Prescribed Class Of Antibiotics Research Articles

Antibiotic utilization pattern in the department of surgery in a tertiary care centre in eastern India

Background: The overuse and volume of antibiotic prescription has been found to correlate to the incidence of bacterial resistance. Clinical audit and education can favourably change antibiotic prescribing patterns among practitioners.Methods: Prospective cross-sectional prevalence survey carried out in inpatient department (IPD) and outpatient department (OPD) of department of Surgery, Rajendra Institute of Medical Sciences, Ranchi. 200 prescriptions from OPD and 200 case sheets from IPD were randomly selected. Data was analyzed as per WHO outpatient prescribing indicators. ICU patients and patients on anti-tubercular treatment, antifungals etc. were excluded from this study. Data were computed and analyzed using MS Excel.Results: In the OPD, the average no of drugs per patient was 3.445 of which 17% were injections. 33% of drugs prescribed were antibiotics. Beta-lactams followed by nitroimidazoles were the most common antibiotic class. In the IPD, an average of 2.26 antibiotics per patients was prescribed. 21% of antibiotics were prescribed by a generic name and 196 patients received antibiotic prophylaxis. β-lactams again were the most commonly prescribed antibiotic class with 42.7% (n=193) of total antibiotics prescriptions, Metronidazole (n=101, 22.37%) was the most prescribed antimicrobial agent.Conclusions: The practice of polypharmacy and high antibiotic prescription rate is a concern in our part of the country. Prescriptions writing in generic name needs to be encouraged. There is an acute need for the development of antibiotics prescribing guidelines in India.

2388. High-risk antibiotics associated with Clostridioides difficile infection: a national, multicenter analysis

BackgroundHistorically, antibiotics with the highest Clostridioides difficile infection (CDI) risk included clindamycin, advanced-spectrum penicillins, and cephalosporins; however, a recent CDI epidemic involving fluoroquinolone (FQ)-resistant ribotype 027-added FQs as a high-risk class. Now that the ribotype 027 strain is part of an endemic population of C. difficile strains, no contemporary analysis of high-risk antibiotics and CDI risk has been conducted. The primary objective of this study was to identify the strongest antibiotic predictors for CDI.MethodsThis was a case–control study in the national United States Veterans Health Administration (VHA). The study included patients 18–89 years old with an ICD-9-CM code for CDI (008.45), a positive stool test, and active CDI therapy between 2002 and 2014. A random sample of VHA patients without a CDI ICD-9-CM code served as the control cohort. Antibiotic use was defined as any use in the 90 days prior to inclusion. Antibiotic risk factors for CDI were evaluated in a multivariable logistic regression model that included 33 covariates. Results were validated in non-VA patients at a quaternary care medical center in Houston, TX.ResultsA total of 85,451 VHA patients were included (26,149 CDI patients and 59,302 controls). FQs were most commonly prescribed: 24.9% (CDI group) and 7.3% (controls). Strongest predictors of CDI included carbapenems (OR 54.39, 95% CI 25.42–116.36), advanced-spectrum penicillins (OR 41.54; 95% CI 31.49–54.78), third/fourth-generation cephalosporins (OR 17.35; 95% CI 14.49–20.77), clindamycin (OR 3.63; 95% CI 3.26–4.02), and FQs (OR 1.48; 95% CI 1.40–1.57). Macrolides (OR 0.83; 95% CI 0.77–0.91) and tetracyclines (OR 0.58; 95 CI 0.51–0.66) were negatively associated with CDI risk. In a validation cohort of 68,795 patients, carbapenems (OR 2.19; 95% CI 1.86–2.57), third/fourth-generation cephalosporins (OR 1.70; 95% CI 1.50–1.93), and advanced-spectrum penicillins (OR 1.64; 95% CI 1.42–1.89) were also the strongest predictors for CDI. FQs were not significantly associated with CDI.ConclusionAlthough FQs were the most prescribed antibiotic class, carbapenems were the strongest predictor of CDI development in a national cohort of veterans and a validation cohort.Disclosures All authors: No reported disclosures.

Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria.

Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS). Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions. The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure. There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.

Antibiotic use and associated factors in a large sample of hospitalised older people.

The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance.

1240. Antibiotic Prescribing in US Nursing Homes Using National Pharmacy Transaction Data

BackgroundAntibiotics are frequently prescribed inappropriately in nursing homes (NHs); however, national estimates of NH antibiotic use are limited. We aimed to describe antibiotic prescribing in US NHs to identify potential targets for antibiotic stewardship.MethodsA descriptive analysis was conducted using the 2014 proprietary IQVIA long-term care (LTC) Xponent database, which captures oral and intravenous antibiotic prescription transactions from sampled LTC pharmacies representing 70–85% of the LTC market. The data are projected to 100% of the US LTC market. Denominators for rate calculations were captured from the 2014 Minimum Data Set as the number of residents with at least one resident day in an NH in 2014. Antibiotic transaction counts and rates were calculated by resident gender, age, US census region, route of administration, antibiotic class and agent, and total transaction counts were summarized by provider type. Prescribing patterns for antibiotic classes and agents stratified by resident age were also calculated.ResultsIn 2014, there were over 14 million antibiotic transactions in LTC pharmacies, for a rate of 3,302 per 1,000 residents. Female residents accounted for 62% of antibiotic transactions at a rate of 3,305 transactions per 1,000 residents compared with 3,240 per 1,000 male residents. Antibiotic prescribing was highest in the South at 3,752 transactions per 1,000 residents (vs. 2,601 per 1,000 residents in the West). Oral antibiotics accounted for 85% of transactions. Fluoroquinolones were the most frequently prescribed antibiotic class (22%; 723 transactions per 1,000 residents) and the most common agents were levofloxacin, ciprofloxacin, and sulfamethoxazole–trimethoprim. Stratified by age, the percent change in prescribing rates among residents aged <85 to residents aged ≥85 was largest for fluoroquinolones (645 vs. 883) and urinary anti-infectives (210 vs. 319). Internal medicine and family practice providers accounted for 37% and 32% of all antibiotic transactions, respectively.ConclusionA potential antibiotic stewardship target in NHs is fluoroquinolone prescribing. Targeting states in the South for interventions may have the largest impact. Figure. Antibiotic prescribing rates in long-term care by U.S. census regionsDisclosures All authors: No reported disclosures.

Increased use of third-generation cephalosporin antibiotics in the outpatient setting in Korean children and adolescents.

Antimicrobial resistance is a concern to public health, and controlling antibiotic use is therefore important. This study analyzed the trend in outpatient antibiotic prescriptions in children and adolescents in Korea. Using National Prescribing Sample data from the Korea Health Insurance Review and Assessment Service between 1 January 2010 and 31 December 2014, we analyzed outpatient systemic antibiotic (anatomical therapeutic chemical [ATC] J01) prescriptions in patients aged 2-17years. The antibiotic rate was defined as the proportion of all outpatient prescriptions for antibiotics. We calculated absolute and relative differences with 95%CI between 2010 and 2014 in the antibiotic rate by age group (2-6, 7-11, and 12-17years) and the percentage of antibiotic prescriptions by antibiotic class. Seven of the most commonly used antibiotic drugs were identified based on defined daily dose. A total of 7261176 prescriptions were written for 1039756 pediatric patients between 2010 and 2014. The antibiotic rate in all patients increased from 34.8% in 2010 to 70.4% in 2014, resulting in the relative difference of 102.1% (95%CI: 101.7-102.5). Extended spectrum penicillins were the most commonly prescribed antibiotic class, accounting for 40.0-41.0% of all antibiotic prescriptions. The use of third-generation cephalosporins increased steeply with the relative difference of 55.7% (95%CI: 55.2-56.2). Amoxicillin/clavulanate, an extended spectrum antibiotic drug, was the predominately used antibiotic drug but the use of cefpodoxime, a third-generation cephalosporin, increased by 96%. The use of outpatient antibiotics, especially third-generation cephalosporins, has increased in children and adolescents in Korea.

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections.

BackgroundIn 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices.MethodsWe performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration.ResultsWe identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers.ConclusionsInappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

275 Epidemiology of antibiotic prescribing in Dermatology: A retrospective analysis 2008-2016

Introduction: Dermatologists prescribe more oral antibiotics per capita than any other specialty; this use may be associated with a number of adverse outcomes including antibiotic resistance, inflammatory bowel disease, and colon cancer, among others. Understanding the epidemiology of prescribing practices in Dermatology will help identify opportunities to optimize the use of antibiotics. Methods: All prescriptions for oral antibiotics written by dermatologists were identified from 2008-2016 in the de-identified Clinformatics DataMart. Prescriptions were consolidated into courses of therapy and associated with the primary diagnosis from the most recent visit. Courses were separated into those of extended duration (>28 days) and short duration (≤28 days). Results: Tetracyclines were the most frequently prescribed antibiotic class. The top 3 diagnoses associated with extended courses were acne, rosacea, and hidradenitis suppurativa; the number of extended courses prescribed per 100 visits declined from 1.44 in 2008 to 0.87 in 2016. The top 3 diagnoses associated with short courses were skin and soft tissue infections, skin cancer, and follicular disorders; the number of short courses prescribed per 100 visits increased from 0.53 in 2008 to 0.75 in 2016. Between 2008 and 2016 , prescriptions related to acne decreased from 8.75 to 6.73 courses per 100 visits, while prescriptions associated with visits for skin cancer increased from 1.35 to 2.37 courses per 100 visits. Discussion: Antibiotic use in Dermatology appears to be decreasing overall, although use remains common for a variety of conditions. Continuing to develop alternative strategies to oral antibiotics for the management of non-infectious conditions can improve antibiotic stewardship and reduce complications associated with antibiotic use. In addition, given the rising prevalence of antibiotic use associated with visits for skin cancer, there may be an opportunity to evaluate optimal practices for the use of perioperative antibiotics in Dermatology.

Fluoroquinolone Restriction as an Effective Antimicrobial Stewardship Intervention.

Fluoroquinolones are a commonly prescribed antibiotic class that has come under scrutiny in recent years due to mounting evidence of association between adverse drug events, C. difficile infection and isolation of antibiotic-resistant bacteria. Inpatient antimicrobial stewardship (AMS) programs have a toolbox of potential interventions to curb inappropriate antibiotic use, prevent antibiotic-associated adverse drug events, and avoid unnecessary costs of care. Fluoroquinolone restriction policies in the acute care setting have demonstrated beneficial effects, including decreased rates of C. difficile infection and ESBL-producing Enterobacteriaceae. However, a simple blanket restriction policy may "squeeze the antibiotic balloon" and will likely be insufficient if not implemented in conjunction with other AMS interventions. There is a growing body of evidence to support formulary restriction of fluoroquinolones in the acute care setting to decrease rates of C. difficile infection and development of ESBL-producing organisms. Data on how to best implement these restrictions or how to implement outside of acute care settings is limited.

Outpatient Antibiotic Prescribing Among Older Adults in the United States, 2011 to 2014

BackgroundAntibiotics are some of the most commonly prescribed medications for older adults, but antibiotic prescribing practices are poorly understood. We analyzed outpatient antibiotic prescribing data for older adults to identify potential targets for antibiotic stewardship.MethodsOutpatient oral antibiotic prescriptions dispensed in the United States for older adults (i.e., ≥ 65 years) between 2011 and 2014 were extracted from the QuintilesIMS Xponent database. The number of prescriptions and U.S. Census denominators were used to calculate prescribing rates. A chi-square for trend test was used to evaluate annual trends in antibiotic prescribing rates. A descriptive analysis of prescribing rates according to antibiotic, age group, sex, state, census region, and provider specialty was completed.ResultsIn 2011–2014, antibiotic prescribing rates remained stable in U.S. older adults (P = 0.89). In 2014, older adults were prescribed 51.6 million prescriptions at a rate of 1115 prescriptions/1000 persons. Within this cohort, the rate of prescriptions increased with age; persons aged ≥75 years had a rate of 1157 prescriptions/1000 persons compared with 1084 prescriptions/1000 persons in persons aged 65–74. Rates were highest in the South census region and lowest in the West (1228 vs. 854 prescriptions/1000 persons). Although azithromycin was the most commonly prescribed drug followed by amoxicillin and ciprofloxacin, the most commonly prescribed antibiotic class was the fluoroquinolones (245 prescriptions/1000 persons), followed by penicillins and macrolides. Among individuals aged ≥75 years, ciprofloxacin was the most frequently prescribed drug. Family physicians (23%), followed by internists (20%), prescribed the most antibiotic courses for older adults.ConclusionOn average, U.S. older adults receive enough antibiotic courses for every older individual to receive a prescription each year. Fluoroquinolone use is a potential target for addressing the appropriateness of outpatient antibiotic prescribing practices among older adults. As with antibiotic use in other age groups, efforts to improve antibiotic prescribing may be most needed in the South.Figure:Antibiotic Prescribing per 1000 Persons by State for Adults ≥65 years in 2014.Disclosures All authors: No reported disclosures.

Antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China

Whilst the ‘Principles of clinical use of antibiotics’ was released by the Ministry of Health of the People's Republic of China in 2004, limited research has been conducted to evaluate the quality of antibiotic use in real-world practice. In this study, we sought to examine antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China. De-identified outpatient and emergency department pharmacy records containing antimicrobials were extracted from the hospital electronic health records system. Antimicrobial prescribing patterns and out-of-pocket medical costs for antimicrobials were evaluated by patient demographics and the primary diagnosis. Antimicrobial prescriptions stratified by patient age group (<5, 5–17, 18–49, 50–64 and ≥65 years) were also examined. A total of 363 642 antimicrobial prescriptions in 2014 were obtained, corresponding to 197 781 unique patients. Approximately 18% of antimicrobial-containing prescriptions were for acute upper respiratory infection and bronchitis, 15% for fever or cough, 5% for gastritis and duodenitis and non-infective gastroenteritis and colitis, and 7% for other diagnoses without clear indications of bacterial infection. Cephalosporins were the most frequently prescribed antibiotic class (55%). Age-specific antimicrobial prescriptions showed different patterns between children and adults. A total of US$4.6 million were spent as out-of-pocket costs on antimicrobials in 2014, and the median antimicrobial cost per prescription was $9. Unnecessary antibiotic use is still common in real-world clinical practice and remains a public health challenge. Antibiotic-related medical expenditure also presents an important economic burden.

Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India.

IntroductionInfectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India.MethodsData from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008–2011) using a customized form. Data from inpatients aged 0–18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant.ResultsOftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95%confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral- and enteric fever were frequently prescribed antibiotics at both hospitals, yet higher proportion were prescribed antibiotics at the NTH compared to the TH. Broad-spectrum antibiotics were the most commonly prescribed antibiotic class in both hospitals, namely third generation cephalosporins, J01DD (69%) at the TH, and new fixed dose combinations of antibiotics J01R (FDCs, 42%) at the NTH. At the TH, 37% of the antibiotic prescriptions were comprised of antibiotics listed in the IAP-LEM, compared to 24% at the NTH (p<0.05).ConclusionsBroad-spectrum antibiotics were prescribed frequently in both hospitals also for the un-indicated conditions such as viral fever and enteric fever. At the NTH, new FDCs were more frequently prescribed and adherence to the IAP-LEM was substantially lower at the NTH compared to the TH. The results demonstrate need to develop diagnosis-specific prescribing guidelines to facilitate rational use of antibiotics and implement antibiotic stewardship program.

English

Objectives: To empirically classify the etiology of URTI; to study the prescription pattern for antibiotics in URTI; and to analyze the necessity and adequacy of prescribed therapy.Study design: Observational non analytical cross-sectional study.Study sites: Two community pharmacies located in Almada and in Elvas.Study population: Patients with an antibiotic prescription for a URTI (self use) and age greater than or equal to 18 years.Methods: Clinical and therapeutic data were collected during patient observation performed by a training pharmacist, and complemented with information collected through a questionnaire administered face-to-face to patients meeting the inclusion criteria and agreeing to participate. Empirical classifications were developed, one to ascertain the probability of URTI, based on Centor criteria, and another, to judge the need for antibiotic therapy, based on additional criteria considering subpopulations known to be at higher risk. Data was analyzed using the software SPSS, version 20.0.Results: The sample included 22 patients (27.3% recruited in Almada and 72.7% in Elvas). The most frequently prescribed antibiotic class was macrolides (54.5%), followed by penicillins (36.4%). In the first group, clarithromycin prevailed (66.7%) and in the second group, the more common was the association amoxicillin/clavulanic acid (75%). Considering the empirical classification developed, it was estimated that only one patient (4.5%) presented signs and symptoms suggestive of URTI with probable bacterial aetiology, and only three patients (13.6%) had an indication for antimicrobial therapy.Conclusion: The majority of patients observed were classified as having infections with apparently non-bacterial aetiology, for which the prescription of antibiotic would have been probably needless. This alerts to the overuse of antibiotics in the community setting, particularly for URTI, and its contribution to resistance.

Antibiotic prescribing pattern in elderly acute diarrhoeal patients

Objective: The study was aimed to analyze the Antibiotic prescribing pattern in elderly acute diarrhoeal patients. Material & Methods: The study was conducted in outpatients of various public facilities (S.N. Medical College, Agra, CHC and PHC) and private facilities (private hospital/clinics) within 5 Km range from S.N. Medical College, Agra, from March' 2011 to Aug' 2011. A total of 182 prescriptions of outpatients >60years presenting with acute diarrhoea were reviewed. A specially designed data entry form was used to collect data. Antibiotic use was measured in the terms of Percent of patients receiving antibiotics and Prescribing patterns of various antibiotics were analyzed. Results: Total 182 Number (97 from Public facilities + 85 from Private facilities) of Prescriptions collected from both type of facilities out of which 127 Number (53 from Public facilities + 74 from Private facilities) Of Prescriptions received at least one antibiotic. Overall from both public and private facilities 69.78% (127 out of total 182) of the patients with acute diarrhoea were prescribed at least one antibiotic. 54.63% (53 out of 97) of the patients at public facilities and 87.05% (74 out of 85) at private facilities were prescribed at least one antibiotic. In public sector facilities, Fluroquinolones 23(23.71%) were the most prescribed antibiotic class, followed by the FDCs 21 (21.64%), Macrolides 08(8.24%), Tetracyclines 01(1.03%), while in private facilities FDCs 59(69.41%) were the most prescribed antibiotic class, followed by the Fluroquinolones 06(7.05%), Macrolides 04(4.7%), Cephalosporins 03(3.52%), Tetracyclines 01(1.05%) and Penicillin’s 01(1.05%). Conclusion: From our study it was observed that antibiotics are being extensively prescribed for elderly acute diarrhoeal patients. There was high use of newer Antibiotics. Further studies are needed to rationalize such high uses of antibiotics in elderly acute diarrhoeal patients.

Study the outpatients′ prescription pattern of antibiotics in paediatric populations of two hospitals

Objective: To assess the outpatients prescription pattern of antibiotics in paediatric population of a rural and an urban hospital. Materials and Methods: A prospective, cross-sectional and interventional study was carried out in the paediatric departments of Adichunchanagiri Hospital and Research Centre and Jabilli Children HospitalRajahmundry for a period of 7 months, after taking permission from the ethics committee. The consent/assent of the patients was taken, and their data and prescription information was collected by using a patient data collection form This was done for a period of 3 months in each hospital. The collected information was subjected for suitable statistical analysis. Results: A total of 1170, hospital 1: 915/218 and hospital 2: 255/175, prescriptions were screened. Out of which 218 and 175 were contained antibiotics, and the average number of drugs was (2.84 ± 0.11) and (3.61 ± 0.15) for hospital 1 and 2, respectively. The prescriptions contained only one antibiotic. No drug interaction (DI) and adverse drug reactions (ADRs) were found. Most common diseases found were lower respiratory tract infections (LRTI) and upper respiratory tract infections (URTI) (hospital 1), and fever and LRTI (hospital 2). Commonly prescribed antibiotic class and drugs was penicillin-amoxicillin (hospital 1), cephalosporins-cefixime, cefuroxime, and cefalexin (hospital 2). The antibiotic combination used was amoxicillin + clavulanic acid. The average total prescription cost and antibiotic cost was Rs. 106.66 and Rs. 70.32 (hospital 1), and Rs. 245.41and Rs. 113.32 (hospital 2), respectively. Conclusion : The prescribing pattern of antibiotics was rational in both the hospitals.

Fluoroquinolone resistance in Mycobacterium tuberculosis: the effect of duration and timing of fluoroquinolone exposure.

Fluoroquinolones are the most commonly prescribed antibiotic class in the United States. They have the potential to become first-line antituberculosis therapy, but the effect of fluoroquinolone use on fluoroquinolone resistance in Mycobacterium tuberculosis is not well characterized. To determine the prevalence of and risk factors for fluoroquinolone-resistant tuberculosis in a large United States population. We identified all people with culture-confirmed tuberculosis enrolled in TennCare (Medicaid) and reported to the Tennessee Department of Health from January 2002 to December 2006. People with fluoroquinolone-resistant M. tuberculosis isolates (cases) were compared with those with susceptible isolates (control subjects). Fluoroquinolone resistance was determined by agar proportion using ofloxacin 2 microg/ml. Outpatient fluoroquinolone exposure in the 12 months before tuberculosis diagnosis was ascertained from TennCare pharmacy data. Of 640 study patients, 116 (18%) had fluoroquinolone exposure in the 12 months before diagnosis, and 16 (2.5%; 95% confidence interval [CI], 1.4-4.0%) M. tuberculosis isolates were fluoroquinolone resistant. Among the 54 patients with more than 10 days of fluoroquinolone exposure, 7 (13%) had fluoroquinolone resistance. In multivariable logistic regression analyses using propensity score to control for age, sex, race, HIV serostatus, and site of disease, more than 10 days of fluoroquinolone exposure before tuberculosis diagnosis was associated with fluoroquinolone resistance (odds ratio 7.0; 95% CI, 2.3-20.6; P = 0.001). Fluoroquinolone exposure for more than 10 days that occurred more than 60 days before tuberculosis diagnosis was associated with the highest risk of resistance (20.8%; odds ratio 17.0; 95% CI, 5.1-56.8; P < 0.001 compared with no exposure). Overall, fluoroquinolone resistance was relatively low. However, receipt of fluoroquinolones for more than 10 days, particularly more than 60 days before tuberculosis diagnosis, was associated with a high risk of fluoroquinolone-resistant tuberculosis.

Antibiotic Treatments for Children Ages 0–23 Months in a Northern Italy Region: a Cohort Study

This study aims to describe the pattern of antibiotic treatments in the community for children ages 0-23 months in Emilia-Romagna (a northern Italy region) pointing out possible changes of prescribed agents when first treatments in the life of each children are compared to successive ones. The Regional Drug Prescription and the Resident Population databases were used as data sources to study the cohort of children born between January 1 and December 31, 2000 and resident in Emilia-Romagna. The cumulative incidences of children with at least one treatment were 22%, 55% and 82% at 6, 12 and 24 months of age, respectively. Broad spectrum penicillins were the most prescribed antibiotic class for children at their first treatment while cephalosporins were the most prescribed class for successive treatments and when pooling all treatments. Cephalosporins and other second line antibiotics are frequently prescribed to 0 to 23-month-old residents in Emilia-Romagna even when only first treatments are considered; further research is needed to quantify inappropriateness of antibiotic prescription.

Associated Diarrhea: Another Reason to Limit Fluoroquinolone Use

Fluoroquinolones are powerful antimicrobial agents, the most widely prescribed class of antibiotics in the U.S. Concern about the rapid emergence of

A three‐year population‐based study of antibiotic treatments for children

To describe the use of systemic antibiotics in the paediatric population of the Emilia-Romagna region (Italy) during the period 2000-2002. Data were extracted from the drug prescription database of Emilia-Romagna. Treatment rates were within the range 1016-1151 treatments per 1000 children-years, according to the observed year. Chephalosporins were the most prescribed antibiotic class. The paediatric population of Emilia-Romagna is heavily exposed to systemic antibiotics. Further studies are needed to find out determinants of antibiotic overuse.

Microbiologic survey of long-term care facilities

Background: We undertook a microbiologic survey of long-term care facilities to categorize bacteria found in cultures of residents. Culture and sensitivity data were collected on 566 samples from indwelling bladder catheters, percutaneous gastrostomy tubes, nares, stool, wounds, pressure ulcers, and tracheostomies in 25 Nebraska and Iowa facilities. Information was also collected on resident factors (eg, presence of indwelling urinary catheter, prior antibiotic administration) and institutional variables (eg, number of beds, nosocomial infection rates).Results: There were 478 gram-negative isolates, the leading organisms being Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli, and Klebsiella pneumoniae. There were 221 gram-positive isolates, the most frequently seen of which were enterococci and Staphylococcus aureus. Of the 442 residents sampled in the study, 168 (38%) were taking, or had within the previous month been taking, a systemic antibiotic. Quinolones were the most frequently prescribed antibiotic class. The institutional prevalence of urinary catheterization averaged 6.7%.Conclusions: Significant antibiotic pressure exists in long-term care facilities, a fact that is reflected in antibiotic resistance patterns. A variety of gram-positive and gram-negative bacteria were found in nursing home culture specimens.