Antibacterial Prescribing Research Articles

Daily defined dose-costs have a stronger influence on antibacterial drug prescriptions in Germany than bacterial resistance: economic factors are more important than scientific evidence

AbstractPrevious research from our group revealed a strong association between daily defined dose (DDD)-costs and -prescriptions of antibacterial drugs in Germany (https://pubmed.ncbi.nlm.nih.gov/38842562/; https://pubmed.ncbi.nlm.nih.gov/39042156/). These data indicate that low costs are major driver of high prescription numbers. This study examines the relationship between bacterial resistance and DDD-prescriptions of antibacterial drugs using data from the Arzneiverordnungsreport (AVR) from 2008 to 2022 and the Antibiotic Resistance Surveillance (ARS) statistics provided by the Robert Koch Institute (RKI). We hypothesized that semi-rational or irrational prescribing behavior of antibacterial drugs is evident in Germany, i.e., prescriptions are driven to a greater extents by low DDD-costs than bacterial resistance. A bivariate correlation analysis was performed to test these models. Our data point to irrational prescribing behavior for amoxicillin, cefuroxime axetil, doxycycline, nitrofurantoin, ciprofloxacin, and clarithromycin. For amoxicillin clavulanic acid and sulfamethoxazole-trimethoprim, data point to semi-rational prescribing. For no antibacterial drug, a model pointing to rational drug prescribing was found. In conclusion, our study shows that DDD-costs exert a more significant influence on DDD-prescriptions than bacterial resistance, indicating that economic factors, rather than scientific evidence, primarily drive antibacterial drug prescriptions in outpatient settings in Germany. It will be important to conduct similar studies on the prescription of antibacterial drugs in other countries. It will also be important to study the relation between DDD-costs and -prescriptions for other drug classes and assess the scientific basis for these relations.

Impact of the COVID-19 Pandemic on Inpatient Antibiotic and Antifungal Drug Prescribing Volumes in Germany.

Previous studies found that the coronavirus disease 2019 (COVID-19) pandemic had a variable impact on the consumption of antimicrobial drugs in human medicine, with trends in several European countries differing between community and inpatient prescribing. This study analysed changes in the volumes and use density of antibacterial and antifungal drugs dispensed in acute care hospitals in Germany between 2019 and 2022. Surveillance data for the four years available from 279 hospitals were expressed as the total volumes of daily doses or as use density (daily doses per 100 patient/occupied bed days) per year and analysed descriptively, using recommended hospital-adapted daily dose definitions (RDDs) and (as sensitivity analysis) WHO/ATC-defined daily dose definitions (DDD). Hospitals were stratified according to size (number of beds), university affiliation, and location (East, West, South). There were significant decreases in both the total number of patient days and antibacterial drug volumes in 2020 through 2022 compared with 2019. The relative changes between 2019 and 2020, 2021, and 2022 were -12.8%, -13.5%, and -13.3% for patient days, and -9.7%, -11.0%, and -10.1% for antibacterial RDDs, respectively. Broad-spectrum betalactams, notably piperacillin-tazobactam and carbapenems, increased in volume, unlike most other drug classes. The resulting antibacterial drug use density was slightly but significantly increased, with pooled means (and medians) of 43.3 (40.0) RDD/100 in 2019 compared to 44.8 (41.7), 44.5 (40.80), and 44.9 (41.7) RDD/100 in the years 2020 through 2022, respectively. Antifungal drug volumes and use density increased after 2019 and peaked in 2021 (the difference between 2019 and 2021 for total volumes was +6.4%, and that for pooled mean use density values was +22.9%, respectively). These trends were similar in the different hospital strata and comparable when DDDs instead of RDDs were used. Similar to what has been observed in a majority of European countries, the total volume of antibacterial drug use in German acute care hospitals decreased with the pandemic, without a rebound phenomenon in 2022. In association with restricted hospital capacities and presumably more immunocompromised general medicine patients, however, inpatient prescribing of (primarily broad-spectrum) antibacterials and of antifungal drugs increased.

Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative

BackgroundThere is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum...

DDD-costs have a strong influence on antibacterial drug prescription in Germany: a differentiated correlation analysis from 1985 to 2022.

Antibacterial drugs are vital in modern medicine, and understanding the factors influencing their prescriptions is essential for maintaining their effectiveness and accessibility. This study investigates the hypothesis that costs significantly impact the prescriptions of antibacterial drugs, a factor previously underrecognized. To investigate this, we conducted correlation analyses on defined daily dose (DDD-) prescriptions and DDD-costs for the 15 most prescribed antibacterial drugs in Germany in 2022, using data from the Arzneimittelverordnungsreport (Drug Prescription Report)(1985-2022). The analysis focused on the periods 1985-2022, 1985-2011, and 2012-2022. Our findings revealed significant correlations between DDD-prescriptions and -costs for nearly all drugs over the entire period (1985-2022), with strong negative correlations for amoxicillin (- 0.941), cefuroxime axetil (- 0.900), clindamycin (- 0.800), nitrofurantoin (- 0.895), and cefaclor (- 0.819). From 1985 to 2011, only significant negative correlations were observed. In 2012-2022, significant correlations included both negative and positive, with strong positive correlations for ciprofloxacin (0.950) and clarithromycin (0.962). Overall, DDD-costs showed a persistent and strong correlation with DDD-prescriptions, particularly in the earlier period. This influence appears to diminish slightly in recent years, suggesting other factors might become more significant as DDD-costs plateau. Notably, amoxicillin, amoxicillin clavulanic acid, and nitrofurantoin consistently exhibited strong cost-prescription correlations throughout the entire period. While correlation does not imply causation, the significant and strong correlations, coupled with logical explanations, support the hypothesis that costs area primary factor in prescribing patterns. Further research is needed to establish causality and examine other potential systemic factors affecting antibacterial drug prescriptions.

Costs are a major driver of antibacterial drug prescriptions in Germany: market analysis from 1985 to 2022

In recent years, several threatening developments regarding antibacterial drugs, such as rising bacterial resistance and delivery bottlenecks, have occurred. Since antibacterial drugs are crucial for modern medicine, understanding events and influencing factors relevant for long-term developments is essential. Therefore, we analyzed the number of prescriptions and costs, defined daily dose (DDD) and DDD costs of antibacterial drugs in Germany, based on the Arzneiverordnungsreport (AVR, Drug description report) between 1985 and 2022. Based on prescription rates in 2022, we selected the TOP15 and TOP5. For a more in-depth analysis, we analyzed data from the wissenschaftliches Institut der AOK (WidO, scientific institute of the AOK). The number of prescriptions increased between 1985 and 2013, but since 2014, there has been a declining trend with a noticeable COVID-related dip. Over the years, a shift in drug classes occurred. Once very popular drugs like penicillins and tetracyclines are no longer as important. Conversely, aminopenicillins and cephalosporins have become more relevant. Particularly, the TOP5 drugs have seen an increasing proportion. DDD costs have decreased in most substance classes over time. There is a strong association between decreasing costs and rising prescriptions. Falling costs have a stronger immediate impact on prescriptions that rising costs. When costs are very low, drugs might be prescribed excessively. Supply bottlenecks can also result. The main prescribers are mainly in primary care. Their share of prescription has changed little over the years, but is decreasing regarding total consumption. In comparison to other European countries, Germany ranks in the lower third regarding prescriptions. In most countries, the COVID pandemic has led to a reduced prescription of antibacterial drugs. In conclusion, we provided a comprehensive overview of the antibacterial drug market in Germany over the past four decades and identified costs as a major driver of antibacterial drug prescriptions. Increased costs may reduce uncritical prescription of antibacterial drugs, development of bacterial resistance, supply shortages and occurrence of adverse effects.

Short- and mid-term morbidity and primary-care burden due to infant respiratory syncytial virus infection: A Spanish 6-year population-based longitudinal study.

The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach. Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period. The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection. Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.

Oral antibacterial drug prescribing in primary care out-of-hours services in Wales: a secondary analysis study

Abstract Introduction Antibacterial drug consumption is posing significant threats and contributing to antimicrobial resistance.[1] Individuals are frequently exposed to antibacterials, either with intentional use or unintentionally through environmental contamination, such as when drug residues are excreted into water resources.[2] To address these concerns and promote sustainability in human health and the environment, adopting rational prescribing practices is essential, especially in primary care (PC) settings where antibacterial prescribing is high. Healthcare practitioners often face various challenges when prescribing these drugs. The challenges are more pronounced in out-of-hours (OOH) encounters, where additional factors, including managing unfamiliar patients and limited safety netting, further complicate their prescribing decisions. Limited research has been conducted in these settings until recently, and the evidence in Wales is lacking. Aim Investigate oral antibacterial drug prescribing volume over time in PC, focusing on OOH services. Methods Retrospective descriptive analyses on All-Wales antibacterial prescriptions were carried out using longitudinal secondary data that were readily available when data was accessed, i.e., between the financial years 2015-16 and 2021-22. National Health Service financial years cover the period from April to March. These routinely collected data, which are not publicly available, were requested from All-Wales Therapeutics and Toxicology Centre and extracted from the Comparative Analysis System for Prescribing Audit (CASPA), an electronic-based system used by Wales Shared Services Partnership to maintain records of PC prescriptions dispensed in the community. Number of items prescribed during daytime and OOH services was obtained for all antibacterials and the 4Cs associated with Clostridioides difficile infections (co-amoxiclav, clindamycin, cephalosporins, quinolones). Data were processed and adjusted per 100,000 population using mid-year estimates, and the overall percentage changes in volumes were calculated. Results The total number of items prescribed in PC was 14,997,291, of which 1,265,499 (8.44%) were 4Cs. For OOH services, the total number of items was 445,339 (3% of PC); 4Cs accounted for 50,527 (11.35% of OOH, 4% of PC 4Cs). OOH antibacterial and 4Cs prescribing represented relatively small proportions over the 7-year period in relation to PC, ranging between 2.7%-3.2% and 3.6%-4.2%, respectively. Data revealed a decline in prescribing in PC as a whole and OOH services, reaching its lowest in 2020-21 when COVID-19 hit. Throughout the study, prescribing volume per 100,000 population decreased by 20.7% in PC and 31.2% in OOH services when examining all oral antibacterials, and by 40.9% and 38.5%, respectively, when examining 4Cs. Data from 2021-22 indicated a rise (14% in PC; 19% in OOH) in total antibacterial prescriptions from the previous year. Conclusion To our knowledge, this study is the first to examine oral antibacterial prescribing volume in Wales OOH services, revealing downward trends of prescribing in PC generally and OOH services. The reduction in PC was primarily driven by daytime prescribing, where most consultations usually take place. Various factors may contribute to this reduction, warranting further exploration of antimicrobial stewardship activities. Additionally, investigating COVID-19 potential impact on prescribing and its sustainability is crucial. Qualitative interviews are ongoing with lead antimicrobial pharmacists in Wales, to understand the observed trends and uncover their underlying driving causes.

TeamSTEPPS improves patient safety

BackgroundExamine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients.MethodsIn order to...

Antibiotic therapy in pediatric outpatient ENT infections

Inflammatory diseases of the ENT organs are currently the most common pathology in children. Diseases of the nasal cavity and paranasal sinuses occupy the leading place in the structure of primary morbidity, averaging 55.5%. In the paediatric population, ENT pathology develops more often as a secondary bacterial complication of a previous viral infection of the upper respiratory tract. Bacterial otorhinolaryngological complications often require the prescription of antibacterial drugs. In outpatient practice, the choice of rational and safe therapy is of utmost importance. The article presents clinical cases of ENT diseases in children and algorithms for the choice of initial antibacterial therapy. Recommended drugs for the treatment of ENT diseases and the main indications for their administration are presented. Most national and international guidelines recommend amoxicillin as a first-line drug for the treatment of major respiratory pathogens (S. pneumoniae, H. influenzae, S. pyogenes) and bacterial complications of ENT diseases in children, taking into account its low toxicity, cost and convenient form of administration. In case of ineffective therapy or in the presence of risk factors for drug resistance of pathogens, semi-synthetic penicillins in combination with β-lactamase inhibitors are recommended.

Challenges Facing Antimicrobial Stewardship Programs in the Endemic Region for Coccidioidomycosis.

Coccidioidomycosis poses a significant cost and morbidity burden in the United States. Additionally, coccidioidomycosis requires constant decision-making related to prevention, diagnosis, and management. Delays in diagnosis lead to significant consequences, including unnecessary diagnostic workup and antibacterial therapy. Antifungal stewardship considerations regarding empiric, prophylactic, and targeted management of coccidioidomycosis are also complex. In this review, the problems facing antimicrobial stewardship programs (ASPs) in the endemic region for coccidioidomycosis, consequences due to delayed or missed diagnoses of coccidioidomycosis on antibacterial prescribing, and excess antifungal prescribing for prevention and treatment of coccidioidomycosis are elucidated. Finally, our recommendations and research priorities for ASPs in the endemic region for coccidioidomycosis are outlined.

Overprescribing of potentially harmful medication: an observational study in England's general practice.

Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation. To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation. An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE). Practice-level prescribing data were obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model. Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = -0.01578, P = 0.004) and antibacterials (coefficient = -0.02769, P = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, P<0.001), opioids (coefficient = 0.08919, P<0.001), hypnotics (coefficient = 0.09038, P<0.001), gabapentinoids (coefficient = 0.1095, P<0.001), and antibacterials (coefficient = 0.01601, P = 0.19). The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.

Antibiotic Use in Patients With COVID-19

Abstract Introduction Antimicrobial resistance is a serious threat to public health. The ongoing antimicrobial resistance pandemic has been fueled by the COVID-19 pandemic. Methods We analyzed patients 15 years or older with COVID-19 who were admitted to a teaching hospital in Mashhad, Iran, during the period between the third and fourth COVID-19 waves. COVID-19 was diagnosed if the SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction test was positive in patients with compatible clinical syndromes. Results Overall, 532 episodes of COVID-19 were diagnosed. The median age of patients was 61 years (interquartile range, 48–73). One hundred twenty-five patients (23.4%) with COVID-19 died, and 165 (31%) experienced major complications. Over the study period, 134 DDD (defined daily dose) per 100 hospital bed days of antibacterial were used. Glycopeptides, third-generation cephalosporins, and carbapenems were the antibacterials most frequently used, based on the DDD per 100 hospital bed days. In a multivariate analysis, factors associated with antibacterial prescription in COVID-19 patients were lung involvement of greater than 50% (odds ratio [OR], 14.6), C-reactive protein of greater than 100 mg/L (OR, 3.35), and hypoxia (OR, 3.06). Univariate but not multivariate analysis showed that antibiotic use in COVID-19 patients was associated with 4 times increase in the chance of death (OR, 4.23). Conclusion Our study highlights a high rate of antibacterial use in COVID-19 patients. Hypoxia, C-reactive protein of greater than 100 mg/L, and severe lung involvement were associated with a higher rate of antibacterial prescription. The patients who received antibiotics died 4.23 times more often than patients treated without antibiotics. These findings emphasize the need for integrating antimicrobial stewardship programs as an integral part of the pandemic response and the need for improving diagnostic tests for early detection of bacterial coinfections in COVID-19 patients.

The substantiation of the role of a clinical pharmacist in preventing antibiotic resistance

Aim. To study the role of a clinical pharmacist in overcoming antibiotic resistance in healthcare institutions that provide both primary (outpatient) and specialized (inpatient) medical care.&#x0D; Materials and methods. The research materials were the Order of the Ministry of Health of Ukraine No. 1513 of 23.08.2023 “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”. Such methods as analysis, synthesis, grouping, formal-dogmatic, logical-semantic, ascent from abstract to concrete, historical, comparative, systematic, graphic ones were used.&#x0D; Results. According to the results of the analysis of the new standard of medical care “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”, it can be noted that clinical pharmacists are responsible for promoting, managing and optimizing the use of antimicrobial drugs. It is the level of professional training, qualification and experience in working with infectious diseases that allow clinical pharmacists to be leaders of programs to combat antibiotic resistance.&#x0D; Conclusions. According to the provisions of the Standard, the clinical pharmacist should be in close cooperation with the doctor through counseling. An important aspect of preventing complications of antibacterial pharmacotherapy and developing antibiotic resistance is a retrospective audit of antibacterial drug prescriptions performed by a clinical pharmacist. Taking into account the above, in our opinion, it will be rational to include the elements of practical training on prospective counseling and retrospective audit of the use of antibacterial agents in the working program of “Clinical Pharmacy and Pharmaceutical Care” for applicants of higher education of the educational and professional program “Clinical Pharmacy”.

The role of irrigation salt solutions with silver ions in the treatment and prevention of ENT diseases in children

ENT diseases are one of the most common reasons for visiting a doctor, especially in paediatric practice. The issue of interdisciplinary interactions between otorhinolaryngologists and paediatricians, their consistency in choosing therapy is extremely important. About 90% of morbidity rates relate to acute infectious respiratory viral etiology, which is characterized by high transmissibility and variability of manifestations. Particular attention should be paid to children attending preschool facilities, as they can catch acute respiratory viral infections up to 8 times a year, and 10-15% of them up to 12 times a year, which is 2 times more often than children who do not attend school, kindergarten, or any other educational facilities. The premature and unjustified prescription of antibacterial drugs, both local and systemic, remains a serious problem in the choice of therapy, which leads to increased number of antibiotic-resistant bacterial strains. Therefore, the issue of prevention and rational therapy, improvement of its effectiveness by the use of safe drugs appears relevant. The article points out that the irrigation-elimination therapy has been and remains the foundation of the prevention and treatment of diseases of the nasal cavity, paranasal sinuses and nasopharynx. The effectiveness and safety of this therapy has been studied and proven in the studies, and the inclusion of irrigation-elimination therapy in the international consensus documents such as EPOS 2012 and ARIA 2008 allows it to be widely used for the treatment of various ENT pathologies. It should be noted that availability of irrigation salt solutions with silver ions have significantly added to the possibilities of keeping the use of more aggressive drugs to a minimum, especially if the course of the disease is not complicated. Aquanasal drug containing natural Altai mineral water rich in silver ions is one of the commonly used drugs of a similar character with a wide range of indications, which has anti-inflammatory, anti-edematous, antimicrobial, antifungal and antiviral effects.

Therapy of acute respiratory viral infections in adults in outpatient clinical practice: new opportunities for the prevention of bacterial complications (Results of the observational program RAPORT)

The frequency of routine prescription of systemic antibacterial drugs in outpatient practice is still unreasonably high despite the desire to reduce them. Under the auspices of the Alliance of Clinical Chemotherapists and Microbiologists, the observational program RAPORT was conducted to assess the therapeutic potential (including bacterial complications preventing) of Raphamin in routine clinical practice in adults with acute respiratory viral infection (ARVI). The program included 14,033 patients aged 1897 years with ARVI who received an investigational drug (ID) as monotherapy (93%) or in combination with basic therapy (7%). The frequency of prophylactic prescribing antibacterial drugs was 0.6%. It was shown that fever duration was 2.311.38 days, and the duration of the disease 3.61.52 days. In 99.4% of patients, ID allowed to avoid the development of bacterial complications and prescription of antibacterial drugs. ID showed a stable therapeutic effect in patients who started treatment late, as well as in patients with a moderate course of ARVI, there was no delay in recovery. The results obtained a broad prospect for the use of ID in order to minimize the number of bacterial complications and the frequency of use of antibiotics in ARVI, which may reduce rate of resistance of topical pathogens in the future.

“Acute urinary antibiotics”—A simple metric to identify outpatient antibiotic stewardship opportunities in renal transplant

Background:International Classification of Diseases, Tenth Edition (ICD-10) data help track outpatient antibiotic prescribing but lack validation in immunocompromised populations or subspecialty clinics for this purpose. Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are important stewardship targets in renal transplant (RT) patients, but they may require alternative metrics to best monitor prescribing patterns. We describe ICD-10 utilization for RT clinic encounters in which antibiotics were prescribed. We developed a metric classifying “acute urinary antibiotics” (AUA) to track antibiotic use for ASB and UTI, and we validated systematic identification of AUA to enable practical implementation. Methods: We examined RT clinic visit and telemedicine encounters from 2018 to 2021 conducted 1 month after transplant. This project was deemed non–human-subjects research by the Stanford Panel on Human Subjects in Medical Research. Results: The analytic cohort included 420 antibacterial prescriptions from 408 encounters (Fig. 1). Of 238 patients, 136 (57%) were male and 112 (47%) were Hispanic or Latino. The most common primary ICD-10 code was Z94.0 (kidney transplant status) (N = 302 of 408 encounters, 75%); 26 encounters (6%) were coded for UTI (eg, N39.0, urinary tract infection, site not specified); and 214 encounters (53%) had multiple ICD-10 codes. The R82.71 code (bacteriuria) was never used. However, 215 prescriptions (51%) were classified as AUA (Fig. 2). The validation cohort included 130 prescriptions; 59 (45%) were classified as AUA and 51 (39%) had documented intent to treat ASB or UTI (positive percent agreement, 83%; negative percent agreement, 97%) (Table 1). For patients &gt;1 month after transplant, the positive percent agreement was 95% and the negative percent agreement was 98%. Of 51 patients receiving AUA, 32 (63%) were asymptomatic despite frequently having a code for UTI (Fig. 3). Conclusions: ICD-10 coding may not be helpful in monitoring antibiotic prescribing in RT patients. The AUA metric offers a practical alternative to track antibiotic prescribing for urinary syndromes and reliably correlates with physician intent. Monitoring AUA prescribing rates could help identify opportunities to optimize antibiotic use in this complex outpatient setting.Disclosures: None

448 Prescribing of oral antibacterial drugs in primary care out-of-hours services: a scoping review

Abstract Introduction The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). Aim To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. Methods The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and abstracts were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. Results The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time; of these, three explored prescribing trends before and during COVID-19. The impact of ­intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients’ expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers’ experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. Conclusion This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR.

Antibacterial therapy: questions posed by COVID-19 and real clinical practice

The COVID-19 pandemic was accompanied at different times by the prescription of various drugs. The prescription of antibacterial drugs was regarded differently, and even the term “pneumonia” was the subject of discussion. The frequency of antibiotic use during the pandemic varied widely across countries, with a general trend towards overprescribing. According to most studies, in the early period of this viral infection, there were no indications for antibiotic therapy, while later, when a bacterial process is attached, a rational choice of the drug is important, taking into account the potential resistance of the pathogen, including the production of beta-lactamase. In the current version of the guidelines on COVID-19, the topic of bacterial infections has been carefully worked out. It is clearly stated that antibiotic therapy is prescribed only if there are convincing signs of a bacterial infection. On the one hand, it was noted that most patients with COVID-19 do not need antibiotic therapy, and on the other hand, for patients who do not need hospitalization with signs of a bacterial infection, amoxicillin and amoxicillin/clavulanate are the drugs of choice. The latter combination is also approved for hospitalized patients. Literature analysis has shown that amoxicillin/clavulanate remains a highly effective antibiotic for the initial treatment of community-acquired respiratory tract infections. In the conditions of import substitution, the creation of effective and safe, affordable domestic generics that have therapeutic equivalence with original drugs is a significant achievement of the Russian pharmaceutical science and industry. This review assesses the efficacy and safety of antibiotic use during a pandemic, as well as the place of amoxicillin/clavulanate in modern clinical practice.

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Accuracy of antibacterial indication documentation in an electronic medicines management system.

Electronic medicines management (EMM) systems are relatively new in the Australian healthcare system. This tertiary hospital network implemented an EMM in 2018, with mandatory documentation of antimicrobial indication when prescribing. Free-text (unrestricted) and pre-defined dropdown (restricted) indications are utilized according to antimicrobial restriction. To determine accuracy of antibacterial indication documentation on the medication administration record (MAR) when prescribing and to evaluate factors influencing accuracy of documentation. A random sample of 400 inpatient admissions of ≥24 h, between March and September 2019, with the first antibacterial prescription per encounter reviewed retrospectively. Demographic and prescription details were extracted. Indication accuracy was assessed by comparing MAR documentation with the medical notes (gold standard). Statistical analysis compared factors associated with accuracy of indication using chi-squared and Fisher's exact tests. Antibacterials were prescribed in 9708 admissions. Of the 400 patients included (60% male; median age 60 years, IQR 40-73), 225 prescriptions were unrestricted and 175 were restricted. Patients were managed by emergency (118), surgical (178) and medical (104) teams. Overall accuracy of antibacterial indication documentation on the MAR was 86%. A higher accuracy rate was found for the unrestricted proportion compared with the restricted proportion (94.2% versus 75.2%; P < 0.0001). Surgical teams had higher accuracy compared with medical and emergency teams (94.4% versus 78.8% versus 79.7%; P < 0.0001). Antibacterial indication documentation on the MAR when prescribing demonstrated a high rate of accuracy. Multiple factors influenced this accuracy, which requires further study to determine the impact on accuracy, with a view to improve future EMM builds.