Antibiotic Prescribing Patterns Research Articles

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 & 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&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.

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 programs (ASPs) have gained prominence with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescriptions is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescriptions at a tertiary care hospital in Korea. We analysed the patterns of oral antibiotic prescription from June 1, 2018 to May 31, 2023, at the outpatient department of Seoul National University Bundang Hospital. Appropriateness was assessed for prescriptions issued between May 15 and May 19, 2023. The assessment criteria included: indications for antibiotic use, antibiotic choice, duration, dose, and frequency. Pharmacists and infectious diseases specialists performed evaluations. A total of 7,282,407 outpatient visits were recorded within the 5-year duration. Of these, 243,967 (3.4%) were prescribed oral antibiotics. 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. Inappropriate prescriptions were identified in 28.4% (82/289) and 70.9% (95/134) of the treatment and prophylaxis cases, respectively. The primary reason for inadequacy in both treatment and prophylaxis was inappropriate indications, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions. Antibiotics were administered in 3.4% of all outpatient visits, with 28.4% of treatment and 70.9% of prophylactic antibiotics prescribed inappropriately. 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.

Prescription patterns of antibiotics and associated factors among outpatients diagnosed with respiratory tract infections in Jinja city, Uganda, June 2022–May 2023

BackgroundMost respiratory tract infections (RTIs) are viral and do not require antibiotics, yet their inappropriate prescription is common in low-income settings due to factors like inadequate diagnostic facilities. This misuse contributes to antibiotic resistance. We determined antibiotic prescription patterns and associated factors among outpatients with RTIs in Jinja City, Uganda.MethodsWe conducted a retrospective observational study that involved data abstraction of all patient records with a diagnosis of RTIs from the outpatient registers for the period of June 1, 2022, to May 31, 2023. An interviewer-administered questionnaire capturing data on prescribing practices and factors influencing antibiotic prescription was administered to drug prescribers in the health facilities where data were abstracted and who had prescribed from June 1, 2022, to May 31, 2023. We used modified Poisson regression analysis to identify factors associated with antibiotic prescription.ResultsOut of 1,669 patient records reviewed, the overall antibiotic prescription rate for respiratory tract infections (RTIs) was 79.8%. For specific RTIs, rates were 71.4% for acute bronchitis, 93.3% for acute otitis media, and 74.4% for acute upper respiratory tract infections (URTIs). Factors significantly associated with antibiotic prescription included access to Uganda Clinical Guidelines (Adjusted prevalence ratio [aPR] = 0.61, 95% CI = 0.01–0.91) and Integrated Management of Childhood Illness guidelines (aPR = 0.14, 95% CI = 0.12–0.87, P = 0.002), which reduced the likelihood of prescription. Prescribers without training on antibiotic use were more likely to prescribe antibiotics (aPR = 3.55, 95% CI = 1.92–3.98). Patients with common cold (aPR = 0.06, 95% CI = 0.04–0.20) and cough (aPR = 0.11, 95% CI = 0.09–0.91) were less likely to receive antibiotics compared to those with pneumonia.ConclusionThe study reveals a high rate of inappropriate antibiotic prescription for RTIs, highlighting challenges in adherence to treatment guidelines. This practice not only wastes national resources but also could contribute to the growing threat of antibiotic resistance. Targeted interventions, such as enforcing adherence to prescription guidelines, could improve prescription practices and reduce antibiotic misuse in this low-income setting.

Awareness of Antimicrobial Resistance and Antimicrobial Drugs Prescription Pattern in Small Animal Clinical Practice in Ogun State, Nigeria

Antimicrobial resistance (AMR) is a global health challenge in veterinary and human health, leading to monitoring of resistance and promotion of responsible antimicrobial use. This survey assessed the use of antimicrobials among government veterinarians in Ogun state, Nigeria. Clinicians were requested to fill questionnaires designed to extract information on the frequency of antibiotics use, antibiotic prescription patterns and evaluation of perception on AMR and use of antibiotics with compromised efficacy in veterinary practice in the last three years. Fifty-two (52) questionnaires were administered and duly completed upon return. Data analysis showed 100% awareness of AMR with 80.8% (42/52) agreeing to have encountered AMR in the course of managing small animal cases. The tetracycline class of antibiotics 49(94.2%) was the most prescribed, followed by aminoglycosides 40(76.9%) and fluoroquinolones 35(67.3%). Empirical therapy (34/52) 65.4% is the most common treatment option among clinicians while 18 (34.6%) out of 52 clinicians performed antibiotic susceptibility testing along with laboratory diagnosis as treatment guide. Furthermore, 75.0% of the respondents affirmed administering antibiotics formulated for human use in small animal treatment. Thirty-three (63.5%) respondents administered human antimicrobials in animals according to the recommended dosage in humans. This survey identified that AMR was common in small animals in the state studied and this may be due to the irrational use of antibiotics. Promoting antimicrobial stewardship in small animal medicine therefore is paramount to mitigating antimicrobial resistance and data obtained from this study will contribute to developing evidence-based policy on the rational use of antibiotics in small animal practice in Nigeria.

Antibiotic De-escalation Patterns and Outcomes in Critically Ill Patients with Suspected Pneumonia as Informed by Bronchoalveolar Lavage Results.

Antibiotic stewardship in critically ill pneumonia patients is crucial yet challenging, partly due to the limited diagnostic yield of noninvasive infectious tests. In this study, we report an antibiotic prescription pattern informed by bronchoalveolar lavage (BAL) results, where clinicians de-escalate antibiotics based on the combination of quantitative cultures and multiplex PCR rapid diagnostic tests. We analyzed data from SCRIPT, a single-center prospective cohort study of mechanically ventilated patients who underwent a BAL for suspected pneumonia. We used the novel Narrow Antibiotic Therapy (NAT) score to quantify day-by-day antibiotic prescription pattern for each suspected pneumonia episode etiology (bacterial, viral, mixed bacterial/viral, microbiology-negative, and non-pneumonia control). We also analyzed and compared clinical outcomes for each pneumonia etiology, including unfavorable outcomes (a composite of in-hospital mortality, discharge to hospice, or requiring lung transplantation during hospitalization), duration of ICU stay, and duration of intubation. Clinical outcomes were compared with the Mann-Whitney U test and Fisher's exact test. We included 686 patients with 927 pneumonia episodes. NAT score analysis indicated that an antibiotic de-escalation pattern was evident in all pneumonia etiologies except resistant bacterial pneumonia. Microbiology-negative pneumonia was treated similarly to susceptible bacterial pneumonia in terms of antibiotic spectrum. Over a quarter of the time in viral pneumonia episodes, antibiotics were completely discontinued. Unfavorable outcomes were comparable across all pneumonia etiologies. Patients with viral and mixed bacterial/viral pneumonia had longer durations of ICU stay and intubation. BAL quantitative cultures and multiplex PCR rapid diagnostic tests resulted in prompt antibiotic de-escalation in critically ill pneumonia patients. There was no evidence of increased incidence of unfavorable outcomes.

Antibiotic use in surgical infections at a tertiary teaching hospital in Ghana.

The study aimed to assess antibiotic prescribing and use patterns at the Department of Surgery, Korle Bu Teaching Hospital. A cross-sectional study design was employed in this study. The study was conducted at the Department of Surgery, Korle Bu Teaching Hospital. Forty-two prescribers out of 63 (67%) at the Department of Surgery responded to questionnaires. Over the study period, prescriptions and medical records of 1715 patients from the general surgery, neurosurgery, and urology units were reviewed. Percentage of prescriptions with antibiotics, percentage of prescribers using guidelines for antibiotic prescriptions, and percentage using culture and sensitivity to inform antibiotic prescriptions. Of the 1715 prescriptions assessed, 75% (1294/1715) were from inpatients, and 45% (772/1715) included an antibiotic. Ciprofloxacin and metronidazole constituted 54% of antibiotic prescriptions from general surgery. Amoxicillin/clavulanic acid and ceftriaxone constituted 64.7% of antibiotic prescriptions from neurosurgery, and ceftriaxone and ciprofloxacin made up 37.7% of antibiotic prescriptions from urology. Microbiology testing was done for only 14.5% (9/62) of inpatients who received antibiotics for treatment. The choice of antibiotics was influenced mainly by doctors' previous experience (37/42, 88.1%). Antibiotics are widely used. About half of all prescriptions had antibiotics, with ciprofloxacin and metronidazole constituting more than half of antibiotic prescriptions from general surgery. Doctors mainly based their antibiotic prescriptions on previous experience and occasionally on microbiological investigations. None declared.

Prescription pattern and appropriateness of antibiotics in the management of cough/cold or respiratory disorders

Prescription pattern and appropriateness of antibiotics in the management of cough/cold or respiratory disorders

Comparing antibiotic prescribing patterns for hidradenitis suppurativa between dermatology and non-dermatology ambulatory providers.

Oral antibiotics are a mainstay of treatment for hidradenitis suppurativa (HS) primarily due to their anti-inflammatory and anti-microbial properties. Because antibiotics are frequently prescribed to treat HS, concerns exist regarding antibiotic stewardship. There is a paucity of literature comparing how antibiotic prescribing patterns for HS differ between dermatology and non-dermatology clinicians in the ambulatory setting. This study aims to compare the antibiotic prescribing patterns of dermatology versus non-dermatology clinicians treating HS in the ambulatory setting. We utilised the National Ambulatory Medical Care Survey (NAMCS) to identify visits for HS patients from 2005 to 2016. We performed multivariate logistic regression analysis to compare the likelihood of prescribing (1) antibiotics and (2) tetracyclines between dermatology and non-dermatology clinicians in the ambulatory setting. We identified a total of 2424125 (weighted) HS visits. Approximately 28.0% of visits were conducted by dermatology clinicians, while 72.0% were conducted by non-dermatology clinicians. Antibiotics were prescribed in 51.9% of visits. Tetracyclines were the most commonly prescribed antibiotics among visits with dermatology clinicians (33.4%), while penicillins/cephalosporins were the most commonly prescribed antibiotic among visits with non-dermatology clinicians (14.9%). Multivariate logistic regression analysis demonstrated no difference in the overall likelihood of prescribing antibiotic therapy between dermatology and non-dermatology clinicians (p=0.35). However, dermatology clinicians were significantly more likely to prescribe tetracyclines than non-dermatology clinicians (OR 5.48, 95% CI 1.19-25.26, p=0.03). In conclusion, dermatology clinicians were significantly more likely to prescribe tetracyclines than non-dermatology clinicians for HS patient visits.

Antibiotic utilization at an orthopedic inpatient department in a large governmental hospital in the north of the West Bank, Palestine; a retrospective observational study

BackgroundStudies evaluating the patterns of antibiotic consumption are becoming increasingly necessary as a result of the increased use of antibiotics and development of antibiotic resistance globally. This study aimed to evaluate the use of antibiotics in in terms of both quantity and quality at the largest surgical hospital in the north of the West Bank, Palestine.MethodsAn observational retrospective study with a total population sampling method was conducted to collect data from the inpatients of the orthopedic departments of a large governmental hospital in the northern West Bank, Palestine. The data were collected from patients’ files and evaluated using the anatomical therapeutic chemical and defined daily dose (ATC/DDD) methodology, and the drug utilization 90% (DU90%) index. The ATC/DDD methodology, designed by the World Health Organization (WHO), as a well-trusted and standardized tool that allows measuring and comparing antibiotic utilization across different contexts. Antibiotic prescriptions were classified using the World Health Organization Access, Watch and Reserve classification (WHO AWaRe).ResultsOf the 896 patients who were admitted to the hospital in the year 2020 and included in the study, 61.9% were males, and 38.1% were females. The percentage of patients who received antibiotics was 97.0%, and the overall antibiotic usage was 107.91 DDD/100 bed days. The most commonly prescribed antibiotic was cefazolin (50.30 DDD/100 bed days), followed by gentamicin (24.15 DDD/100 bed days) and ceftriaxone (17.35 DDD/100 bed days). The DU90% segment comprised four different agents. Classification of antibiotics according to the WHO AWaRe policy revealed that 75.9% of antibiotics were prescribed from the access list.ConclusionThis study comes as part of the efforts exerted to combat the growing problem of antibiotic resistance in Palestine. Our results showed that the consumption of antibacterial agents in the orthopedic unit at a large governmental hospital in Palestine was relatively high. The results of this study provide valuable insights for the decision-makers to create policies aimed at regulating antibiotic prescriptions. This study also aims to provide a look into the antibiotic prescription patterns, offering a clearer understanding of the current situation of antibiotic consumption in Palestine. It also emphasizes the need for antibiotic stewardship and surveillance programs.

Antibiotic prescription pattern among Primary Healthcare General Practitioners in the South Batinah Governorate of Oman, 2019

BackgroundMisuse and overuse of antibiotics comprise leading causes of antimicrobial resistance. The study aims to assess the pattern of antibiotic prescription among primary healthcare general practitioners in the South Batinah Governorate of Oman.MethodA cross-sectional study of 600 antibiotic prescriptions issued in the South Batinah Governorate in 2019 was conducted to verify the triggering diagnoses and determine the appropriateness of the prescribed antibiotic. Logistic regression analysis was used to determine the association between predictors and inappropriate use.ResultsRespiratory infections accounted for 62% of antibiotic prescriptions, of which 92.2% were inappropriately prescribed. Extended-spectrum antibiotics were inappropriately prescribed in 33.3% of cystitis cases, while 14.3% of gastroenteritis received incorrect spectrum of antibiotics. Amoxicillin represented 46.2% of antibiotic prescriptions, of which 84.4% were unnecessarily prescribed. Lower inappropriate antibiotic prescribing rate was linked to patients ≥ 18 years (OR = 0.46, 95% CI: [0.26, 0.82]), those who underwent laboratory tests (OR = 0.22, 95% CI: [0.12, 0.39]), and consultations at health centers (OR = 0.44, 95% CI: [0.24, 0.79]). Arabic-speaking physicians were more likely to prescribe antibiotics inappropriately.ConclusionInappropriate antibiotic prescription was frequently observed in mild respiratory infections and associated with specific patient and physician characteristics. Appropriateness of antibiotic prescriptions issued can be improved through enhanced testing capacities as well as implementation of physician and community awareness campaigns.

Prescribing Trend of Antibiotics Among the Patients Admitted in Intensive Medical Care Unit: A Prospective Observational Study.

Intensive medical care units (IMCUs) usually admit patients who are in critical medical need and require the utmost attention of healthcare professionals, along with the best treatment options available. These patients are prone to infections and require various antibiotics for the treatment. Varying costs of antibiotics, variable dosage forms, and antibiotic resistance cause an economic burden on patients Methodology: This study was designed and conducted prospectively to evaluate the prescribing pattern of antibiotics at the IMCU in a tertiary care hospital. A total of 102 patients were included in the study based on the exclusion and inclusion criteria, and the collected data was tabulated in an Excel sheetand analyzed using Prism GraphPad software. Data were presented as numbers and percentages. Most of the patients were in the age group of 41-50 years. The number of male patients was slightly more than that of female patients. The majority of the patients admitted to the IMCU had acute pulmonary edema and cerebrovascular accidents. Most antibiotics were prescribed empirically and administered parenterally, of which Amoxicillin + Potassium clavulanate was the most commonly used antibiotic. Tigecycline had the highest daily defined dose per 100 bed days value, and injection Sulbactam + Cefoperazone was the costliest of all antibiotic therapy. Antibiotic therapy used in the IMCU consisting of Sulbactam + Cefoperazone was found to be costlier, and Amoxicillin + Potassium clavulanate were the commonly prescribed antibiotics among the other prescribed antibiotics. The average cost of antibiotics was found to be higher, which increased the economic healthcare burden for patients and their families.

Antibiotic resistance risk assessment in Mymensingh, Bangladesh: Current scenario from human-animal-environmental interfaces viewpoint

The imprudent use of antibiotics increases the environmental microflora's resistance to various drugs, particularly antibiotics. Prescription data is crucial for understanding antibiotic usage frequency and dosage. This health-focused study aims to analyze antibiotic prescription patterns in human and veterinary practices to identify emerging trends in environmental antibiotic resistance.For this survey, A total of 6550 prescriptions were randomly collected from hospitals and pharmacies in Mymensingh sadar upazila, Bangladesh, between August and October 2022. Of these, 5123 (78 %) were for human cases and 1427 (22 %) for veterinary purposes. Photos of the prescriptions were taken and analyzed to understand prescribing habits. Additionally, 30 water samples from rivers, ponds, sewage, and households in Mymensingh City Corporation were collected to assess environmental antibiotic levels and resistance patterns of microorganisms.The analysis showed that Cephalosporins were the most prescribed antibiotics, found in 570 (56.27 %) of human prescriptions and 230 (42.99 %) of veterinary prescriptions. Aminoglycosides had the lowest frequency, with 13 (1.2 %) for humans and 46 (8.6 %) for animals. Macrolides (12.24 %), carboxylic acids (1.87 %), and rifamycins (1.28 %) were only found in human prescriptions, while sulfa drugs (10.84 %), tetracyclines (5.42 %), and combinations of antibiotics (14.77 %) were only in animal prescriptions. Quinolones were prescribed 4.06 times more for humans, while aminoglycosides were used 3.54 times more for animals. Environmental samples showed E. coli had the highest resistance (MAR Value: 0.625) against eight antibiotics.This study illuminates the human-animal prescription patterns that are influenced by environmental factors which drive antibiotic stewardship in Bangladesh. It is imperative for practitioners to exercise caution and adhere to guidelines when prescribing antibiotics, both in human and veterinary practices, given the alarming trend of antibiotic resistance. Additionally, measures must be taken to restrict the influx of antibiotics residue into the environment.