Antibiotic Prescribing Patterns Research Articles

Did the COVID-19 pandemic impact antibiotic prescribing patterns among dentists?

Patient records from Wits Oral Health Centre were collected over two years (March 2019-March 2021). The records were divided into two groups: pre-COVID-19 (March 2019-March 2020) and COVID-19 (March 2020-March 2021). The total sample size was 698 systematically selected patient records who received antibiotics. A systematic random sampling method was used to select a sample of patients who received prescriptions for antibiotics. Patients were included based on their treatment time and need for antibiotic prescription. Patients whose records were missing information or treated by independent private practitioners for whom records access was not feasible were excluded. The extracted data contained information regarding the patients' demographics, medical histories, dental condition, dental procedure, antibiotic type, frequency, dosage, duration of use, and prescribers' disciplines. The information was categorized and captured in Microsoft Excel to analyze and create figures and tables. Analysis was performed using descriptive statistics, chi-squared, and z-tests to compare pre-COVID-19 and COVID-19 prescription patterns in RStudio. From an initial pool of 44,067 patient consultations, a systematic random sample of 698 records met the eligibility criteria for inclusion in this study. The sample was divided between pre-COVID-19 (n = 350) and COVID-19 (n = 348). A significant increase in antibiotic prescriptions was found during COVID-19 (1571 prescriptions) compared to pre-COVID-19 (1109 prescriptions). The most commonly prescribed antibiotics were amoxicillin and metronidazole. Specifically, amoxicillin was used in most cases before and during COVID-19. The combination of amoxicillin with metronidazole increased from 16.6% pre-COVID-19 to 24.4% COVID-19. It was found that many of the antibiotics prescribed from both periods were not clinically indicated (53.1% pre-COVID-19 and 54.3% COVID-19). The authors concluded that the COVID-19 pandemic significantly increased antibiotic prescriptions despite fewer in-person consultations. This was likely due to insufficient surgical intervention and reliance on antibiotics to treat dental conditions. The lack of proper antibiotic use raises concerns regarding dental practitioners' appropriate use of antibiotics. There is an urgent need for improved antibiotic stewardship to prevent the misuse and growing public health issue of antimicrobial resistance.

BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age > 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.

Characteristics of imported and domestic malaria cases in Gyeonggi Province, Republic of Korea.

This study explored 11 years of malaria data from mandatory reporting in Gyeonggi Province, Korea, to provide information for prevention strategies by linkage to nationwide health claims data. Reported malaria cases in Gyeonggi Province from 2011 to 2021 were linked to medical usage data from the National Health Insurance Database. Data about hospitalization, antibiotic prescription and duration, malarial species, and sociodemographic information of the cases were included. Between 2011 and 2021, a total of 3,011 malaria cases were reported, consisting of 2,828 domestic (93.9%) and 183 imported (6.1%) cases. Over 80% of the cases involved males, with the majority of patients being in their 20s. Both domestic and imported cases peaked between June and August over the years. Imported cases had a higher hospitalization rate (66.9%) compared to domestically-acquired cases (54.9%). There was a significant variation in treatment rates, with 80.7% of imported cases and 74.6% of domestic cases receiving treatment. For domestic cases, chloroquine combined with primaquine was the most commonly prescribed treatment (77.0%), while atovaquone-proguanil was frequently used for imported cases (25.9%). Plasmodium vivax was the predominant species in domestic cases (94.9%), whereas Plasmodium malariae was more common in imported cases (62.3%). The overall number of reported malaria cases declined following a sharp decrease in imported cases in 2020 and 2021. Despite a decreasing trend in malaria cases reported in Gyeonggi Province, imported cases exhibited higher hospitalization rates and different antibiotic prescription and treatment patterns, reflecting the presence of a different malarial species.

ASSESSMENT OF ANTIBIOTIC STEWARDSHIP IN TERTIARY HEALTH CARE TEACHING MEDICAL INSTITUTION IN CENTRAL INDIA

Objective: The objective of the study was to mitigate the impact of antimicrobial resistance and ensure continued access to effective treatments for bacterial infections. This study was undertaken to explore the hospital status of antibiotic prescription and evaluate the impact of antibiotic stewardship in clinical wards of tertiary health care settings. Methods: This is hospital-based observational prospective study carried out in a tertiary health care settings. All patients of either sex of any age who came in outpatient department and admitted in inpatient department of medicine, orthopedics, surgery, and pediatric departments and prescribed antibiotics were selected randomly in the study. Results: Study response rate was male predominance (57%). Empiric antimicrobials were mainly prescribed orally (47.3%), significantly higher than injectable route (22.8%) (p<0.001), while the majority were not given an empiric antibiotic by a clinical expert. A significantly high number of patients were prescribed injectable 1st Antimicrobial after surgery/culture, namely, injectable piperacillin+tazobactum (35.5%), followed by injectable cephalosporin (34.0%), amikacin injection/4.5%, and injection carbapenem/1.8% (p<0.001). Its frequency is significantly high with BD dose (66.8%) and the majority prescribed for period of 6–10 days (63.5%) followed by 1–6 days (19.5%) (p<0.001). Conclusion: As all prescriptions got optimal dose and duration of therapy, the stay of patients in the hospital was following Indian Council of Medical Research (2019) guideline therefore, it can thus be said that the results of this study revealed precise prescribing pattern of antibiotics. However, emphasis on information technology staff and patient education is vital in incorporating stewardship protocols. Emphasizing the importance of conducting antibiotic time-outs within 48–72 h is crucial for reassessing the necessity and choice of antibiotics. Such stewardship studies are instrumental in monitoring patterns of antibiotic usage and aid in future policy-making steps.

Antibiotic Prescription Patterns Study in Surgical Intensive Care Unit

Introduction: This study aimed to assess Antibiotic prescription patterns study in surgical intensive care unit. Materials and methods: This was a prospective, observational study of antibiotic prescribing patterns at admission into the surgical ICU. The prescription data on 100 consecutive patients at admission into the surgical ICU was audited. Patients of all age of either gender admitted in the surgical ICU during the study period, who have been prescribed with antibiotics. The study was conducted over a period of eight months from August 2022 march 2023. During this period, all the included patients were followed up for their entire duration of stay in surgical ICU. Results: The prescriptions of 100 consecutive patients admitted into the ICU were analyzed. This included 68 male and 32 female patients. Most of the patients admitted in SICU were of the age groups 20-40 years. Most of the patients admitted in surgical ICU of 35-65 age group and two/three antibiotics prescription was statistically significant (P<0.05) in compare to one/ more than three antibiotic prescription in that age group. Those patients were stayed < 6 days or > 10 days mostly prescribed two or three antibiotics. The mortality rate was 31% in surgical intensive care unit. 69% patients were transferred to different wards of the hospital. The mortality rate was high before 7 days (67.7%) as compared to after 07 days (32.25%). The average duration of stay in surgical ICU was 7.18 days and average number of drugs prescribed was 6.2. The average duration of antimicrobials including all prescribed antibiotics to 100 surgical ICU patients was 6.97. There were 16(16%) single antibiotic prescriptions, 36 (36%) prescription contained 2 antibiotics, 45 (45%) prescriptions contained 3 antibiotics and 03 prescriptions contained more than 3 (3 %) antibiotics. Highest prescribed antibiotic group was cephalosporin (25.10%) followed by carbapenems (20.85%) in surgical intensive care unit. Conclusion: In conclusion, our study reveals that antibiotics continue to be widely prescribed in critically ill patients of surgical intensive care unit.

The pattern of antibiotics prescription for endodontic infections in Malaysia: Cross sectional survey study.

This study aimed to assess the antibiotic prescribing pattern for endodontic infections among general dental practitioners (GDPs) and endodontic specialists in Malaysia. A 22-questions survey on demographic and general information on antibiotic prescribing patterns for endodontic infection was delivered to the email addresses of general dentists and specialists via the Dental Practitifoner Information Management System database. Collected data were analysed using multivariate logistic regression tests at the significance level of 0.05. A total of 372 responses were collected. 94% of respondents were GDPs, and 6% endodontists. Clinical experience and frequency of endodontic treatment performance were the significant factors in prescribing antibiotics (p < 0.05). The common reasons for antibiotic prescription were to control the spread of infection and fever (88%). Endodontists have better knowledge of antibiotic prescription than GDPs. The majority of GDPs had inappropriately prescribed antibiotics. Improving the knowledge of GDPs in Malaysia regarding antibiotics-indications in endodontics is mandatory.

Impact of Education on Inappropriate Antibiotic Prescription for Respiratory Tract Infection Based on Physicians' Justifications: A Web-Based Survey in Japan.

Background: Antibiotics are inappropriately prescribed for respiratory tract infections for various reasons. The differences of the effects of education based on these reasons has not been fully elucidated. This study assessed the impact of an educational film on antibiotic prescription patterns according to physicians' prescribing justifications. Methods: This was a secondary analysis of a nationwide web-based survey involving 1100 physicians. The physicians were required to view a short educational film and determine the need for prescribing antibiotics in simulated scenarios of different acute respiratory tract infectious diseases. The associations between the reasons for antibiotic prescription to patients not requiring antibiotics before viewing the educational film and the positive effects of the intervention were analyzed. Results: The educational intervention positively affected prescribing trends among physicians who prescribed antibiotics for "fever" in mild acute rhinosinusitis (prescription rates from 100% to 25.9%), "pus in the laryngopharynx" in mild acute pharyngitis (prescription rates from 100% to 29.6%), and "purulent sputum" in acute bronchitis without chronic lung disease (prescription rates from 100% to 29.9%) before viewing the film. In contrast, no benefits were observed when the justification was "patient's desire for antibiotics" in mild acute pharyngitis (prescription rates from 100% to 48.5%) and acute bronchitis without chronic lung disease (prescription rates from 100% to 44.0%) or "parents' desire for antibiotics" in narrowly defined common cold in children (prescription rates from 100% to 45.7%). Conclusions: although educational interventions might reduce inappropriate antibiotic prescription by providing accurate knowledge about respiratory tract infections, they appear ineffective for physicians who prescribe antibiotics based on patients' or parents' desires for antibiotic treatment.

Are antibiotics overprescribed for apical periodontitis in dental practice?

There is a discrepancy in the databases and data sources mentioned by the authors. The abstract references four databases, which differ from those listed in the materials and methods section. According to the methods, the literature search was conducted across three databases: PubMed-MEDLINE, EMBASE, and Scielo. However, the abstract mentions four databases, including MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus. All relevant articles were searched using specific keywords derived from Medical Subject Headings (MeSH) terms and text words (TW) related to the topic. Following the screening of titles and abstracts, the full texts of the selected studies were reviewed, and inclusion and exclusion criteria were applied. Any disagreements regarding study inclusion were resolved by consensus. Studies that reported data on antibiotic prescription patterns by dentists for the treatment of apical disease were included. Data extraction was carried out by three independent reviewers, with a fourth author resolving any disagreements. Extracted data included publication details (authors, year of publication), number of respondents, response rate, survey location, and prescriber type (general practitioner, endodontist, or dental surgeon). The primary outcome measured was the percentage of dentists prescribing antibiotics for each form of periapical endodontic disease. The search strategy identified a total of 96 studies, of which 39 cross-sectional studies met the inclusion criteria. Dentists prescribed antibiotics in 25.8% of cases of symptomatic apical periodontitis (AP) and in 31.5% of asymptomatic AP cases. In instances of acute symptomatic apical abscess with swelling and moderate to severe symptoms, approximately 89% of dentists prescribed antibiotics, compared to nearly 100% of endodontists. Endodontists demonstrate more appropriate antibiotic-prescribing practices than general practitioners. Globally, dentists tend to over-prescribe antibiotics for managing apical disease. Therefore, there is a pressing need to enhance antibiotic prescribing practices in the treatment of endodontic infections.

Pattern of Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital of Bangladesh

Background: Surgical Site Infection (SSI) is a common form of hospital-acquired infection and major cause of postoperative illness accounting for approximately a quarter of all nosocomial infections. As a result, surgical antibiotic prophylaxis is now considered essential to conventional surgical procedure in order to reduce surgical site infections and improve postoperative recovery. The misuse and overuse of antibiotics has led to an increase in treatment costs and the emergence of antimicrobial resistance. The goal of the study is to identify the pattern of prophylactic antibiotic prescriptions for different surgical operations. Materials and methods: A retrospective observational study was conducted among 600 patients undergoing different surgeries in a tertiary care hospital of private setting in Dhaka, Bangladesh from July 2023 to December 2023. The demographic data, types of surgery, types of therapy, choice of antibiotic along with dosage formulations were collected. Results: Out of 600 patients, 245 (41%) were male and 355 (59%) were female. Highest bulk of patients were from Department of General Surgery (47.5%), followed by Department of Obstetrics &amp; Gynecology (24.16%) and Department of Otolaryngology (16.7%). Surgical prophylactic antibiotic was used in all 600 patients, and all antibiotics were given in intravenous route (100%). Almost 505 patients (84.2%) had received ceftriaxone as antimicrobial agent. Ceftriaxone with metronidazole or gentamicin and Cefuroxime with metronidazole or amikacin drugs combination were given to 75 (12.5%) and Cefuroxime, Amikacin, Metronidazole drugs combination were given to 20 patients (3.3%). 3rd generation cephalosporin, Ceftriaxone, was the most commonly prescribed antibiotic as monotherapy (94.3%), followed by 2nd generation cephalosporin, cefuroxime (4%). Conclusion: Ceftriaxone was the preferred antibiotic for surgical prophylaxis. Existence of an antimicrobial guideline along with antibiotic stewardship program in every hospital could be helpful for prescribers to play role in containment of antimicrobial resistance. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 70-74

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Antibiotic Prescription for Treatment and Prevention of Odontogenic Infections: A Cross-Sectional Survey of Lithuanian Dentists.

Background and Objectives: The inappropriate use of antibiotics can lead to antimicrobial resistance. Overprescribing in dental practice has been reported. This study aimed to describe patterns of antibiotic prescription for treating and preventing odontogenic infections based on reports from Lithuanian dentists. Materials and Methods: Questionnaires were sent to all 4751 Lithuanian dentists registered in the database of the Lithuanian Dental Chamber who had consented to participate in surveys. The questionnaire addressed antibiotic prescription preferences for the treatment and prevention of various dental pathologies. The statistical analysis included chi-square tests and a factor analysis to evaluate prescription frequences in different clinical scenarios considering the respondents' specialty and age. Results: Of 647 responses, 497 were from general dentists, 35 from oral surgeons, 40 from endodontists, 20 from periodontists, and 35 from prosthodontists. Respondents were grouped by age: A (≤35 years, n = 207), B (36-50 years, n = 224), and C (≥51 years, n = 209). Amoxicillin was the first-choice antibiotic for 81.1% of respondents (group A more frequently than other groups, p = 0.001). A 7-day treatment duration was preferred by 60.8%, while 33.6% chose 5 days. For patients allergic to β-lactam antibiotics, 63% preferred clindamycin. Over 90% cited acute apical abscess with systematic involvement as an indication for antibiotic prescription. A factor analysis of 18 clinical scenarios revealed prescription differences among dental specialists, oral surgeons, and periodontists prescribing antibiotics more frequently than general dentists and endodontists. For prophylaxis, 87.5% recommended antibiotics for patients at risk of infectious endocarditis after a cardiologist's consultation (group C less frequently than other groups, p = 0.021). Conclusions: Lithuanian dentists generally prefer narrow-spectrum antibiotics for the treatment of odontogenic infections. There are notable differences in prescription patterns among dental specialists, with younger dentists showing a trend towards more rational antibiotic use.

Exploring the association between phytopharmaceutical use and antibiotic prescriptions in upper respiratory infections: results from a German cohort study evaluating the impact of naturopathy qualifications of general practitioners using routine data.

Antibiotic resistance is a significant global health threat, exacerbated by inappropriate prescribing practices, particularly for upper respiratory infections that are predominantly viral. Complementary and Integrative Medicine (CIM), including the use of phytopharmaceuticals, offers a potential strategy to reduce antibiotic prescriptions. This study aimed to describe the impact of General Practitioners' (GPs) naturopathy (NP) qualifications and phytopharmaceutical prescriptions on the rate of antibiotic prescribing for upper respiratory infections (RTI). We conducted a retrospective cohort study using routine data from the CONTinuous morbidity registration Epidemiologic NeTwork (CONTENT), which includes over 200,000 patients across four federal states in Germany. The study included data from n = 36 GPs who recorded at least one ICD-10 diagnosis of RTI. Antibiotic and phytopharmaceutical prescriptions were identified and analyzed through mixed-effects logistic regression models to explore the influence of GPs' naturopathy qualifications and phytopharmaceutical use on antibiotic prescribing patterns. The study included 40,344 patients managed by 36 GPs. Prescriptions of phytopharmaceuticals significantly reduced the likelihood of antibiotic use (OR 0.48, 95% CI 0.45-0.52). Additionally, holding a naturopathy qualification was associated with lower rates of antibiotic prescriptions (OR 0.73, 95% CI 0.69-0.78). The interaction between naturopathy qualification and phytopharmaceutical prescriptions also showed a significant effect (OR 1.43, 95% CI 1.27-1.62). Patient's year of birth influenced prescribing patterns indicating a reduction of antibiotic prescriptions for younger patients, while patients' gender did not reveal a significant effect. Prescriptions of phytopharmaceuticals were significantly associated with a decrease antibiotic prescriptions among GPs, especially when combined with naturopathy qualifications. Training in naturopathic approaches could enhance antibiotic stewardship efforts in primary care settings, suggesting that broader integration of CIM elements into medical training could be beneficial in mitigating antibiotic resistance.

Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections

ObjectiveTo evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family...

Antibiotic prescribing patterns and risk of antibiotic-resistant infections and Clostridium difficile in Warfarin and Direct Oral Anticoagulant users: matched population-based cohort study

BackgroundWarfarin and Direct Oral Anticoagulant (DOAC) users may have more frequent antibiotic prescriptions than non-users. The aim of this study was to estimate rates of common and resistant infections, and antibiotic prescribing amongst warfarin and DOAC users versus non-users.MethodsThis matched retrospective cohort study used data from patients registered with General practices in England contributing to the Clinical Practice Research Datalink GOLD. We included 61,750 adults who initiated warfarin or a DOAC between 1st January 2011 and 31st December 2019, matched 1:1 to non-users. We estimated Incident Rate Ratios (IRR) and 95% Confidence Intervals for three common infections and all-cause antibiotic prescribing. We estimated hazard ratios (HRs) and 95% CIs for the risk of methicillin resistance Staphylococcus aureus (MRSA), other antibiotic-resistant organisms, or Clostridium difficile. We assessed the extent to which any of the effect of warfarin and DOAC use on antibiotic resistant infections or Clostridium difficile was mediated by antibiotic prescribing patterns.Results37,143 warfarin users and 24,607 DOAC users were matched 1:1 to non-users. Warfarin and DOAC users had greater relative consultation rates for respiratory, urinary, and skin infections. All-cause antibiotic prescribing was greater in warfarin and DOAC users (warfarin; adjusted IRR 1.47, 95% CI 1.45–1.50, DOAC; adjusted IRR 1.66, 95% CI 1.63–1.69). Largest effect sizes were observed for flucloxacillin (adjusted IRR 2.11, 95% CI 2.01–2.20), and erythromycin (adjusted IRR 2.32, 95% CI 2.00–2.70). Warfarin users had significantly higher risk of MRSA (adjusted HR 1.68, 95% CI 1.38–2.05) and hospital admission with antibiotic resistant infections (adjusted HR 1.91, 95% CI 1.11–3.30). DOAC users had significantly higher risk of MRSA (adjusted HR 1.57, 95% CI 1.20–2.06), hospital admission with antibiotic resistant infections (adjusted HR 2.13, 95% CI 1.61–2.82), and Clostridium difficile (adjusted HR 1.45, 95% CI 1.10–1.92). We found little evidence to suggest that the increased risks of studied outcomes were mediated by rates of antibiotic prescription.ConclusionWarfarin and DOAC use was associated with greater rates of infection consultations, all-cause antibiotic prescribing, antibiotic resistant infections, and Clostridium difficile, but there was little evidence that antibiotic prescribing rates mediated risk of resistant infections or Clostridium difficile.

Post-pandemic consumption of outpatient antibiotics in Switzerland up to pre-pandemic levels, 2018–2023: An interrupted time series analysis

BackgroundThe COVID-19 pandemic has been a challenge for health-care systems and antibiotic stewards as uncertainty regarding treatment and bacterial coinfections raised concern. MethodsThis retrospective observational study examined the association of the pandemic on outpatient antibiotic sales and prescriptions in Switzerland using interrupted time series (ITS) analyses. Data from IQVIA™ and the Sentinella Network were used to analyze antibiotic consumption and prescription patterns over a 72-month period from January 2018 to December 2023, divided into pre-pandemic, pandemic, and post-pandemic periods. ResultsAntibiotic consumption decreased during the pandemic and returned to pre-pandemic levels in the post-pandemic period. A decrease in level was most pronounced in the French-speaking region (−2.82 defined daily doses per 1,000 inhabitants per day (DID) per month, 95 %CI [−4.34, −1.30], p < 0.001) and the Italian-speaking region (−2.80 DID per month, 95 %CI [−4.78, −0.82], p < 0.01), followed by the German-speaking region (−1.72 DID per month, 95 %CI [−2.71, −0.74], p < 0.01). Similarly, in the ITS, the relative change of model estimates in antibiotic prescriptions by GPs and pediatricians for upper respiratory tract infections, was of −36.0 % and −50.3 % resp. in the pandemic period and +10.1 % and −2.6 % in the post-pandemic period compared with the pre-pandemic period. ConclusionsA decrease of antibiotic prescriptions was observed in GPs and pediatricians during the COVID-19 pandemic, followed by a return to pre-pandemic levels. The patterns in antibiotic prescriptions aligned with the epidemiology of respiratory infections and demonstrated a pronounced association with the implementation and subsequent removal of non-pharmaceutical interventions.

Antibiotic prescribing patterns in pediatric patients using the WHO access, watch, reserve (AWaRe) classification at a quaternary hospital in Nampula, Mozambique.

Antibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference. A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0-10years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories. Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1-3years and 28days-12months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria. 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection. All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy to combat AMR.

The impact of the COVID-19 pandemic on antibiotic prescription rates in out-of-hours primary care – a register-based study in Denmark

Background Antibiotic prescription rates can be affected by pandemic measures such as lockdowns, social distancing, and remote consultations in general practice. Therefore, such emergency states may negatively affect antimicrobial stewardship, specifically in out-of-hours (OOH) primary care. As contact patterns changed in the COVID-19 pandemic, it would be relevant to explore the impact on antimicrobial stewardship. Aim To study the impact of the pandemic on antibiotic prescription rates in OOH primary care, overall and per age group. Methods This cross-sectional register-based study used routine data from OOH primary care in the Central Denmark Region. We included all patient contacts in two equivalent time periods: pre-pandemic and pandemic period. The main outcome measure was defined as the number of antibiotic prescriptions per contact (antibiotic prescription rate). Results The overall antibiotic prescription rate decreased during the first year of the pandemic compared to the pre-pandemic period (RR = 0.97, 95%CI: 0.96–0.98). Likewise, the rate decreased for clinic consultations (RR = 0.63, 95%CI: 0.62–0.64). However, an increase was seen for telephone consultations (RR = 1.73, 95%CI: 1.70–1.76). The decline in clinic consultations was largest for consultations involving children aged 0–10 years (RR = 0.53, 95%CI: 0.51–0.56). Conclusion Antibiotic prescription rates in Danish OOH primary care decreased during the first year of the COVID-19 pandemic, especially for young children. Prescription rates decreased in clinic consultations, whereas the rates increased in telephone consultations. Further research should explore if antibiotic prescription rates have returned to pre-pandemic levels, and if the introduction of video consultations has affected antibiotic prescription patterns in OOH primary care.

Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea

Antimicrobial stewardship programmes (ASPs) have gained prominence, with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescription is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescription at a tertiary care hospital in Korea. This study analysed the patterns of oral antibiotic prescription between 1st June 2018 and 31st May 2023 at the outpatient department of Seoul National University Bundang Hospital. The appropriateness of prescriptions issued between 15th and 19th May 2023 was assessed. The assessment criteria included: indication for antibiotic use; antibiotic choice; duration; and dose/frequency. Pharmacists and infectious diseases specialists performed evaluations. In total, 7,282,407 outpatient visits were recorded over the 5-year study period, and oral antibiotics were prescribed in 243,967 (3.4%) cases. The frequency of antibiotic prescription was highest in dentistry, dermatology and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Prescriptions were classified as inappropriate in 28.4% (82/289) and 70.9% (95/134) of treatment and prophylaxis cases, respectively. The primary reason for inappropriateness in both treatment and prophylaxis cases was inappropriate indication, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions. Antibiotics were prescribed at 3.4% of all outpatient visits. The prescription was inappropriate in 28.4% of treatment cases and 70.9% of prophylactic cases. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.

Primary Healthcare Physicians' Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study.

Overuse of antibiotics in healthcare remains prevalent and requires urgent attention in China, particularly in primary healthcare (PHC) facilities. This study aimed to describe the patterns of antibiotic prescriptions for acute upper respiratory tract infections (URTIs) in PHC facilities in China and to investigate how PHC physicians' knowledge influences their antibiotic prescribing behavior. A cross-sectional survey linking physician questionnaire responses and their prescription data was conducted in Shaanxi Province, China. The proportions of URTI visits that received at least one antibiotic, combined antibiotics, and broad-spectrum antibiotics were the main outcomes reflecting antibiotic prescribing behavior. Multivariate mixed-effects logistic regressions were applied to analyze the relationship between PHC physicians' knowledge about antibiotics and their antibiotic prescribing behavior. A total of 108 physicians filled out the questionnaires between February 2021 and July 2021, and a sample of 11,217 URTI visits attended by these physicians from 1 January 2020 to 31 December 2020 were included in the analysis. The overall mean score of our respondents on the knowledge questions was 5.2 (total score of 10). Over sixty percent (61.2%; IQR 50.2-72.1) of the URTI visits received antibiotics. The percentages of URTI visits prescribed with combined and broad-spectrum antibiotics were 7.8% (IQR 2.3-10.2) and 48.3% (IQR 36.7-58.7), respectively. Third-generation cephalosporins were the most frequently used antibiotics. Physicians with lower antibiotic knowledge scores were more inclined to prescribe antibiotics (p < 0.001), combined antibiotics (p = 0.001), and broad-spectrum antibiotics (p < 0.001). Physicians' insufficient knowledge was significantly associated with antibiotic overprescribing. Professional training targeting physicians' knowledge of antibiotics is urgently needed to improve the rational use of antibiotics in grassroots healthcare facilities in China.

Performance feedback in healthcare organizations: The role of accountability measures and competition

This study examines the impact of accountability arrangements in the form of performance feedback on organizational behaviors among healthcare organizations. Specifically, it evaluates the effectiveness of a performance management program implemented in South Korean healthcare settings, focusing on antibiotic prescription patterns. The study presents three key findings. First, significant performance improvement occurred mainly among low performing organizations. Second, public healthcare organizations exhibited greater performance enhancements compared to their private counterparts. Third, organizational responses to performance feedback were more pronounced when robust competition prevailed among the assessed healthcare institutions. This synergy between performance management and competitive environments was primarily evident in private organizations.