Antibiotic Prescribing Patterns Research Articles

Impact of Sulfonamide Allergy Label on Clinical Outcomes in Patients with Pneumocystis jirovecii Pneumonia.

The presence of antibiotic allergy labels can have harmful impacts on clinical outcomes, particularly among immunosuppressed patients, in whom there have been associations with increased complications, readmission rates, and mortality. We explore the effects of a sulfonamide allergy label (SAL) on clinical outcomes in adult patients with Pneumocystis jirovecii pneumonia (PJP). In this retrospective matched cohort study, we utilized TriNetX, a multicenter national database, to match 535 adult patients with PJP and SAL to an equal number of controls. We identified cases indexed between 01/01/2010 and 01/01/2023 utilizing ICD-10 codes for PJP and allergy status to sulfonamides and through detection of P. jirovecii antigen with immunofluorescence or PCR. Propensity score matching was performed in a 1:1 fashion for demographics and comorbidities, and our analysis included clinical outcomes that occurred within 30days after the occurrence of the index event. While hospitalization risk tended to be lower among patients with SAL as compared to controls (RR: 0.90; 95% CI 0.81-1.01), there were no major differences in the risk of respiratory failure (RR: 0.94; 95% CI 0.84-1.05), prednisone use (RR: 1; 95% CI 0.91-1.10), intensive level of care requirement (RR: 0.85; 95% CI 0.69-1.06), intubation (RR: 0.85; 95% CI 0.61-1.19), or mortality (RR: 0.98; 95% CI 0.68-1.42). The presence of SAL did however impact antibiotic prescription patterns, with an underutilization of trimethoprim (RR: 0.50; 95% CI 0.43-0.59) and sulfamethoxazole (RR, 0.47; 95% CI 0.40-0.56) and overuse of alternative agents by patients with SAL as compared to controls. Yet, there was no difference in the occurrence of adverse outcomes such as hepatotoxicity (RR: 1.09; 95% CI 0.49-2.45) or acute kidney injury (RR: 0.94; 95% CI 0.78-1.14) between patients with SAL and controls. The presence of SAL alters antibiotic prescription patterns among adults with Pneumocystis infection but has no clinically significant impact on outcomes.

Prescrizione di antibiotici in Pronto Soccorso pediatrico

Background - The emergency department (ED) is an important site of care in which inappropriate antibiotic prescribing and the consequent impact of antibiotic-resistant bacteria can be reduced. Objective - The aim of this retrospective study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections in children examined in 3 different ED located in Azienda Ospedaliera Bergamo-Est and to highlight the possibilities for a reduction and a more appropriate use of this class of drugs, overprescribed in paediatric age. Methods - A retrospective observational study was performed on children younger than 18 years of age, who were examined in a general hospital near Bergamo from January 2020 to September 2022. The proportion and type of antibiotic prescription according to demographic, clinical, laboratory and imaging data were determined. Results - 4,731 children were included in the study and 894 (18.9%) received an antibiotic prescription. The prevalence of antibiotic prescription varies with age, with a peak at 1-5 years (21.7%), and depending on the diagnosis, from 2.5 % in children with influenza to 78.4% in children with otitis. Amoxicillin/clavulanate was the most prescribed antibiotic (47% of antibiotic prescriptions), while the percentage of amoxicillin prescription was low (36%). In patients examined for pharyngotonsillitis, amoxicillin was prescribed to 43% of those treated with antibiotics. Conclusions - This study supports the need for a new comprehensive approach to ensure successful antibiotic stewardship. A guide to the use of new diagnostic tests (molecular biology, genome sequencing and immunoenzymatic assays) in a “diagnostic stewardship” perspective may be helpful; however, clinical evaluation remains of fundamental and central importance.

Optimizing Antibiotic Treatment for Diabetic Foot Infections: A Study From a Tertiary Public Healthcare Center in Puducherry, South India.

Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to increased morbidity and mortality. Understanding antibiotic prescribing patterns and microbial susceptibility is crucial for effective management. This study aimed to assess antibiotic prescribing trends and microbial susceptibility patterns in DFIs in a tertiary care center in Puducherry. A prospective observational study was conducted over two months, involving patients with DFIs attending surgery OPD and admitted inpatient wards. Data on demographics, comorbidities, ulcer characteristics, antibiotic prescriptions, and microbial culture results were collected. Descriptive statistics and appropriate statistical tests were used for analysis. Of 110 patients included, most were males (80, 72.7%) aged 51-60 years (43, 39.1%). Common risk factors included poor glycemic control (85, 77.3%), barefoot walking (29, 26.4%), and a family history of diabetes (46, 41.8%). Gram-negative organisms (78, 70.9%) predominated, with Escherichia coli(17, 15.5%), Pseudomonas aeruginosa (12, 10.9%), and Staphylococcus aureus (10, 9.1%) being common isolates. Polypharmacy was observed, with (63) 57.3% receiving multiple antibiotics, mainly via the parenteral route (16, 64.5%). Ceftriaxone (31, 28.2%) and cefotaxime (21, 19.1%) were frequently prescribed. Antibiotic resistance varied among isolates. This study underscores the predominance of gram-negative organisms in DFIs and highlights the need for rational antibiotic prescribing. Cephalosporins were commonly used, emphasizing the importance of empirical therapy. Understanding local microbial patterns and susceptibility is crucial for guiding antibiotic selection and optimizing clinical outcomes. In addition, addressing modifiable risk factors is imperative for preventing DFIs and reducing associated complications. This study provides valuable insights for strengthening antimicrobial stewardship programs and improving patient care in diabetic foot management. Furthermore, the present study highlights the importance of essentially deprescribing the prescriptions both from the patient, their primary carer, and the treating physician/surgeon's perspective.

Assessment of antibiotic prescribing pattern and cost for hospitalized patients: A study from Palestine.

One of the largest problems facing the world today is the morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing pattern and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals, they were evaluated by some drug use indicators. The cost of antibiotics in these prescriptions was calculated based on the local cost. Descriptive statistics were performed using IBM-SPSS version 21. The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic.

Development of antibiotic metrics for hospitalists via multi-institutional modified Delphi survey.

Closing the gap between evidence-supported antibiotic use and real-world prescribing among clinicians is vital for curbing excessive antibiotic use, which fosters antimicrobial resistance and exposes patients to antimicrobial side effects. Providing prescribing information via scorecard improves clinician adherence to quality metrics. We aimed to delineate actionable, relevant antimicrobial prescribing metrics extractable from the electronic health record in an automated way. We used a modified Delphi consensus-building approach. Our study entailed two iterations of an electronic surveydisseminated to hospital medicine physicians at 10 academic medical centers nationwide. Main outcomes comprised consensus metrics describing the quality of antibiotic prescribing to hospital medicine physicians. Twenty-eight participants from 10 United States institutions completed the first survey version containing 38 measures. Sixteen respondents completed the second survey, which contained 37 metrics. Sixteen metrics, which were modified based on qualitative survey feedback, met criteria for inclusion in the final scorecard. Metrics considered most relevant by hospitalists focused on the appropriate de-escalation of antimicrobial therapy, selection of guideline-concordant antibiotics, and appropriate duration of treatment for common infectious syndromes. Next steps involve prioritization and implementation of these metrics based on quality gaps at our institution, focus groups exploring impressions of clinicians who receive a scorecard,and analysis of antibiotic prescribing patterns before and after metric implementation. Other institutions may be able to implement metrics from this scorecard based on their own quality gaps to provide hospitalists with automated feedback related to antibiotic prescribing.

Comparative analysis of antibiotic prescription and resistance patterns in the management of pediatric urinary tract infections

Abstract: INTRODUCTION: Urinary tract infections (UTIs) exhibit a significant prevalence rate in the pediatric population. Antibiotic therapy is a commonly recommended treatment option. Our objective was to investigate the resistance pattern of antibiotics in relation to the prescribed drugs among pediatric patients. MATERIALS AND METHODS: This was a retrospective analysis of pediatric patients with diagnosed UTIs. A total of 100 samples were analyzed for culture and sensitivity. RESULTS: Escherichia coli (33%) was the most common organism isolated, followed by Klebsiella (27%) and Enterococcus (12%). Ceftriaxone (CTR) (85%) was the most commonly prescribed drug, followed by cefixime (CFM) (32%) and ciprofloxacin (25%). The overall resistance pattern of antibiotics to pathogens isolated was highest for cefoperazone (51%), nitrofurantoin (36%), amikacin (28%), and gentamicin (24%). The lowest resistance was observed for vancomycin (0%). The overall sensitivity was highest for imipenem (65%) and piperacillin-tazobactam (50%). The lowest sensitivity was observed for cefotaxime and ceftazidime. CONCLUSION: CTR and CFM were the commonly prescribed drugs for pediatric UTI treatment due to their low resistance rate and adequate sensitivity, high efficacy, well-tolerance, and convenient administration.

Prescription pattern of antibiotics and infection control among outpatients presented at the different community pharmacies in Lahore, Pakistan

Prescription pattern of antibiotics and infection control among outpatients presented at the different community pharmacies in Lahore, Pakistan

A situational analysis of antibiotic prescription, dispensing practices and resistance pattern in Nepal: Are we losing the battle?

Background: Antibiotics are widely utilized to treat infections and provide preventative and therapeutic benefits in animal and human healthcare. However, because of the emergence and spread of resistance mechanisms, which cause bacteria to become less susceptible to antibiotics and other treatments and less effective, antimicrobial resistance (AMR) has grown to be one of the most significant worldwide public health concerns. Low- and middle-income countries (LMICs) such as Nepal have a high rate of infectious illnesses and antibiotic resistance, which can lead to both human and financial losses. Methods: The information for the scenario analysis was acquired through a review of published and grey literature, as well as interviews with important stakeholders from all sectors. Conclusion: Besides knowing all the challenges of antibiotic resistance, the programs assuring towards AMR is conducted in Nepal in very infrequent way. The antibiotic use should be optimize by giving various personalized treatment approaches and accurate diagnosis which plays vital roles in minimizing unnecessary antibiotic prescriptions. We can organize different awareness programs to reduce antibiotic resistance that may enhance the proper use of antibiotic with proper dose and prescription in accordance health care professionals. Interpreting all the problems, government should give more priority to antibiotic resistance and should be able to minimize the problems. If antibiotic resistance is not taken in a very serious way by all the healthcare workers like doctors, nurses, pharmacists, lab technicians, etc. then the battle we are fighting leads to be defeated and problem will never end.

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices-5-Year National Study.

Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period. This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient's and prescriber's characteristics. The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications. The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary.

A Pharmacy-Based Cross-Sectional Study to Assess the Antibiotic Prescription Pattern by Medical and Dental Practitioners in Saudi Arabia

ABSTRACT Introduction: The misuse and overuse of antibiotics in dental practice are well known and have become widespread worldwide. Its potential effect and high risk of serious reaction have emphasized the need to reduce and limit the precipitation. In this study we aimed to identify the prevalence, type, dose, and duration of antibiotics prescribed by general medical and dental practitioners in Saudi Arabia. Materials and Methods: This cross-sectional study was performed from April 2020 to December 2020. A total of 45,100 antibiotic prescriptions were collected from different governmental and private pharmacies and screened to be included in this study. Data extraction from all prescriptions followed a standardized form that included the following information: Doctor specialty, type of antibiotic, duration, and dose of antibiotic. Results: A total of 38,175 antibiotic prescriptions prescribed by licensed doctors practicing in governmental or private hospitals were included in this study. Thirty-five thousand one hundred and seventy-eight (92%) outpatient antibiotics were prescribed by medical practitioners, and 2997 (8%) antibiotics were prescribed by dentists. The most commonly prescribed antibiotic was Augmentin (60%), followed by metronidazole and amoxicillin (35%). The most common dose and duration prescribed by dentists for Augmentin was 625 mg, 3 times per day for 5 days, whereas that of metronidazole was 500 mg, 3 times per day for 7 days. Prescribed dose and duration of amoxicillin was 500 mg, 3 times per day for 7 days. Conclusions: This study helps in understanding healthcare practitioners’ patterns and adds to the knowledge on how to deal with odontogenic infections. Further national studies are recommended to include more regions in Saudi Arabia and to illustrate the misuse of outpatient antibiotics.

Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway-an interrupted time series analysis.

Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P < 0.001), followed by a significant reduction of -2.64 prescriptions after reintroduction (95%CI -3.66, -1.63, P < 0.001). During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

Antibiotic prescription sources and use among under-5 children with fever/cough in sub-Saharan Africa.

Childhood febrile illness is among the leading causes of hospital admission for children <5y of age in sub-Saharan Africa (SSA). Antibiotics have played a pivotal role in enhancing health outcomes, especially for children <5y of age. Antibiotics prescription pattern evidence exists for SSA, however, prescription sources (either from qualified or unqualified sources) and use among children with fever or cough have not been explored. Thus the present study assessed antibiotic prescription sources and use among children <5y of age with fever and cough in SSA. We used Demographic and Health Survey data from 37 countries with a total of 18866 children <5y of age who had fever/cough. The surveys span from 2006 to 2021. The dependent variable was antibiotics taken for fever/cough based on prescriptions from qualified sources. The data were weighted using sampling weight, primary sampling unit and strata. A mixed-effects logistic regression model (both fixed and random effects) was fitted since the outcome variable was binary. Model comparison was made based on deviance (-2 log likelihood) and likelihood ratio tests were used for model comparison. Variables with p≤0.2 in the bivariable analysis were considered for the multivariable mixed-effects binary logistic regression model. In the final model, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p<0.05 in the multivariable model were used to declare a significant association with taking antibiotics for fever/cough prescribed from qualified sources. The percentage of unqualified antibiotic prescriptions among children <5y of age who had a fever/cough and took antibiotics was 67.19% (95% CI 66.51 to 67.85), ranging from 40.34% in Chad to 92.67% in Sao Tome. The odds of taking antibiotics prescribed from unqualified sources for fever/cough among children <5y of age living in rural areas were 1.23 times higher (AOR 1.23 [95% CI 1.13 to 1.33]) compared with urban children. The odds of taking antibiotics prescribed from qualified sources for fever/cough among children <5y of age whose mothers had primary, secondary and higher education decreased by 14% (AOR=0.86 [95% CI 0.79 to 0.93]), 21% (AOR 0.79 [95% CI 0.72 to 0.86]) and 21% (AOR 0.79 [95% CI 0.65 to 0.95]) compared with those whose mother had no formal education, respectively. The study showed that the majority of the children who received antibiotics obtained them from unqualified sources in the 37 SSA countries. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in children <5y of age.

Attitudes, Beliefs, and Behaviors of Topical Antibiotic Prescribing among Primary Care Providers in Saudi Arabia: A Cross-Sectional Study.

The World Health Organization (WHO) estimates that 20-50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription.

Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease. PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE. The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low. Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

Expert Opinion on the Clinical use of Antibiotics for the Management of Infections and Enteric Fever in Indian Settings

Objective: The present survey-based study aims to gather clinicians’ perspectives regarding the antibiotic prescription pattern for the management of infections and enteric fever in Indian settings. Methodology: The current multiple-response questionnaire-based survey consisted of 17 questions pertaining to clinical observations, clinical experience, and antibiotic prescription practice of specialists involved in the management of infections and enteric fever. Result: Out of 246 participants, 89% recommended cefixime as the preferred monotherapy drug for enteric fever. The recommended combination therapies for enteric fever were cefixime and ofloxacin, cefixime and azithromycin, and cefpodoxime and ofloxacin, as indicated by 38%, 32%, and 25% of clinicians, respectively. Approximately 61% of the clinicians reported frequently prescribing cefixime for urinary tract infections (UTI). According to 68% of the clinicians, the recommended cefixime dose for treating typhoid fever is 15-20 mg/kg. More than half (55%) of the clinicians recommended amoxicillin/clavulanic acid for the treatment of respiratory infections. Majority (78%) of the clinicians chose cefixime as an effective option for managing recurring infections. A considerable proportion (76%) of clinicians reported no side effects following antibiotic therapy. Conclusion: The study provides valuable insights into the use of antibiotics in infection and enteric fever in Indian settings. Cefixime therapy is recommended by clinicians in the treatment of enteric fever, UTI, and recurring infections. The preferred treatment option for enteric fever includes a combination of cefixime with either ofloxacin or azithromycin. The recommended cefixime dose for typhoid fever is in the range of 15-20 mg/kg. Respiratory infections are typically treated with amoxicillin/clavulanic acid.

Antibiotic prescribing patterns and carriage of antibiotic-resistant Escherichia coli and Enterococcus species in healthy individuals from selected communities in Lusaka and Ndola districts, Zambia.

This study assessed antibiotic prescribing patterns in primary healthcare facilities and antimicrobial resistance (AMR) profiles of commensal Escherichia coli and enterococci isolated from pregnant women and children under 5 years of age. This cross-sectional study was conducted in Lusaka and Ndola districts of Zambia. Prescription pattern data were obtained from hospital pharmacies. Identification and antimicrobial susceptibility profiles of E. coli and enterococci were determined by conventional methods, while confirmation of both pathogens and AMR genes were determined by PCR. Data were analysed using WHONET and SPSS version 25.0. Most prescribed antibiotics at the primary healthcare facilities belonged to the Access group of the WHO Access, Watch and Reserve (AWaRe) classification. All the primary healthcare facilities adhered to the AWaRe framework of ≥60% prescribed antibiotics belonging to the Access group. However, resistance was highest in the Access group of antibiotics. E. coli resistance to ampicillin ranged from 71% to 77% and to co-trimoxazole from 74% to 80%, while enterococcal resistance to tetracycline was 59%-64%. MDR was highest in E. coli (75%) isolates, while XDR was highest in enterococcal isolates (97%). The identified AMR genes in E. coli included blaCTX-M, sul2 and qnrA, while those of enterococci included erm(B), erm(C) and erm(A). Resistance was highest in the prescribed WHO Access group of antibiotics. These findings highlight the need to use local susceptibility data to formulate country-specific treatment guidelines in line with WHO AWaRe classification and enforce regulations that prohibit easy access to antibiotics.

Implementation of an antibiotic resistance surveillance tool in Madagascar, the TSARA project: a prospective, observational, multicentre, hospital-based study protocol

IntroductionAntimicrobial resistance (AMR) has become a significant public health threat. Without any interventions, it has been modelled that AMR will account for an estimated 10 million deaths annually by 2050,...

Antibiotic Prescribing Patterns for Urinary Tract Infections and Pneumonia by Prescriber Type and Specialty in Nursing Home Care, 2016–2018

ObjectiveTo identify whether differences in antibiotic prescribing practices by prescriber type and specialization in nursing home (NH) care exist for urinary tract infection (UTI) and pneumonia. DesignRetrospective cohort. Setting and ParticipantsThis national study included antibiotic dispensings to traditional Medicare beneficiaries aged ≥65 years with UTI or pneumonia infections residing long-term (≥100 days) in US NHs between 2016 and 2018. MethodsMinimum Data Set assessment data were linked to Medicare data [Part D prescription drug, inpatient hospital (MedPAR), prescriber characteristics, and enrollment]. We compared antibiotic prescribing patterns by prescriber type [physician vs advanced practice practitioner (AP)] and NH specialization (≥90% vs <90% of all associated medication dispensings to NH residents). Antibiotic dispensing measures included the total number of dispensings and duration of therapy (median number of days supplied) by antibiotic class. ResultsThere were 264,735 antibiotic dispensings prescribed by 32,437 prescribers for 140,360 residents in 14,035 NHs. NH specialists were less likely to prescribe fluoroquinolones for UTI (22.9% NH specialist physician, 23.9% non-NH specialist physician, 21.3% NH specialist AP, 24.2% non-NH specialist AP), but more likely to prescribe fluoroquinolones for pneumonia (38.9%, 37.8%, 38.8%, 37.3%, respectively). Over time, NH specialists reduced fluoroquinolone prescribing for pneumonia to a greater extent than non-NH specialists. The duration of therapy was similar across prescriber groups for UTI, but longer among non-NH specialist APs for several antibiotic classes for pneumonia, including tetracyclines, glycopeptides and lipoglycopeptides, and metronidazole. Conclusions and ImplicationsThere were differences in antibiotic prescribing patterns by prescriber type and specialization in NH care between 2016 and 2018. Understanding how antibiotic prescribing differs based on prescriber characteristics is essential to inform antibiotic stewardship efforts. Tailoring antibiotic stewardship efforts to prescribers by NH specialization is rational given differences in antibiotic prescribing patterns based on NH specialization.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Study of Empiric Antibiotic Prescription Patterns and Microbiological Isolates in Hemodynamically Stable and Unstable ICU Patients With Community-Acquired Sepsis.

Background: The efficacy of combination empiric antibiotic therapy for all intensive care unit (ICU) patients with community-acquired sepsis is a subject of ongoing debate in the era of increasing antibiotic resistance. This study was conducted to evaluate the patterns of antibiotic usage and microbial resistance in sepsis patients admitted to the ICU with both hemodynamically stable (HS) and unstable states and to analyze their clinical outcomes. Methods: In this observational study, patients aged 18 years and above who received antibiotics upon admission and had a culture report were included. These patients were categorized into the following groups: HS and hemodynamically unstable (HU), single or combined antibiotics group (more than one antibiotic used empirically to cover one or more groups of organisms), culture-positive and culture-negative group. The microbiological isolates were grouped according to their identified resistance patterns. The outcome parameters involved assessing the differences in empiric antibiotics use upon admission and microbial resistance with hemodynamic stability and investigating any associations with ICU and hospital outcomes. Results: The study included a total of 2675 patients, of which 70.3% were in the HS group, and 29.7% in the HU group. The use of combination antibiotics was significantly higher (p < 0 .0001) across all groups. Carbapenems were used more frequently in the single antibiotic group (p < 0 .001). The culture was positive in 27.8% (n = 747) of patients. A significantly higher number of patients in the HU group (p < 0 .001) were found to have carbapenem-resistant and multidrug-resistant organisms. The ICU and hospital mortality rates were significantly higher in the HU group (p < 0 .001), the culture-positive group with resistance (p < 0 .001), and the HS patients who received combination antibiotics. Conclusion: The usage of combination antibiotics, coupled with the presence of resistant organisms, emerged as an important variable in predicting ICU and hospital mortality rates in cases of community-acquired sepsis.