medicines were prescribed in 776 prescriptions. Due to lack of legibility, we were unable to decode ten medicines out of 4350 medicines prescribed. The dosage forms prescribed were; oral 95.7%, injections 3.8%, inhalational agents 0.4%, and topical agents 0.2%. Average number of medicines per prescription was 5.6. Percentage of medicines prescribed by generic name was 41%. Percentage of antibiotics per prescription was 25%. Percentage of injections per prescription was 21.1%. Percentage of medicines prescribed as per National Essential Drugs List (EDL) (2015) was 2.6% and as per WHO EDL (20th list March 2017) was 1.7%. Percentage of fixed dose combinations (FDCs) was 5.3%. Conclusions: From the findings in this study, all prescribing indicators except percentage of antibiotics per prescription showed deviation from the WHO standards. All the prescriptions were legible.

Prescription audit of patients in a teritiary care hospital

Background: This study was prescribed errors to promote irrational use of drug and decrease patience compliance. Prescription audit can improve prescribing practices and patients to receive high quality drugs.Methods: The study was observational carried out in 150 patients attending outpatient department for period of 6 months from April 2019 to October 2019. Data was analysed using WHO core indicatorsResults: 16% of prescriptions demographic details like age, sex, age were incomplete. In few (15%) prescriptions omission of diagnosis and irrational combination was reported. Dosing errors like doses and duration of treatment were not mentioned in some of prescriptions. Percentage of antibiotics per prescription was found to be 23.64%, which is much higher than the ideal value recommended by WHO.Conclusions: The average number of drugs was higher in prescriptions and trend of polypharmacy was noted with antibiotics usage. Dosing error and few prescriptions were irrational FDCs. Generic drugs were written in majority of prescriptions from essential drug list. Our study need to highlight to write rational prescription by adhering to WHO guidelines with feed back to prescribers and training session regarding safe use of drugs.

Assessment of Drug use Pattern in Paediatric Department of a Tertiary Care Hospital

: Background: Prescription analysis is an essential means to monitor drug use and ascertain the rationality of prescriptions. This study was conducted to assess the drug usage pattern and identify the possible drug-drug interaction in the paediatric ward of the tertiary care hospital. Methods: A prospective observational study was conducted in the paediatric department to analyse the prescriptions using WHO core prescribing indicators and also to identify the possible drug-drug interactions. The study was conducted for a period of 6 months. The drug therapy details were collected and documented in a specially designed data collection form. Descriptive statistics were applied to analyse the data. Results: Among 340 prescriptions studied, 1091 drugs were prescribed. The most commonly prescribed drug class was antibiotics (25.93%), followed by antipyretic and anti-inflammatory agents (16.68%). Acetaminophen was the frequently prescribed drug (14.57%), followed by amoxicillin-clavulanic acid (12.09%). The average number of drugs prescribed per prescription was 3.2. 24.11% of drugs were prescribed as generics. The percentage of antibiotics and injections prescribed was 68.52% and 25.58%, respectively. The percentage of drugs that are prescribed from EDL was 88.52%. One hundred forty-three drug interactions were identified from the prescriptions, of which the majority were found to be moderate in severity (86.01%). Conclusion: The study observed increased use of antibiotics when associated with WHO core prescribing indicators. It also observed a majority of moderate drug-drug interactions.Key words: Paediatrics, Prescribing indicators, Prescription pattern, WHO core indicators, Drug-drug interactions, Antibiotics.

Assessment of Prescribing and Dispensing Practices Based on WHO Core Prescribing Indicators in Hospital and Community Pharmacies in Khartoum State - Sudan

Background Rational drug management has become an increasingly important topic in order to make optimal use of the drug budget to offer health services of the highest possible standard. It is important that continuous assessment for rational prescribing and use of drug have to be carried. Objective of this study was to gather data on existing drug prescription and dispensing practices and to evaluate the prescribing and dispensing indicators as described by the WHO. Method Observational, cross-sectional, prospective study was designed and conducted to evaluate the performance of hospital and community pharmacies in Khartoum state, related to rational drug use and prescribing and dispensing practices during the period from November 2018 to March 2019. 297 Hospital and community pharmacies from public and private sectors were contacted for carrying out this study survey and the collected data were analysed against WHO standards for core drug use indicators. Results The average number of drugs per encounter was 3.98 drugs. Hospital pharmacies had a higher (4.18±1.516) number of drugs prescribed than community pharmacies (3.87±1.331) with significance difference between mean of two types of pharmacies (P = 0.015). The percentage of antibiotic per prescription was (53.7%). Antibiotic prescribing was much higher (54.0%) in the hospital pharmacies compared to (48.6 %) in community pharmacies. The average percentage of injections per prescription at the facilities was found to be (57.6%). The percentage of prescription with written diagnosis was (26%.0) and the percentage of prescriptions with written dose was (78%.0). The average dispensing time was (1.75) minutes, The Percentage of drugs actually dispensed was (55.99%), the average adequacy of labelling of drugs was (30.4%). Overall prescribing and dispensing indicators were higher than WHO standard. Conclusion The degree of poly pharmacy was greater than of WHO criteria. The completeness and rationality of prescription was found suboptimal and components were missed.

Antibiotic dosing adjustments in patients with declined kidney function at a tertiary hospital in Jordan.

Estimating kidney function is essential to consider in drug dosing for renally eliminated drugs. It has been estimated that more than half of medications' adverse effects are caused by the inappropriate dosing. Limited data are available on drug dosing adjustment, particularly the antibiotics, among Jordanian patients with declined kidney function. The aim of this study was to evaluate the extent of antibiotics' dose adjustment according to the recent guidelines of drugs' renal dose adjustment. The present study utilised data from a previous retrospective study, which recruited inpatients who were clinically stable and received IV antibiotics for more than 24hours at King Abdullah University Hospital. Sociodemographic and clinical data were collected by referring to information technology departments at KAUH. The percentage of antibiotics which were inappropriately adjusted based on creatinine clearance was evaluated using Lexicomp-Clinical Drug information website. A total of 110 antibiotics were dispensed for 80 patients. Results showed that (36.25%) of patients were given antibiotics without renal dose adjustments based on their creatinine clearance. Urinary tract infections followed by respiratory tract infections were the most common among the study participants. The most commonly prescribed antibiotic was Imipenem/cilastatin (41.25%). Among antibiotics prescribed without renal dose adjustment, Imipenem/cilastatin was the most common and represented 62% of the cases while vancomycin was the least and represented only 3.45% of the non-renally adjusted doses. The current study clearly demonstrates the lack of adherence to recent guidelines of renal dose adjustment for renally excreted antibiotics. Such findings shed the light on the necessity of considering antibiotics dose adjustment in patients with declined kidney function with the aim of ensuring medication safety and improve health outcomes.

A study on prescribing pattern of antibiotics in medicine ward of tertiary care teaching hospital

Background: Antibiotics are most frequently prescribed and problem associated with antibiotics over and under use leads to treatment failure and on the other side resistance to drugs increases. Assessment of antibiotics prescribed is important for checking quality and standard of prescriptions. The objective of the study was done for assessing the prescribing pattern of antibiotics using WHO indicator in medicine ward of tertiary care teaching hospital.Methods: Prospective observational study was carried out for a period of six months in medicine ward after ethical committee approval. Data was collected in data collection forms and evaluated using WHO indicator.Results: A total of 190 prescriptions was collected in which 1145 drugs were prescribed. Total number of antibiotics in prescription was found to be 164. Percentage of antibiotics was found to be 14.32% which was according to WHO prescribing indicator. Various class of antibiotics was prescribed in which cephalosporin with total of 90 (54.87%) followed by penicillin 18 (10.97), macrolide 18 (10.97%) fluoroquinolones 11 (6.70%), nitroimidazole 8 (4.87%), amino glycoside 8 (4.87%) and other classes 11 (6.70%).Conclusions: The study shows that pattern of antibiotics was according to the WHO prescribing indicator but still practice was lacking in terms of selection of antibiotics as there was no culture sensitivity test was performed.

1145. Reducing Antibiotic Use In Children With Respiratory Syncitial Virus-related Bronchiolitis: Implementation of TeamSTEPPS® 2.0 to Improve Pharmacy-Physician Communication in a Community Hospital Antibiotic Stewardship Program

BackgroundOveruse of antibiotics in Respiratory Syncytial virus (RSV) bronchiolitis in children has been reported between 29–80%. Our antibiotic stewardship program (ASP) utilized a validated communication tool using TeamSTEPPS ® 2.0 principles to improve pharmacy-physician communication and improve audit-feedback technique (AFT).MethodsWe trained pharmacists and physicians in TeamSTEPPS ® 2.0 using simulation-based training. The key component of the training was: closed-loop communication and using a scripted pharmacy communication tool. The scripted pharmacy communication tool was modified from the “DESC” script used in TeamSTEPPS ® 2.0, which includes (1) Describing the situation, (2) Expressing concern, (3) providing Solutions, (4) stating Consequences and coming to an agreement. We incorporated this to improve the audit-feedback technique. We aimed to: (1) Reduce overall percentage of antibiotic (abx) use in RSV bronchiolitis by 25%, (2) reduce use of ceftriaxone, (3) reduce average antibiotic days of therapy (DOT).ResultsOur baseline data from 2017–18 RSV season showed a 42% (48/113) use of abx, of which 10% were deemed inappropriate. When compared with the 2018–2019 season, no differences were noted in patient demographics. The median length of stay between the two time periods was similar (2.9 days, IQR 1.9–4.8 days vs. 3.1 days, IQR 2.1–5.1 days, P = 0.17). More patients were admitted to the pediatric intensive care unit (PICU) in the 2018–2019 period: 35/96 (36.4%) as compared with 17/113 (15%) in the previous season. Although similar proportions of patients received abx (42% vs. 41%) in the two groups (Figure 1), average abx DOT, significantly decreased in the 2018–2019 period as compared with 2017–2018 (Figure 2). There was also a decrease in the use of ceftriaxone during the 2018–2019 (Figure 3). All physicians and pharmacists were satisfied with the communication technique and thought that it improved their interaction and understanding of the ASP process.ConclusionThough we did not reduce the overall abx use in RSV bronchiolitis, we did reduce the average abx DOT and use of ceftriaxone in our institution. The use of a validated communication tool to improve prospective AFT was crucial to the success of the ASP program. Disclosures All authors: No reported disclosures.

Assessment of Prescriptions Patterns and Drug Use across the Kurdistan Region

Background: Errors in drug prescriptions are the most common preventable medication errors encountered in clinical practices worldwide. The purpose of this study is to examine the pattern of prescriptions and drug use in the Kurdistan region and to determine whether prescription patterns are based on rational therapeutic considerations. Methods: A cross sectional-observational study was conducted in the Kurdistan region of Iraq over a period of five months. A total of 1000 prescriptions were selected randomly from different pharmacies and data obtained from each prescription. In these prescriptions a total of 2878 medications were prescribed. After collection, excel software was then used to perform calculations. Results: The average number of drugs per prescription was calculated to be 2.8. Drugs prescribed by generic name were 27% and more than 98 percent of prescriptions were handwritten. The duration of therapy was mentioned in 56.5% of prescriptions. However, the dose and dosage form of medications were recorded 62% and 87.3% respectively. The percentage of prescriptions containing a signature was 88.1%. Furthermore, the percentage of antibiotics, supplements, non-steroidal anti-inflammatory drugs and other painkillers were prescribed at a rate of 51.8%, 44.2%, 31.8%, and 21.8% per prescription. Conclusion: Whilst observing the data we can conclude that the rate of drugs written per prescription is much higher than the suggested World Health Organization (WHO0 average. Prescribing errors are one of the most common preventable causes of medication errors and the use of electronic prescriptions may play a huge role in ameliorating this fact.

Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study

BackgroundAntibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines.MethodsA prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22).ResultsThe average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71–5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10–2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35–3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62–2.52).ConclusionsThis study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20–26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4–24.0%. Patients’ age, gender and number of medicines were significantly associated with antibiotic prescribing.