Use Of Antibiotics In Practice Research Articles

Evaluation of mothers' knowledge, attitude and practice of antibiotic use in children under 7 years old referred to Jahrom children's clinic

Evaluation of mothers' knowledge, attitude and practice of antibiotic use in children under 7 years old referred to Jahrom children's clinic

Surveys of knowledge and awareness of antibiotic use and antimicrobial resistance in general population: A systematic review.

BackgroundCurrently, various tools exist to evaluate knowledge and awareness of antibiotic use and antimicrobial resistance (AMR) and are applied by various organizations. Previous systematic reviews have focused mainly on study findings such as levels of knowledge and AMR awareness. However, the survey procedures and data instruments used ought to be scrutinized as well, since they are important contributors to credible results. This review aims to assess the study methods and procedures of existing population-based surveys and explore key components which determine the general population’s levels of knowledge and awareness of antibiotic use and AMR.MethodsWe searched existing literature for population -based surveys which sought knowledge and awareness of antibiotic use or AMR in the general population. Databases searched included Ovid, MEDLINE and EMBASE, PsycINFO and Scopus, domestic journals and gray literature sources. Population-based cross-sectional studies published in English or Thai from January 2000 to December 2018 were included in the review. Quality assessment was conducted using the ‘Appraisal Tool for Cross-Sectional Studies’ (AXIS).ResultsAll 22 studies included in the analysis had clear objectives focusing on assessing people’s levels of knowledge, awareness, attitudes and behavior relating to antibiotic use and awareness of AMR. These studies had employed appropriate methodologies for population-based cross-sectional surveys relative to research questions. More than half of studies (14 out of 22) had scientifically soundly designed methodologies which captured the representativeness of the population; whereas the remaining studies had unclear sample size estimations, inappropriate sample frames and selection biases. Half of the studies had tested the validity and reliability of the questionnaire. The common questions used by these surveys were categorized into four themes: behavior related to antibiotic use, knowledge and awareness of antibiotic use, knowledge and awareness of AMR and others such as receiving information about antibiotic use and AMR or cross-cutting issues like self-medication.ConclusionThis review identified four key features of good practices in antibiotic use and awareness surveys: a) clear survey objective; b) scientifically sound sampling techniques ensuring representativeness; c) strategies for recruitment of samples and survey administration methods; and d) credible measurement to prevent non-sampling biases. During questionnaire design, the health systems context in terms of access to health services and antibiotics should be taken into account. In conclusion, to maximize the use of surveys, the application of findings in surveys and associated factors related to antibiotic use and AMR should primarily generate public health interventions and target specific groups to make progress in solving AMR problems.

Antibiotic use in chicken farms in northwestern China

BackgroundMisuse of antibiotics in food animals contributes to an increase of antibiotic resistant bacteria transmitting to humans. China is the largest producer and user of antibiotics in the world, of which animals share more than half of the total consumption. This study aimed to explore Chinese farmer’s practice of antibiotic use and the factors associated with their use.MethodsIn this cross-sectional survey, we interviewed farmers from 88 chicken farms in northwestern China. We defined two kinds of misuse: 1) using antibiotics in the Chinese prohibited list, and 2) using antibiotics within the recommended withdrawal period. Factor analysis was used to select farmers’ knowledge variables and multinomial logistic regression was used to determine factors associated with antibiotic misuse.ResultsAll the participating farmers used antibiotics on their farms. Amoxicillin was the most common antibiotic used (76.5%), followed by norfloxacin, ofloxacin, ceftriaxone and oxytetracycline. 75% of farmers used antibiotics in the prohibited list while 14.8% continued to use antibiotics during the withdrawal period. Hierarchical cluster analysis revealed three patterns of antibiotic use: 1) excessive use of non-prohibited and prohibited antibiotics or an excessive user, 2) low use of a few types of non-prohibited and moderate use of prohibited antibiotics or a low user, 3) multiple use of a variety (≥ 7 types) of non-prohibited and prohibited antibiotics or a moderate user. Farmers from medium size, family-based farms, those with a low education level and low income were more likely to misuse antibiotics. Prior formal agricultural training was associated with reducing multiple types of antibiotic use. There was a huge gap between policy and reinforcement causing antibiotic misuse in the study community.ConclusionAntibiotics are commonly used on chicken farms; misuse of antibiotics is high; improvement in farm sanitation, education on antibiotic use for farmers and veterinarians/pharmacists and enforcement of the regulations may reduce antibiotic use on chicken farms in China.

Knowledge, Attitudes and Practices in Antibiotic Use in Family Medicine Students.

BackgroundInappropriate prescriptions of antibiotics lead to ineffective and unsafe treatments and worsening of diseases. Medical students may have deficiencies in their prescription skills and they may need further training in the use of antibiotics for their practice. Medical skills in prescribing antibiotics can be improved through continuous medical education. The aim of this study was to assess the current levels of knowledge, attitudes, and practices (KAP) in antibiotic prescription in upper respiratory tract infections (URTI) among postgraduate family medicine students in Ecuador.MethodsA cross-sectional study with an on-line survey, based on micro-curricular contents, to evaluate KAPs regarding antibiotic prescription in URTI among postgraduate family medicine students in 5 provinces of Ecuador.ResultsTwo hundred and seventy-three physicians responded (94.1%). Most physicians treated between 1 and 5 URTI cases per day. The odds for inadequate knowledge and inappropriate practices in URTI among postgraduate family medicine students were 8.74 (95%CI, 4.94-15.46, P < .001) and 5.99, (IC95%, 2.66-13.50, P < .001) in physicians who were students of the first half of the study program.ConclusionThe knowledge in URTI was limited among physicians. Nonetheless, they expressed a positive attitude toward not using antibiotics in URTI. A postgraduate program can significantly improve the knowledge and practices related to antibiotic prescriptions in URTI.

Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members.

BackgroundAntimicrobial resistance (AMR) is a serious public health problem and a global concern. The inappropriate use of antibiotics has been identified by the World Health Organization as a major risk factor for AMR.MethodsThe purpose of this research study is to assess the prevalence of inappropriate antibiotic use among Qatar University students and their family members, detect sociodemographic factors associated with inappropriate use, evaluate the knowledge and attitude towards antibiotic use, and assess respondents’ opinions on healthcare providers’ antibiotic prescription practices. Participants (N = 596) completed a self-administered questionnaire. Descriptive analysis, the Pearson chi-squared test, and multivariate logistic regression analyses were performed.ResultsThe major inappropriate antibiotic use practices followed by the respondents were using antibiotics without prescription (82%), not completing the antibiotic course (45%), and obtaining antibiotics from the pharmacy without prescription (23%). The chi-square test results showed that age (p = 0.031) and nationality (p = 0.041) were associated with using antibiotics without prescription. In addition, respondents less than 21 years of age (p<0.001), who had only a secondary education (p = 0.007), and who lived in one of the large and crowded cities in Qatar (p = 0.011) had higher odds of stopping the antibiotic before completing the course. Our study also revealed that almost 60% of the respondents had inadequate knowledge and a negative attitude towards antibiotic use. Nationality and municipality were the independent factors associated with having appropriate knowledge of antibiotic use. Univariate logistic regression analyses in our study demonstrated that older (>26 years), married and university-graduated participants were more likely to have a positive attitude towards antibiotic use than others. Respondents also reported that neither doctors nor pharmacists were providing adequate patient education about appropriate antibiotic use. The Socio-Ecological Model was applied to interpret the findings and frame implications.ConclusionThe findings shed light on various factors shaping antibiotic use practices and provide evidence to design multilevel behavioral interventions to improve public practices of antibiotic use.

A non-interventional comparative study between medical and dental undergraduates regarding their knowledge, attitude and practice of antibiotic use in a tertiary care teaching rural hospital: emphasis on WHO fact-sheets

Background: The threat of antibiotic resistance is rapidly progressing and intensifying. The awareness generation of antibiotic use, its seriousness and significance are the first step towards restricting its progress. It is in this regards that this comparative questionnaire-based study was conducted.Methods: The knowledge, attitude and practice (KAP) among medical and dental students of a tertiary care teaching rural hospital was assessed. Before initiating the study, their written consent was taken, and 125 structured questionnaires were distributed to medical and dental students. Data collected was further entered in Microsoft excel sheet and further comparison of KAP between them was analysed.Results: The results were depicted in percentage. Regarding the indiscriminate and injudicious use of antibiotics can lead to prolongation of illness, the medical students were more aware 82.4% compared to the dental 65.6%. When asked about additional burden of medical cost to the patient, the medical students responded with yes 88.8% and dental student’s response of yes was 47.22%. Also, medical 90.4% students had heard about antibiotic resistance and 60.8% from dental students, which implies that UG students should be made more aware of antibiotic resistance and its consequences.Conclusions: Thus, the results of the study give useful information about the knowledge, attitudes and practices of medical and dental students, that can be further utilized to plan suitable educational interventions that target at improving the knowledge for prescribing antimicrobial medicines. This can further help in minimizing the development of bacterial resistance.

Assessing the knowledge, attitude, and practice on antibiotic use in under-5 children with respiratory tract infection among mothers attending a pediatric outpatient department

This study aimed to assess the knowledge, attitude, and practice among mothers on antibiotic use in under-5 children with respiratory tract infection attending the pediatric outpatient department at Sri Ramachandra Hospital in Chennai city, South India. A cross-sectional descriptive design was adopted in this study. The target population was mothers of under-5 children attending the pediatric outpatient department in the G block of Sri Ramachandra Hospital, Chennai city, South India. The sample size of 240 was estimated by a single proportion. The non-probability convenience sampling technique was used to select samples. A structured questionnaire developed by the investigator based on previous study literatures was used to assess the knowledge, attitude, and practice of antibiotic use in respiratory tract infections. The study revealed that 49.6% of mothers had moderately adequate knowledge, 92.1% of mothers had moderately favorable attitude, and 70% of mothers had unsatisfactory practice. There was a statistically considerable positive correlation between knowledge and attitude (p < 0.05) and attitude and practice (p < 0.001). There was a significant association between knowledge on antibiotic use and number of children, education, occupation, and monthly family income of mothers at a significant level of p < 0.05 and p < 0.01, respectively. There was a significant association between attitude on antibiotic use and age of child at p < 0.05. There was a significant association between practice on antibiotic use and education, age of child at levels of p < 0.05 and p < 0.01, respectively. This study suggested that perfection in the appropriate use of antibiotics would require multi-sectorial cooperation and long-term efforts. Healthy communication with mothers through mass media will be useful in enhancing and promoting changes in mothers’ knowledge, attitude, and practice towards the use of antibiotics for their children, especially among parents from rural areas and with no formal education.

Knowledge of antibiotic use and resistance among students of a medical school in Nigeria.

Antimicrobial resistance presents a growing concern worldwide. Medical students are potential antimicrobial prescribers and stewards following graduation as doctors. The aim of this study was to assess the knowledge regarding antibiotic use and resistance among pre-final year and final year medical school students of Ebonyi State University, Nigeria. A cross-sectional study was conducted among all the 184 pre-final and final year medical students of the College of Medicine at Ebonyi State University, Nigeria. Information was collected in April 2018 using a semi-structured, self-administered questionnaire and data were analysed with Epi-Info Version 7.2. Analytical decisions were considered significant at P < 0.05. Respondents were mostly males (62.5%), aged 20-29 years (68.9%) with 60.9% of them in the final year class. Eighty-seven percent of them desired more education on antibiotic use and resistance. Majority 119 (64.7%) respondents had good knowledge of antibiotic use and resistance, however, 39% incorrectly answered that bacteria cause common cold. Only 103 (56.0%) of them had positive practice of antibiotic use. While 8.2% of respondents always consulted a doctor before starting an antibiotic. 37.2% of them never discarded their remaining leftover medications. Knowledge was associated with respondent's gender (P=0.035) while practice was associated with the class of study (P<0.001). There was good knowledge of antibiotic use and resistance, however, practice levels were poor. There is need to enrich existing courses and training about antibiotic use in the curriculum of the medical schools with more emphasis on antimicrobial stewardship.

Knowledge, attitude and practice of antibiotic use among university students: a cross sectional study in UAE

BackgroundAntibiotic resistance became a marker of irrational and overuse of these medicines in many countries. This study aims to evaluate the knowledge, attitude and practice (KAP) of medical students (MS) and non-medical students (NS) towards antibiotic use in the United Arabs Emirates (UAE).MethodA descriptive cross-sectional study was conducted amongst 1200 MS and NS from Ajman University in UAE. A self-administered questionnaire was used to assess the knowledge, attitude and practice of antibiotic use. The later was composed into knowledge, attitude and practice of antibiotic use. Descriptive analysis was used to analyse the qualitative variables while quantitative variables were summarised using mean ± Standard Deviation (±SD). A Chi-square test was used to compare differences in the proportions of qualitative variables. Unpaired student’s t-test was used to test the average differences in quantitative variables across medical and non-medical students. A p < 0.05 was considered statistically significant.ResultsOne thousand two hundred students (MS: 600 and NS: 600) were considered valid for analysis. On average, participants scored higher in attitude score followed by knowledge and practice scores. The average attitude score was 76% (95% CI: [75, 78%]) compared to 59% for knowledge (95% CI: [58, 60%]) and 45% (95% CI: [44, 47%]) for practice. The results suggest that overall, medical students scored remarkably better than non-medical students on KAP of antibiotic use, respectively (p = 0.0001), (p = 0.000) and (p = 0.002).ConclusionThe students’ knowledge, attitude and practice regarding antibiotic use, which drive the practice of self-medication, reflect a gap in medical curricula in UAE institutes and medical colleges.

Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey

ObjectivesTo study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors...

Current antibiotic use in the treatment of enteric fever in children.

Background & objectives:Antimicrobial resistance is a major challenge in the treatment of typhoid fever with limited choices left to empirically treat these patients. The present study was undertaken to determine the current practices of antibiotic use in children attending a tertiary care hospital in north India.Methods:This was a descriptive observational study in children suffering from enteric fever as per the case definition including clinical and laboratory parameters. The antibiotic audit in hospitalized children was measured as days of therapy per 1000 patient days and in outpatient department (OPD) as antibiotic prescription on the treatment card.Results:A total of 128 children with enteric fever were included in the study, of whom, 30 were hospitalized and 98 were treated from OPD. The mean duration of fever was 9.5 days at the time of presentation. Of these, 45 per cent were culture positive with Salmonella Typhi being aetiological agent in 68 per cent followed by S. Paratyphi A in 32 per cent. During hospitalization, the average length of stay was 10 days with mean duration of defervescence 6.4 days. Based on antimicrobial susceptibility ceftriaxone was given to 28 patients with mean duration of treatment being six days. An additional antibiotic was needed in six patients due to clinical non-response. In OPD, 79 patients were prescribed cefixime and additional antibiotic was needed in five during follow up visit.Interpretation & conclusions:Based on our findings, ceftriaxone and cefixime seemed to be the first line of antibiotic treatment for typhoid fever. Despite susceptibility, clinical non-response was seen in around 10 per cent of the patients who needed combinations of antibiotics.

Perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance

ObjectivesTo assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. MethodEuropean junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences. ResultsThe questionnaire was completed by 641 junior physicians: family medicine (37%), other medical specialties (e.g., pediatrics, internal medicine, neurology: 45%), surgical specialties (11%), and anesthesiology-intensive care specialty (7%). Most respondents (93%) declared being aware of the risk of bacterial resistance and 41% acknowledged prescribing antibiotics more often than necessary. Two factors were independently associated with appropriate prescription practices: a high perceived level of education on antibiotic use (OR=1.51; 95% CI [1.01–2.30]) and a medical specialty (OR=1.69; 95% CI [1.16–2.46]). Factors independently associated with taking into account adverse events of antibiotics were a good perceived knowledge of antibiotics (OR=3.71; 95% CI [2.09–6.61]), and a high perceived education level on antibiotics (OR=1.70; 95% CI [1.11–2.58]). ConclusionOur data can help better define interventions targeting junior physicians in antibiotic stewardship programs.

Knowledge, Attitude and Practice of Antibiotic Use and Resistance among Second Year Medical Students in a Teaching Hospital

Knowledge, Attitude and Practice of Antibiotic Use and Resistance among Second Year Medical Students in a Teaching Hospital

Knowledge, Attitude and Practice of Antibiotic Use and Antimicrobial Resistance:A Study Post the ‘Red Line’ Initiative

Antimicrobial resistance (AMR) is propagated by irrational use of antibiotics by healthcare practitioners and the uninformed public. This study assessed a select cohort of 504 urban Indians for their knowledge, awareness and practice of antibiotic use and AMR. Forty seven per cent were unaware of the differences between over-the-counter drugs and antibiotics. One in four believes that dose-skipping does not contribute to AMR. One in ten tends to self-medicate. One in five bought medicines without prescription or started an antibiotic course by calling a doctor. Our results mandate educational campaigns, stewardship and surveillance at the national level for prudent antimicrobial use in the Indian community.

Change in parental knowledge, attitudes and practice of antibiotic use after a national intervention programme.

Nation-wide multifaceted interventions to improve antibiotic use were undertaken in the former Yugoslav Republic of Macedonia in September 2014. This study aimed to assess the parental knowledge and attitudes about antibiotics, and self-medication practices in children, and evaluate the impact of interventions on these parameters. Pre-post-intervention surveys were conducted in May 2014-16 in three administrative regions in the country. Data were collected by interviewing parents of children younger than 15 years of age through a questionnaire. The analysis of knowledge, attitudes and antibiotic use involved descriptive quantitative statistics. The effects of interventions were assessed by a logistic and linear regression analysis. Data from 1203 interviewees showed that 80% of parents knew that antibiotics could kill bacteria, while 40% believed antibiotics could kill viruses. One third of parents expressed potential dissatisfaction with doctors who would not agree with them on antibiotic use. More parents received information about not taking antibiotics unnecessarily after the interventions, but the rates decreased one year later. At baseline, 20% of the parents and 10% of the children who received antibiotics in previous year, took them without prescriptions. Parental self-medication rates did not change over time, while children rates decreased only in 2015. The insignificant and short-term changes in knowledge, attitudes and self-medication demonstrate that interventions need to be implemented for a longer period of time, at a large scale, with active health providers' engagement, and accompanied by inspections to promote appropriate use of antibiotics and discourage self-medication.

The knowledge, practice, and attitude regarding antibiotic use among attendants of primary health care centres: a cross-sectional study in Qatar

Background: The inappropriate use of antibiotics is a significant global health problem as it is contributing to the development of antimicrobial resistance. Thus, this study aimed at assessing the knowledge, attitude, and practice of antibiotic use among patients attending primary health care (PHC) centres in Qatar. Methods: 722 adult patients from the primary health care centres were recruited and a self-administered questionnaire was employed. Results: Regarding the knowledge, 69.9% of patients believed that completing the full course of antibiotics is a necessity. In addition, more than half of the interviewees believed that antibiotics are necessary to treat a sore throat or an ear infection. Interestingly, regarding the practice, more than half (54.4%) of the interviewed patients often requested antibiotics as part of their treatment. Regarding the attitude, many patients (87.2%) pressured physicians to be given an antibiotic. Conclusions: This study revealed that patients often have inadequate knowledge about antibiotic use, which affects their attitude and practice. Thus, educating patients may reduce unnecessary antibiotic use and resistance in the community.

Knowledge, attitude and practice of antibiotic use and misuse among adults in Riyadh, Saudi Arabia.

Objectives:To assess the knowledge, attitude, and practice of antibiotics (ABs) use and misuse among adults living in Riyadh, Saudi Arabia.Methods:In this cross-sectional study, a self-administered questionnaire was distributed to participants from March 2016 to January 2017 in the outpatient department of King Khalid University Hospital and Dental Hospital, King Saud University, Riyadh, Saudi Arabia. The questionnaire was divided into 4 sections. The first and second section inquired regarding demographic details and knowledge of ABs. The third section assessed practice of ABs and the fourth section assessed attitude of participants towards ABs use. Questionnaires were hand delivered to respondents using convenience sampling. Statistical analysis using frequency distributions and knowledge responses of AB resistance for ‘yes’ and ‘no’ were associated with participant characteristics using Chi-square test.Results:A total of 1966 questionnaires were completed (response rate: 93.5%). Sixty-seven percent of the respondents were unaware of the meaning of ABs resistance. Sixty-seven percent of respondents were unaware of ABs being harmful for children’s teeth and 64.9% unaware of ABs that develop allergy and death. Twenty-four percent believed that ABs worked on viruses, 31% on cold and 21% can cure cough. Almost 51% used ABs without physician prescription while 37.5% obtained ABs directly from pharmacists without physician’s prescription. Almost 42% participants discontinued ABs on alleviation of symptoms. There was significant difference in knowledge response of AB resistance and source of AB use (p=0.026), reason of AB use (p=0.038) and discontinuation of ABs (p=0.041).Conclusion:Adults showed insufficient knowledge and understanding regarding the safe use of ABs consumption among the population.

Antibiotic use among health science students in an Indian university: A cross sectional study

BackgroundAntibiotics, one of the frequently prescribed medications in modern medicine is plagued by misuse and consequent development of resistance. We report the knowledge and practice of antibiotic use and the extent of self-medication with antibiotics among health science students of a university in south India. MethodsA cross-sectional study was carried out that included students from various disciplines such as Medicine, Dentistry, Pharmacy, and Nursing. A random sample of 531 students, were recruited into the study and those students with a history of any chronic disease requiring long-term treatment were excluded. ResultsAlmost 58% reported using antibiotics in the last 3 months and 39% frequented its use over 3 times in a year. Thirty percent stated that they had procured antibiotics over the counter without a valid prescription. Common ailments that reportedly triggered antibiotic use, ranged from mild fever to skin infections. Medical (25%) & Dental (36%) students declared self-prescription as a frequent practice. β-lactam group was the most popular group of antibiotics, with over 44% vouching its use. ConclusionThere appears to be inadequate adherence to antibiotic policies among the study population warranting periodic training and monitoring. Establishment of an effective antibiotic stewardship could be the way forward.

PMQR Determinants Expression in Gram-negative Uropathogens Clinically Isolated from Hospitalized Patients with Pyelonephritis in Kharkiv, Ukraine

Background: Resistance to beta-lactams and fluoroquinolones has been increasing in the treatment of urinary tract infections (UTIs), worldwide. Recent studies in Europe and the United States have demonstrated that steady increase in the rate of uropathogen’s resistance to commonly prescribed antibiotics is associated with plasmid-mediated resistance genes existence. According to the published data, acquirеd rеsistance to quinolones is predоminantly mediated by plasmid-mediated quinolone resistance determinants (PMQR) that cоmpromise the efficаcу of the first, second and third generation quinolones. The objective of this study was to determine the prevalence of PMQR genes among uropathogens from hospitalized patients with pyelonephritis and to identify the presence of genes involved in the resistance, specifically - aac(6')-Ib-cr, QnrA and efflux pump QepA. Methods: A cross-sectional study of 105 patients with pyelonephritis, treated in Kharkiv City Clinical Emergency Hospital, Ukraine was carried out. Bacterial isolates were collected, antimicrobial susceptibility of isolates was determined by the Kirby Bauer disk diffusion method and screening for the presence of aac(6')-Ib-cr, QnrA and efflux pump QepA PMQR genes was performed by polymerase chain reaction. Results: Among 81 isolated gram negative bacterial strains, 39 (48.1%) were identified to carry different types of plasmid-mediated resistance determinants, among which 27 (69.2%) were found to be extended spectrum beta-lactamases producers, and 12 (30.8%) – were positive for plasmid-mediated quinolone resistance genes. Most of the identified genes were found in P. mirabilis, E. coli and Serratia spp. strains with its prevalence of 62.5%, 52.8% and 50%, respectively. Most common isolated gene was efflux pump QepA. In this study, 100% of the PMQR producing isolates are identified as meropenem susceptible. Global resistance to fluoroquinolones was ≥ 20% among isolated gram-negative strains. Treatment by fluoroquinolones demonstrated the best favorable clinical response in the patients infected with ESBL-producing organisms, whereas cephalosporins were the most effective in patients infected with fluoroquinolone resistance uropathogens. Conclusion: Therapeutic alternatives for the treatment of UTI patients with resistant uropathogens, particularly in hospitalized patients, are limited. Rational use of antibiotics in practice and/or the proper detection of plasmid-mediated resistance genes among the bаcteria in cоmmunitiеs arе crucial for further prevention of antimicrobial resistance development.

Antibiotic prescribing and dispensing for acute respiratory infections in children: effectiveness of a multi-faceted intervention for health-care providers in Vietnam

ABSTRACT Background: Appropriate antibiotic use is vital to effectively contain antibiotic resistance and improve global health. Acute respiratory infections (ARIs) remain the leading cause of disease and death in children under five in low-income countries. Objective: To evaluate a multi-faceted intervention targeting health-care-providers’ (HCPs) knowledge, practical competences and practices regarding antibiotic use for ARIs. Methods: A multi-faceted educational intervention with a two-armed randomised controlled design targeting HCPs treating ARIs in children was conducted in Bavi district, a rural district in Northern Vietnam in 2010–2011. Thirty-two communes of the district were randomized into two arms, with 144 HCPs in the intervention arm and 160 in the control arm. The intervention, conducted over seven months, comprised: (i) education regarding appropriate-antibiotic use, (ii) case scenario discussion and (iii) poster distribution. Questionnaires to assess knowledge and dispensing/prescribing forms to assess practice were completed before-and after interventions. The main outcome measures were differences in improvement in knowledge and practice in the intervention and control group, respectively. Results: Knowledge improved in the intervention group for ARI aetiology by 28% (ΔDecrement control arm 10%), antibiotic use for mild ARIs by 15% (ΔDecrement control arm 13%) and for severe ARIs by 14% (ΔImprovement control arm 29%). Practical competence for a mild ARI case scenario improved in the intervention and control groups by 20% and 11%, respectively. Total knowledge score increased statistically in the intervention group (Δmean improvement 1.17); less so in the control group (Δmean improvement 0.48). Practice regarding antibiotics for mild ARIs improved by 28% in the intervention group (ΔDecrement control arm 3%). Conclusions: The intervention significantly improved HCPs’ knowledge of ARIs and practice of antibiotic use in treatment of ARIs. We suggest mixed method assessment and long-term follow-up of these interventions to enable better appreciation of the effects and effect sizes of our interventions.