Antibiotic Prescribing Patterns Research Articles

Analysis of Dental Antibiotic Prescriptions for Children and Adolescents in South Korea

Antibiotics are used for the prevention and treatment of infections. This study aimed to investigate the patterns of dental antibiotic prescription in children and adolescents. The Health Insurance Review and Assessment Service provided data on patients who visited medical institutions. It was categorized according to year, sex, age, insurance type, dental institution, and region. Chi-square tests, Fisher’s exact tests, and one-way analyses of variance were performed. Statistical analyses were performed using SAS software (ver. 9.2; SAS Institute, Cary, NC, USA). Amoxicillin and cephalosporins, the most commonly used antibiotics, accounted for approximately 96% of the prescriptions. The younger the child, the more antibiotics were prescribed for trauma, pulpitis, and dental abscesses. However, closer to adolescence, the antibiotics were primarily prescribed to manage impacted teeth and periodontal problems. Antibiotics were prescribed for 3.13 days on average. There were significant differences in the prescription rates according to age, sex, type of insurance, type of medical institution, and region (<i>p</i> < 0.05). This study suggested that antibiotic prescriptions should be closely monitored to ensure appropriate usage of antibiotics.

Empiric Antibiotic Use and the Outcome in Infants at Risk of Early Onset Neonatal Sepsis in a Teaching Hospital in South India: A Retrospective Cohort Study

Background Neonatal sepsis continues to be an important cause of mortality and morbidity in low- and middle-income countries. The identification and early treatment of infants at risk of early-onset neonatal sepsis (EONS) with empiric antibiotics is a preventive strategy. Objectives To study the use of empiric antibiotics in infants at risk for EONS and assess their outcome in terms of the development of sepsis, mortality, and duration of hospital stay. Materials and Methods This retrospective cohort study was done at the Special Newborn Care Unit, GMC Thrissur. The data of babies at risk of EONS over a period of 3 years (2020–2022) was collected. One thousand two hundred and thirty-two babies with at least one risk factor for sepsis, as defined by the National Neonatology Forum (NNF) 2021 guidelines, were enrolled in the study. The antibiotic prescription pattern and the outcomes were measured. Results Empirical antibiotic treatment was received by 61.2% (754/1232) of infants, and of those, 39.5% (298/754) developed EONS. Infants treated with Piperacillin/Tazobactam and Amikacin had a higher incidence of sepsis and mortality than those started on Ampicillin and Gentamicin ( p < .001). In infants less than 32 weeks, the incidence of sepsis increased significantly with increase in number of risk factors ( p < .001). Infants with lower birth weight and gestational age were more susceptible to developing sepsis ( p < .001). EONS was significantly associated with neonatal resuscitation, umbilical vein catheterization, and invasive ventilation ( p < .001). Infants who received empirical antibiotics had a longer hospital stay, with a mean duration of 4.38 days more compared to the no antibiotics group. Conclusion In infants at risk of EONS, the empirical use of antibiotics alone did not show a favorable effect on the incidence of EONS or sepsis-related mortality.

Antibiotic-Prescribing Patterns Among Patients With Respiratory Symptoms in the Eastern Province, Kingdom of Saudi Arabia.

Background Upper respiratory tract infections (URTIs) represent the most common diagnosis in ambulatory care settings. Some of these infections are properly treated with antibiotics, but evidence points to an inappropriate overuse of antibiotics in URTI management. This overuse is linked to antibiotic resistance, drug-related adverse effects, and increased costs. Objective This study evaluated the prevalence and predictors of antibiotic prescription for patients with URTI symptoms at the primary healthcare centers (PHCCs) and pediatric emergency department (ED) of the Maternity and Children Hospital (MCH) in Dammam, Saudi Arabia. Methods A prospective study was conducted in the PHCCs and pediatric ED of MCH. Trained physicians collected data on patients with URTI symptoms aged three years and older. Scores based on modified Centor criteria were calculated, and rapid antigen detection tests(RADTs) were conducted for all study participants. Results Out of 469 patients with a URTI, 141 (30.1%) received a prescription for an antibiotic, with a smaller proportion in the PHCCs (n=85; 24.4%) than in the pediatric ED (n=56; 46.3%). The main significant predictors of antibiotic prescription in terms of odds ratio (OR) and 95% confidence interval (95%CI) were a positive RADT result (OR=41.75, 95%CI=4.76-366.28), the presence of tonsillar exudate (OR=5.066, 95%CI=3.08-8.33), tender and/or swollen anterior cervical lymph nodes (OR=4.537, 95%CI=1.96-10.54), and fever (OR=3.519, 95%CI=2.33-5.31). A higher Centor score was also a predictor (2 to 5 vs. -1 to 1) (OR=2.72, 95%CI=1.8-4.12). The absence of a cough was not a significant predictor (OR=1.13, 95%CI=0.74-1.72). Conclusions Although a positive RADT increased the likelihood that a patient would be prescribed an antibiotic at the time of assessment, most antibiotic prescriptions were not justified. To control expenses, prevent adverse effects, and limit the spread of antibiotic resistance, efforts should be made to reduce unnecessarily high antibiotic usage.

How Did COVID-19 Impact the Antimicrobial Consumption and Bacterial Resistance Profiles in Brazil?

The indiscriminate use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This research evaluated the pattern of antibiotic prescriptions among the Brazilian population between January 2018 and December 2021. Additionally, the study sought to analyze the incidence rates of central line-associated bloodstream infection (CLABSI) and examine the profiles of antibiotic resistance. We assessed the hospital and community antimicrobial consumption from the National Health Surveillance Agency Database and correlated it to microorganisms. The consumption of antimicrobials in the hospital environment increased by 26% in 2021, highlighting polymyxin B, which increased by 204%. In 2021, 244,266 cases of CLABSI were reported, indicating a nosocomial infection rate of 7.9%. The rate of resistance to polymyxin B was higher in Pseudomonas aeruginosa (1400%) and Klebsiella pneumoniae (514%). Azithromycin emerged as the predominant antibiotic utilized within the community setting, accounting for 24% of the overall consumption. Pearson's correlation analysis revealed a significant and positive correlation (r = 0.71) between the elevated usage of azithromycin and the incidence of COVID-19. Our results indicate an increase in antimicrobial consumption during the COVID-19 pandemic and reinforce the fact that the misuse of antimicrobials may lead to an expansion in antimicrobial resistance.

Frequency and Pattern of Antibiotic Prescription for Common Infections Presented in Five Primary Healthcare Centers, Cairo, Egypt

Abstract Background rationale antibiotic prescription is a key strategy to control antibacterial resistance. Objectives to measure the antibiotic prescription rate, and to identify the most commonly prescribed antibiotic, and to explore the reasons for irrational antibiotic prescription in five primary healthcare (PHC) settings in Egypt. Method A Cross-sectional study was conducted on 535 prescriptions collected from five primary healthcare centres; and checklists about symptoms and signs of common health problems of respiratory tract, gastrointestinal tract and urinary tract for antibiotic prescription was fulfilled. Results Antibiotic prescription rate was (33.8%) and the most commonly prescribed antibiotic was Amoxil (Penicillin) (31.5%). Only (26.4%) of antibiotic prescriptions were adherence to the guidelines of Ministry of health of Egypt. Only (31.3%) of patients had upper respiratory tract infection were treated according to the guidelines where Tonsillitis was the most common URT diagnosis (43%), where only (34.3%) of them took Amoxil, followed by bronchitis (67.2%), where (46.3%) of them took Amoxil (adherent to guidelines). Only (31.2%) of patients had lower respiratory tract infection were treated according to the guidelines. Most of urinary tract infections were found among females (86.8%) and cipro was the most commonly prescribed antibiotic (39.5%). Conclusion Antibiotics are frequently prescribed in primary health care centers in Egypt, and most of these prescriptions are inappropriate. Training sessions for physicians is mandatory to improve their awareness, attitude and practice towards antibiotics prescription.

Prescription analysis emphasizing on medication adherence of antibiotics for lower respiratory tract infection.

Antibiotics are choice of drugs in patients with respiratory infections. Irrational use of antibiotics is an important public health issue faced on daily basis by the community and the individual. Keeping this in consideration, the current study investigates the prescription pattern of antibiotics in lower respiratory tract infection in general population.The objectives of the study include prescription pattern analysis of antibiotics for LRTIs in general population and to evaluate adherence to antibiotic treatment.This was a hospital based prospective observational study conducted between November 2021 to April 2022 in the department of general medicine and pediatrics. Compliance to various antibiotics was scrutinized by using MMAS 4 scale. Patient demographics, laboratory details, prescribed antibiotics, duration of hospital stay were gathered over a period of 6 months.A total of 200 patients were involved in the study, out of which 53% were males and 47% were females. A total of 2127 drugs were prescribed in 200 patients (10.6 drugs/prescription). Ceftriaxone was the most commonly used antibiotic followed by azithromycin and piperacillin/tazobactam. The most frequently diagnosed disease was Bronchopneumonia (41%) followed by A/E COPD (28%). Evaluation of medication adherence resulted in 58% high and 11% poor adherence. The number of antibiotics prescribed was found to be rational but prevalence of polypharmacy should be prevented. Medication adherence decreases as the frequency of antibiotic increases, so it is recommended to lower the frequency of drugs as possible to enhance the compliance.

A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit

BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results. METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results. RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.

Antibiotics Prescriptions Pattern among Patients Visiting Primary Health Care Centers (PHCC) before and during COVID-19 Pandemic: A Cross-Sectional Population-Based Study from Qatar.

The COVID-19 pandemic, caused by the novel coronavirus 2 (SARS-CoV-2), has been associated with an increased risk of secondary bacterial infections. Numerous studies have reported a surge in antibiotic usage during the COVID-19 pandemic. This study aims to examine the impact of the COVID-19 pandemic on the frequency and patterns of antibiotic prescriptions at Primary Health Care Centers (PHCC) in Qatar, comparing the period before and during the pandemic. This population-based, cross-sectional study analyzed all antibiotic prescriptions issued in two-month intervals before COVID-19 (November and December 2019) and during the initial wave (June and July 2020) of COVID-19. The study included 27 PHCCs in Qatar. Prior to the COVID-19 outbreak, the PHCCs dispensed a total of 74,909 antibiotic prescriptions in November and December. During the first wave of COVID-19, the number decreased to 29,273 prescriptions in June and July 2020. Antibiotics were most commonly prescribed for adults and least commonly for the elderly, both before and during the COVID-19 period. In the pre-COVID-19 period, Betalactams and macrolides accounted for the majority (73%) of all antibiotic prescriptions across all age groups. However, during the COVID-19 period, Betalactams and other antibiotics such as Nitrofurantoin and Metronidazole (73%) were the most frequently prescribed. The rate of antibiotic prescriptions during the first wave of COVID-19 was lower compared to the two months preceding the pandemic at the PHCC in Qatar.

Antibiotic use and quality indicators of antibiotic prescription in Bhutan: a point prevalence survey using the Australian National Antimicrobial Prescribing Survey tool.

The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.

WHO/INRUD prescribing indicators among tertiary regional referral hospitals in Dar es Salaam, Tanzania: a call to strengthen antibiotic stewardship programmes.

Antibiotic prescribing should be guided by national essential medicines lists (NEMLs) and treatment guidelines; however, there are inadequate data on antibiotic utilization patterns in tertiary hospitals in Tanzania. This study aimed to determine antibiotic prescribing patterns in tertiary hospitals in Dar es Salaam, Tanzania. A retrospective cross-sectional study was conducted in three regional referral hospitals. About 200 prescription records from 2020 to 2022 were analysed at each hospital for prescribing patterns using WHO/ International Network of Rational Use of Drugs (INRUD) indicators (1993) and the AWaRe 2021 classification. Factors associated with receiving an antibiotic prescription were assessed using a logistic regression model. Facilities were ranked on prescribing practices using the index of rational drug prescribing (IRDP). A total of 2239 drugs were prescribed, of which 920 (41.1%) were antibiotics. An average of 3.7 ± 1.5 (optimal: 1.6-1.8) total medicines and 1.53 ± 0.78 antibiotics were prescribed per patient. About 88.0% (528) of the prescriptions contained antibiotics (optimal: 20.0%-26.8%), while 78.2% (413) of all antibiotic prescriptions contained injections (optimal: 13.4%-24.1%). Furthermore, 87.5% (462) of the antibiotics were prescribed in generic names (optimal: 100%), while 98.7% (521) conformed to the NEML (optimal: 100%). Metronidazole was the most frequently prescribed antibiotic (39.2%; n = 134), followed by ceftriaxone (37.1%, n = 127) and amoxicillin/clavulanic acid (8.5%, n = 29). We found substantial empirical prescribing and overuse of antibiotics exceeding WHO recommendations. Antibiotic overuse varied across the hospitals. Being male, having underlying conditions such as diabetes mellitus, and/or being treated at Temeke hospital were associated with receiving an antibiotic prescription. We recommend strengthening antibiotic stewardship programmes in the studied facilities.

Antibiotic Consumption in Primary Care in Costa Rica and Italy: A Retrospective Cross-Country Analysis.

The increasing emergence and spread of drug-resistant pathogens resulting from inappropriate antibiotic usage have become more evident in recent years, particularly with the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections.Since joining the Organization for Economic Cooperation and Development (OECD), Costa Rica can now compare its healthcare system with other countries, and similarities have been noted with Italy regarding health indicators. Both nations have universal healthcare systems, covering their entire populations, and hold similar positions in the Human Development Index (HDI). Consequently, the goal is to compare antibiotic prescribing and consumption patterns to collaboratively develop strategies against bacterial resistance. In order to compare antibiotic consumption between regions, a standardized contrast was utilized, specifically using the defined daily dose (DDD). An Orthogonal Contrast test was performed to test the means, followed by the application of the Student's t-test on these contrasts. This analysis aimed to assess the potential influence of regions on DDD values. Antibiotic consumption data were collected between January 2021 and December 2022 from the Local Health Authority of Naples 3 South (LHANS)in Italy and IMS Health, Q Quintiles, and VIA by way of (IQVIA) reports in Costa Rica. LHANS shows a considerable disparity in gross expenditure compared to Italy's overall expenditure, while the private sector of Costa Rica exhibits even lower gross expenditure than Italy. Antibiotic consumption in Italy exceeds that of Costa Rica, with Costa Rica's consumption amounting to 47.70% of Italy's total consumption. Additionally, LHANS exhibited a 22.43% higher gross expenditure compared to the Campania region, emphasizing the variability in antibiotic usage within the same country The results indicated no statistically significant differences in antibiotic consumption between the regions, as none of the null hypotheses were rejected. The study provides valuable insights into expenditure patterns and antibiotic consumption, highlighting the need for improved prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings emphasize the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.

Impact of COVID-19 on broad-spectrum antibiotic prescribing for common infections in primary care in England: a time-series analyses using OpenSAFELY and effects of predictors including deprivation.

The COVID-19 pandemic impacted the healthcare systems, adding extra pressure to reduce antimicrobial resistance. Therefore, we aimed to evaluate changes in antibiotic prescription patterns after COVID-19 started. With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system in primary care and selected patients prescribed antibiotics from 2019 to 2021. To evaluate the impact of COVID-19 on broad-spectrum antibiotic prescribing, we evaluated prescribing rates and its predictors and used interrupted time series analysis by fitting binomial logistic regression models. Over 32 million antibiotic prescriptions were extracted over the study period; 8.7% were broad-spectrum. The study showed increases in broad-spectrum antibiotic prescribing (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.36-1.38) as an immediate impact of the pandemic, followed by a gradual recovery with a 1.1-1.2% decrease in odds of broad-spectrum prescription per month. The same pattern was found within subgroups defined by age, sex, region, ethnicity, and socioeconomic deprivation quintiles. More deprived patients were more likely to receive broad-spectrum antibiotics, which differences remained stable over time. The most significant increase in broad-spectrum prescribing was observed for lower respiratory tract infection (OR 2.33; 95% CI 2.1-2.50) and otitis media (OR 1.96; 95% CI 1.80-2.13). An immediate reduction in antibiotic prescribing and an increase in the proportion of broad-spectrum antibiotic prescribing in primary care was observed. The trends recovered to pre-pandemic levels, but the consequence of the COVID-19 pandemic on AMR needs further investigation. This work was supported by Health Data Research UK and by National Institute for Health Research.

Prescription Pattern of Antibiotics in Pulmonary Ward of a Tertiary Care Hospital, Jammu and Kashmir

BACKGROUND
 World population growth, pollution and overcrowding have all contributed to an increase in respiratory infections. Antibiotic resistant virulent bacteria are on the rise, and they're spreading quickly. As a general rule, lower respiratory tract infections cause only minor symptoms but can lead to significant morbidity and mortality. Improvements in public and professional awareness of the long-term nature of many LRTIs could lead to better antibiotic stewardship. The objective of the study was to assess the prescription pattern of antibiotics in patients in a pulmonary ward of a tertiary care hospital, Jammu and Kashmir.
 METHODS
 A six-month prospective observational study in a pulmonary ward of a tertiary care hospital in Jammu and Kashmir looked at antibiotic use patterns in a single location. According to the inclusion and exclusion criteria, a total of 355 patients were considered for evaluation. Asthma, bronchitis, pneumonia, chronic obstructive lung disease (COPD), and acute respiratory infections such as the common cold and pharyngitis were all included in the study.
 RESULTS
 In our study, 230 (64.79%) of the 355 patients were males, while 125 (35.21%) were females. Pulmonary Tuberculosis had the highest number of cases observed (157 patients, 44.22 percent), followed by COPD 91 patients (25.63 percent), pneumonia 46 patients (12.95 percent), Pleural effusion cases 43 patients (12.11 percent), and Bronchiectasis cases 18 patients (5.07 percent). The findings revealed that the most commonly prescribed antibiotics were Cephalosporins, Macrolides, Metronidazole, Penicillins, Aminoglycosides, Doxycycline, Fluoroquinolones, and finally Carbapenems.
 CONCLUSIONS
 Globally, respiratory illnesses are on the rise due to a growth in population, pollution, urbanization and overcrowding. There is a rapid increase in the number of multi-drug-resistant pathogenic bacteria. However, lower respiratory tract infections can cause severe morbidity and mortality if left untreated. Understanding and judicious use of antibiotics may be improved if more people are aware of the long-term nature of LRTIs. In order to understand the dangers and advantages of antibiotic treatment, further research is needed. There is a risk that the use of antibiotics for minor viral respiratory infections could lead to the development of antibiotic-resistant viruses in the community.

Prospective observational study on prescription pattern of antibiotics in general ward and intensive care unit in tertiary care hospital

The prescription pattern monitoring facilitate the rational use of drugs in the population. Rational use of drug means patients receive medication appropriate to their clinical needs in closes that meet the individual requirement for an adequate period of time and at an economical price to the individual and overall to the community. Role of Right medicine in the Right manner in the Right patients must be followed while using Antibiotics. Irrational use of medicines is major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicine result in wastage of scarce resource and widespread health hazards. Therefore, appropriate and safe use of antibiotics in healthcare system is more Important. The main objective of the study was to determine the percentage of antibiotics used in general ward and in intensive care unit and to find out most commonly Prescribed antibiotic within 72 hours in intensive care unit, the most common microorganism found in culture sensitivity test and the common route of drug administration in general ward and in intensive care unit. This is a prospective observational study. The study was conducted in tertiary care hospital in Gujarat. The duration of the study was 6 months. Total of 120 patients data was collected from the patient case sheet. Prescription of the patients are collected in designed CRF form and relevant data is analysed to obtain frequency and percentage. Out of 120 patients, majority of patients were male and most commonly used route of administered was Iv. The commonly prescribed antibiotics in general ward was ceftriaxone 28 (29.43%), metronidazole 10 (10.53%), cefoperazone + sulbactum 10 (10.53 %) and Amoxicilin + clavulanic acid 7 (7.37 %) prescribed for different condition. In Intensive care unit, commonly prescribed antibiotics was ceftriaxone 19 (18.1 %), meropenem 15 (14.29 %) and Cefoperazone + sulbactum 12 (11. 44 %). On Discharge Time most of the patients was still on antibiotics therapy.This study analysed 120 prescription and ceftriaxone, cefoperazone + sulbactum, amoxicillin + clavulanic acid, meropenem, cefadroxil ,vancomycin,cefepime + tazobactum piperacilin + tazobactum, doxycycline Cefixime are the hospital formulary. Prescription pattern studies have become a potential tool for evaluating the health care System. This study provides important baseline information on antibiotics use. This study severs to spotlight the current prescribing trends in patients. The use of a single agent and the combination of antibiotics were dependent upon the hospital formulary and protocols and policies for antibiotic use.

POLA PERESEPAN ANTIBIOTIK PADA PASIEN ANAK DENGAN INFEKSI PERNAPASAN AKUT

Prescriptions for children who experience upper and lower acute respiratory infections (ARI), such as the common cold, rhinitis, sinusitis, pharyngitis and tonsillitis, are carried out according to the pattern. The study aimed to determine the pattern of antibiotic prescribing in pediatric ARI patients at the Karadiri Community Health Center, Nabire Regency. This type of descriptive research uses secondary data, namely medical records of antibiotic prescriptions in pediatric patients with ARI. The sample was all medical records of pediatric patients treated with ARI at the Karadiri Community Health Center, Nabire Regency, totaling 92 respondents. Sample selection with inclusion criteria is complete data, residents who live in the work area of the health center, and exclusion is incomplete data and non-residents who are disabled in the work area of the health center. The instrument uses an observation sheet. The results showed that the majority of ARI patients were aged 2-5 years (85%) and male (54%). The antibiotics used were amoxicillin in 58 patients (63%), followed by Co-trimoxazole in 25 (27%), Erythromycin in 9 (10%). The most commonly prescribed antibiotic dose was amoxicillin 66.7 mg (32%) with 24 prescriptions (26%). The duration of antibiotic administration was 5 days for 89 prescriptions (97%), with 67 prescriptions (75%) meeting the guidelines. In conclusion, the prescription of antibiotics for pediatric patients with ARI is not fully in accordance with the guidelines, namely the duration is 4 days and the dose follows the patient's body weight.

Evaluation of Drug Prescription Pattern Using WHO Prescribing Indicators in Libya: A Cross-Sectional Study

Background and aims. The improper use of drugs due to irrational prescriptions is a common problem in Libya. This study aimed to investigate the prescribing pattern and predictors of antibiotic prescription in primary health care facilities in three districts (east, west, and south) in Libya. Methods. In this retrospective study, 484 prescriptions were examined. World Health Organization-recommended indicators for rational use were examined (WHO): e.g., the percentage of prescriptions covering antibiotics, prescription of injections, and prescription of drugs by a generic name and from a national essential drug list, as well as the average number of drugs per prescription, were all considered. Results. The average number of drugs per prescription was 4.72, with a maximum of 7 drugs in a prescription, and the percentage of prescriptions involving antibiotics and injections was 30.4% and 10.5%, respectively. There were 28.6% drugs prescribed by their generic name and 82.8% were retrieved from the essential drugs list. The most common category of medicines were 18.9% antibiotics, 18.3% antihypertensives, and 15.7% multivitamins and minerals. While the lowest consumed drugs were steroids 2.5%. Conclusion. There was some irrational drug prescribing, particularly with regard to injections and antibiotics. It is suggested that physicians participate in continuing education programs on rational prescribing for various medical indications.

Impact of Penicillin Allergy Label on Clinical Outcomes of Pneumonia in Children.

Penicillin (PCN) allergy label, reported in approximately 5% of children, influences antibiotic choice and prolongs hospital stay. To our knowledge, the impact of PCN allergy label on clinical outcomes of pneumonia in children is not well characterized. To investigate the impact of PCN allergy label on clinical outcomes of pneumonia in children. In this propensity score-matched cohort study, we used the TriNetX research network, a population-based database, to compare the 30-day risk of hospitalization, need for intensive level of care, and acute respiratory failure from pneumonia between pediatric patients (aged 1-17 years) with and without a PCN allergy label after matching the 2 cohorts for demographic and medical comorbidities. Antibiotic prescription patterns were also contrasted. When comparing 3793 pediatric patients with pneumonia labeled with a PCN allergy with matched children without a PCN allergy label, PCN allergy label was associated with a higher risk of hospitalization (relative risk [RR], 1.15; 95% confidence interval [CI], 1.07-1.23), acute respiratory failure (RR, 1.27; 95% CI, 1.17-1.39), and need for intensive level of care (RR, 1.46; 95% CI, 1.15-1.84). PCN allergy label resulted in overutilization of broader-spectrum antibiotics and increased complications including cutaneous drug reactions (RR, 2.43; 95% CI, 1.31-4.52) and Clostridioides difficile infection (RR, 2.25; 95% CI, 1.14-4.44). Children with a PCN allergy label are more likely to be hospitalized, receive broader-spectrum antibiotics, and develop acute respiratory failure from pneumonia. Delabeling may offer a way to lessen morbidity from pneumonia in children.

Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy

BackgroundRecurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.MethodsA retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.ResultsA total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).ConclusionDespite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.

Antimicrobial stewardship: Prescribing across the primary care health professions.

We examined the patterns of antibiotic prescribing by medical and non-medical prescribers (dentists, nurse practitioners, and midwives) in Australia. We explored trends in the dispensed use of antibiotics (scripts and defined daily dose [DDD] per 1000 population/day) by Australian prescribers over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered health professionals subsidized on the Pharmaceutical Benefits Scheme (PBS). There were 216.2 million medical and 7.1 million non-medical dispensed prescriptions for antibiotics over 12 years. The top four antibiotics for medical prescribers were doxycycline; amoxicillin, amoxicillin plus clavulanic acid, and cefalexin, constituting 80% of top 10 use in 2005 and 2016; the top three for non-medical were amoxicillin, amoxicillin plus clavulanic acid and metronidazole (84% of top 10 use in 2016). The proportional increase in antibiotic use was higher for non-medical than medical prescribers. While medical prescribers preferentially prescribed broad-spectrum and non-medical prescribers moderate-spectrum antibiotics, there was a large increase in the use of broad-spectrum antibiotics over time by all prescribers. One in four medical prescriptions were repeats. Overprescribing of broad-spectrum antibiotics conflicts with national antimicrobial stewardship initiatives and guidelines. The proportional higher increase in antibiotic use by non-medical prescribers is a concern. To reduce inappropriate use of antibiotics and antimicrobial resistance, educational strategies targeted at all medical and non-medical prescribers are needed to align prescribing with current best practice within the scope of practice of respective prescribers.

An observational study for evaluation of antibiotic utilization and growing resistance against antibiotics in pediatric patients suffering from meningitis in a tertiary care hospital

Background: Meningitis, inflammation of the meninges with systemic septicemia, from the bacterial, viral, or fungal origin, is a fatal disease in all age groups, particularly infants and children. The present study was done to evaluate the usage of antibiotics in pediatric patients with meningitis in a tertiary care hospital. Aims and Objectives: The study was conducted to evaluate the prescription pattern of antibiotics for pediatric patients suffering from meningitis. The efficacy of antibiotics, combination of antibiotics, and the resistance developed against them were reevaluated. Materials and Methods: An observational, noninterventional study with 34 pediatric patients (The mean age of the patients were 6.17 year. ±4.84 SD) admitted in Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar from September 2012 to February 2014 were evaluated. Data were collected after the approval of the research protocol by the Institutional Ethics committee, KIMS from case sheets of patients from the ward as well as the Medical Record and Data section. Comparative statistical analysis was done by using student’s t-test in respect of data measured on a continuous scale. All differences with P&lt;0.05 were labeled as statistically significant. Results: Ceftriaxone±ß lactamase inhibitor (βLI) (77.4%), and Cefoperazone±βLI (12.9%) were the most frequently used cephalosporin. In 55.8% of patients, three or more antibiotics in combination were given. Two drugs regimen like β lacatam+aminoglycoside in 23.5% of patients and β lactam+anti-Methicillin-resistant Staphylococcus aureus (MRSA) in 20.6% were given. Emerging resistance pattern against both Gram-positive cocci and Gram-negative bacilli to penicillins, cephalosporins, and aminoglycosides which are the primary first-line drugs has been observed. Conclusion: Very severe meningitis patients were treated with multiple antibiotics including anti-MRSA agents. High resistance (≥60%) was observed against β lactams.