Prescription Of Systemic Antibiotics Research Articles

Shift in antibiotic prescription at a University Dental Clinic in Norway 2013-2017.

A considerable number of prescriptions for antibiotics are issued by dentists. Educational institutions have a special responsibility to promote informed attitudes among dental students towards prescribing antibiotics. The purpose of this study was to analyze the antibiotic prescriptions issued during a 5-year period (2013-2017) at a University Dental Clinic (UDC) in Norway. All patient records containing prescriptions for patients ≥18yr of age as of 2013-2017 were identified through an electronic search. In total, 6,014 patient record lines containing prescriptions were obtained, 1,047 (17.4%) of which were prescriptions for systemic antibiotics. These patient record lines were analysed to identify the specific antibiotic prescribed, the indication or diagnosis for which it was prescribed, and whether microbiological testing (to determine antibiotic sensitivity) had been carried out. Acute infections were the most common context for prescribing antibiotics. Surprisingly, prophylaxis was the second most frequent reason stated. Disease related to pulp necrosis (43%) and postoperative infections (26%) was the most common diagnosis for therapeutic antibiotic prescriptions. Antibiotic therapy was more commonly used to treat peri-implantitis than to treat periodontitis. Only 60% of the clindamycin prescriptions were issued to patients with penicillin allergy. Further studies are warranted concerning antibiotic use at UDC because this can probably be more restrictive, in particular concerning usage related to antibiotic prophylaxis. Microbiological testing should be performed before administration of antibiotic therapy for periodontitis and peri-implantitis. The reason for prescribing antibiotics should always be stated in the patient's record lines.

Three periodontitis phenotypes: Bone loss patterns, antibiotic-surgical treatment and the new classification.

AimTo compare three periodontitis clusters (A, B and C) for alveolar bone loss (ABL) patterns, antibiotic prescriptions and surgeries and to relate them to the new classification of periodontitis.Materials and MethodsABL patterns, prescription of systemic antibiotics and the number of surgeries were retrieved for all patients (n = 353) in the clusters. Comparisons and possible predictors for antibiotics were assessed, and results also evaluated in relation to the new classification.ResultsCluster A is characterized by angular defects often affecting the first molars and localized stage III/IV grade C periodontitis. Cluster B contains mainly localized or generalized stage III/IV, grade C patients. Cluster C contains mainly patients with generalized stage III/IV grade C periodontitis. Patients in cluster A received significantly more antibiotics compared to B and C (78% vs. 23% and 17%); the predictors for antibiotic prescription were young age and localized ABL. No differences in numbers of periodontal surgeries were observed between clusters (A = 1.0 ± 1.4, B = 1.3 ± 1.4 and C = 1.3 ± 1.5).ConclusionsWithin stage III/IV grade C periodontitis, we could detect three clusters of patients. The distinct localized ABL pattern and younger age in cluster A presumably prompted clinicians to prescribe antibiotics.

Avaliação da prescrição de antibióticos pelos endodontistas em abscesso periapical agudo

Esse estudo teve como objetivo avaliar a prescrição de antibióticos nos abscessos periapicais agudos pelos endodontistas da região metropolitana do Recife - PE. Um estudo transversal com uma amostra de 100 endodontistas, que exerciam suas atividades em faculdades de odontologia e clínicas odontológicas particulares ou públicas. Eles responderam um questionário sobre prescrição de antibióticos sistêmicos no tratamento de abscesso periapical agudo e os dados foram analisados descritivamente por meio de frequências absolutas e relativas. Para avaliar associação entre duas variáveis categóricas foi utilizado o teste Qui-quadrado de Pearson ou teste Exato de Fisher e o programa estatístico utilizado foi o SPSS (Statistical Package for the Social Sciences) na versão 23. A associação de amoxicilina com clavulanato de potássio em pacientes adultos sem alergia a penicilina foi prescrita por 50% dos endodontistas e em casos de alergia a penicilina, a clindamicina foi a droga de primeira escolha com 67%. A maioria dos endodontistas realizava a prescrição do antibiótico por 7 dias. Com relação a prescrição de antibióticos a maioria respondeu que não prescrevia em todas as fases do abscesso periapical agudo, no entanto, quando houve determinação das fases evolutivas dessa doença, resultados mostraram que existiu prescrição em todas as fases, porém com percentuais diferentes, sendo mais indicados quando existia comprometimento sistêmico do paciente. Concluiu-se que a prescrição de antibióticos pelos endodontistas pesquisados não foi coerente com a literatura científica, no entanto, mostrou uma preocupação com a saúde e risco de complicações sistêmicas graves do paciente.

2742. The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

BackgroundAntibiotic resistance is a cause of morbidity and mortality driven by inappropriate prescribing. In the United States, a third of all outpatient antibiotic prescriptions may be inappropriate. Seasonal influenza rates are significantly associated with antibiotic prescribing rates. The impact of influenza vaccination coverage on antibiotic prescribing is unknown.MethodsWe conducted a retrospective analysis of state-level vaccination coverage and antibiotic prescribing rates from 2010 to 2017. We used fixed effects regression to analyze the relationship between cumulative vaccine coverage rates for a season and the per capita number of prescriptions for systemic antibiotics for the corresponding season (January–March) controlling for temperature, poverty, healthcare infrastructure, population structure, and vaccine effectiveness.ResultsRates of vaccination coverage ranged from 33% in Nevada to 52% in Rhode Island for the 2016–2017 season, while antibiotic use rates ranged from 25 prescriptions per 1,000 inhabitants in Alaska to 377 prescriptions per 1,000 inhabitants in West Virginia (Figure 1). Vaccination coverage rates were highly correlated with reduced prescribing rates, and controlling for other factors, we found that a one percent increase in the influenza vaccination rate was associated with 1.40 (95% CI: 2.22–0.57, P < 0.01) fewer antibiotic prescriptions per 1,000 inhabitants (Table 1). Increases in the vaccination coverage rate in the pediatric population (aged 0–18) had the strongest effect, followed by the elderly (aged 65+).ConclusionVaccination can reduce morbidity and mortality from seasonal influenza. Though coverage rates are far below levels necessary to generate herd immunity, we found that higher coverage rates in a state were associated with lower antibiotic prescribing rates. While the effectiveness of the vaccine varies from year to year and the factors that drive antibiotic prescribing rates are multi-factorial, these results suggest that increased vaccination coverage for influenza would have significant benefit in terms of reducing antibiotic overuse and correspondingly antibiotic resistance. Disclosures All authors: No reported disclosures.

Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo

ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of...

Topic inhaled antibiotic therapy in children with prolonged adenoiditis

Currently the issue of antibiotic resistance is urgent due to the unreasonable prescription of systemic antibiotics in the treatment of the upper respiratory tract infections. Frequent use of systemic antibiotic therapy in childhood leads to disruption of the microbiota and the development of secondary immunodeficiency. Alternative topical antibiotic therapy together with mucolytics allows the antibiotic to penetrate directly to the inflammation site and destroy biofilms. The article outlines the use of thiamphenicol glycinate acetylcysteinate in children with prolonged adenoiditis. In Russia this antibiotic is presented by Fluimucil® IT; it is manufactured in the form of a lyophilisate for both injectable solutions and solutions for inhalations and irrigation of mucous membranes. Thiamphenicol glycinate acetylcysteinate helps to improve the course of the disease, in some cases, to avoid invasive procedures and reduce the use of systemic antibiotics.

Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance: Data From eight Point Prevalence Surveys.

Antimicrobial resistance is low in Norway, but to prevent an increase, the Norwegian Government has launched a National Strategy including a 30% reduction of broad-spectrum antibiotics (BSA) in hospitals within 2020. BSA are defined as second- and third-generation cephalosporins, carbapenems, piperacillin/tazobactam and quinolones. There are no recent studies of antibiotic use in Norwegian hospitalized children. The aim of this study was to describe the use of antibiotics with emphasis on BSA in Norwegian hospitalized children and neonates to detect possibilities for optimization. Data were extracted from 8 national point prevalence surveys of systemic antibiotic prescriptions in Norwegian hospitals between 2015 and 2017. The choices of antibiotics were compared with the empirical recommendations given in available Norwegian guidelines. In total, 1323 prescriptions were issued for 937 patients. Twenty-four percent of pediatric inpatients were given antibiotics. Adherence to guidelines was 48%, and 30% (95% confidence interval: 27%-33%) of all patients on antibiotics received BSA. We identified only small variations in use of BSA between hospitals. One-third of the patients on antibiotic therapy received prophylaxis whereof 13% were given BSA. In 30% of prescriptions with BSA, no microbiologic sample was obtained before treatment. This study reveals an excess of prescriptions with BSA in relation to the low resistance rate in Norway. Our findings reveal areas for improvement that can be useful in the forthcoming antibiotic stewardship programs in Norwegian pediatric departments.

Prescribing trends of systemic antibiotics by periodontists in Australia.

Antibiotics are a common systemic pharmaceutical therapy in periodontal conditions for dental practitioners as well as specialists. However, there is limited information about prescribing patterns amongst the periodontists within Australia. The objective of this study is to examine current patterns and perceptions in prescribing systemic antibiotics for the treatment of periodontal and peri-implant diseases. An online questionnaire was disseminated to Australian practicing members of the Australia and New Zealand Academy of Periodontists (ANZAP) to determine their antibiotic prescribing patterns for different periodontal conditions. Indications that were analyzed included: chronic periodontitis, plaque-induced gingivitis, aggressive periodontitis, acute gingival and periodontal conditions, conditions associated with implants and implant placement, periodontal regeneration, and mucogingival surgery. Out of the 50 members that participated in the study, 38 completed the questionnaire. Systemic antibiotics prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 79% reported prescription of systemic antibiotics in the treatment of chronic periodontitis whereas 52.6%, 55.3%, 18.4% of the respondents did so for periodontal regeneration procedures, implant placement surgery, and mucogingival surgery, respectively. Azithromycin, the combination of Amoxicillin and Metronidazole, and Amoxicillin were the three most commonly prescribed systemic antibiotics. Based on the results of this survey, systemic antibiotics are widely used by the group of periodontists surveyed in this study in Australia with varying rates and patterns for different periodontal and peri-implant conditions. The current study highlights the need for recommendations and guidelines in the prescription of antibiotics for periodontal and peri-implant conditions.

A Pilot Study to Investigate Antibiotic Prescribing in Private Dental Practice in the UK.

This paper examines antibiotic prescribing by dental practitioners delivering private dental care in the UK. An online questionnaire utilising the online Surveymonkey tool was used to collate data on aspects of therapeutic and prophylactic antibiotic prescribing in private dental practice. In total, 53 private dental practitioners registered with Simplyhealth professionals (formerly DENPLAN Ltd) responded to this study. All respondents recognised that an elevated temperature associated with a dental infection requires a prescription of systemic antibiotics. Other reported indications for prescribing antibiotics, as an adjunct to definitive management of the cause, included gross diffuse swelling (50%), difficulty in swallowing (48%) or closure of the eye due to swelling (51%). The majority of respondents were found to prescribe the appropriate antibiotic at the correct dose, frequency and duration. Overall, private dental practitioners prescribed or dispensed fewer than six courses of antibiotics each month and just less than half the respondents did not audit their prescribing.<br/>The results of this limited pilot study suggest that most dental practitioners providing private dental care prescribe appropriately and at lower levels than NHS dental practitioners. A definitive larger study of private dental practitioners antibiotic prescribing would be of value in determining their contribution to reducing the development of antimicrobial resistance.

Systemic antibiotic prescription rates and patterns in private sector in India: Evidence from medical audit data

Systemic antibiotic prescription rates and patterns in private sector in India: Evidence from medical audit data

Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

To quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs). Retrospective cohort study. A 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016. Our primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge. Among 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02-1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02-2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9-1.2). Antibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

PHP101 - SOCIO-ECONOMIC AND SOCIO-DEMOGRAPHIC DRIVERS INFLUENCING PREVALENCE OF ANTIBIOTIC USE: AN ANALYSIS IN SOUTHERN ITALY SETTING

To analyze the geographic variation in systemic antibiotic prescription at a regional level and to explore the influence of socioeconomic and sociodemographic variables. Retrospective analysis of reimbursement pharmacy records in the outpatient settings of Italy’s Campania Region in 2016. Standardized antibiotic prescription rates were calculated at municipality and Local Health Unit (LHU) level. Antibiotic consumption was analyzed as DDD/1000 inhabitants per day. Average antibiotic prevalence rate was 46.8%. At LHU level, the age-adjusted prevalence rates ranged from 41.1% in Benevento to 51.0% in Naples2. Significant differences were found among municipalities: from 15.2% in Omignano (Sa-LHU) to 61.9% in Moschiano (Av-LHU). The geographic distribution also showed significant differences in terms of antibiotic consumption: from 6.7 DDD/1000 inhabitants/day in Omignano to 41.6 in San Marcelino (Ce-LHU). Logistic regression showed that both municipality type and average annual income level were the main determinants of antibiotic prescription. Urban municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to rural municipalities [adjusted OR: 8.62 (95%CI: 4.06 – 18.30, P < 0.001)]. Municipalities with low average annual income level were more than eight times as likely to have antibiotic high prevalence rates compared to high average annual income level municipalities [adjusted OR: 8.48 (95%CI: 3.45 – 20.81, P < 0.001)]. We provide a snapshot of Campania’s antibiotic consumption, evidencing the impact of both socioeconomic and sociodemographic factors on the prevalence of antibiotic prescription. The observed intraregional variability underlines the lack of shared therapeutic protocols and the need of a careful monitoring. Our results can be useful for decision-makers to plan educational interventions, thus optimizing health resources and improving rational drug use.

Increased use of third-generation cephalosporin antibiotics in the outpatient setting in Korean children and adolescents.

Antimicrobial resistance is a concern to public health, and controlling antibiotic use is therefore important. This study analyzed the trend in outpatient antibiotic prescriptions in children and adolescents in Korea. Using National Prescribing Sample data from the Korea Health Insurance Review and Assessment Service between 1 January 2010 and 31 December 2014, we analyzed outpatient systemic antibiotic (anatomical therapeutic chemical [ATC] J01) prescriptions in patients aged 2-17years. The antibiotic rate was defined as the proportion of all outpatient prescriptions for antibiotics. We calculated absolute and relative differences with 95%CI between 2010 and 2014 in the antibiotic rate by age group (2-6, 7-11, and 12-17years) and the percentage of antibiotic prescriptions by antibiotic class. Seven of the most commonly used antibiotic drugs were identified based on defined daily dose. A total of 7261176 prescriptions were written for 1039756 pediatric patients between 2010 and 2014. The antibiotic rate in all patients increased from 34.8% in 2010 to 70.4% in 2014, resulting in the relative difference of 102.1% (95%CI: 101.7-102.5). Extended spectrum penicillins were the most commonly prescribed antibiotic class, accounting for 40.0-41.0% of all antibiotic prescriptions. The use of third-generation cephalosporins increased steeply with the relative difference of 55.7% (95%CI: 55.2-56.2). Amoxicillin/clavulanate, an extended spectrum antibiotic drug, was the predominately used antibiotic drug but the use of cefpodoxime, a third-generation cephalosporin, increased by 96%. The use of outpatient antibiotics, especially third-generation cephalosporins, has increased in children and adolescents in Korea.

Using Bacterial Fluorescence Imaging and Antimicrobial Stewardship to Guide Wound Management Practices: A Case Series

The urgent need to eliminate unnecessary use of antibiotics in wound patients has been hampered by diagnostic uncertainty and the time required to obtain culture results. The authors evaluated bedside use of a handheld bacterial fluorescence imaging device for real-time visualization of bacteria within and around wounds, used in addition to monitoring of clinical signs and symptoms of infection, in a series of 7 patients (5 women, 2 men; age range 57-93 years) with varying comorbidities who were referred to the wound ostomy continence clinician for wound assessment. When excited by 405-nm violet light, tissues fluoresce green (collagens) and bacteria fluoresce red; specialized optical filters reveal these colored signals in real time on the device's display screen. Wounds exhibiting red fluorescence were presumed to have moderate/heavy bacterial contamination (≥104 CFU/g) and were subsequently swabbed. Swabs from the 5 wounds with regions of red fluorescence confirmed heavy growth of 1 or more pathogenic bacterial species. Images revealing pronounced bacterial fluorescence in 3 patients with pressure injuries about to be discharged led to prescription of systemic antibiotics and additional patient monitoring. In 2 patients (1 with a skin tear, 1 with a surgical wound), the absence of bacterial fluorescence prevented planned, unwarranted use of systemic antibiotics. Fluorescence images obtained bedside during routine wound assessments had a direct effect on antimicrobial stewardship practices. Follow-up images demonstrated antibiotic effectiveness and, in some instances, led to reduced antibiotic courses and duration. This case series demonstrates the potential use for real-time information on bacterial presence obtained via bacterial fluorescence imaging to guide evidence-based deployment of antibiotics and prevent unnecessary use. Additional studies to optimize the diagnostic potential and randomized controlled studies to examine the effect of this technique on antibiotic usage, antimicrobial stewardship practices, and wound outcomes are warranted.

Prevalence of antibiotic prescription in southern Italian outpatients: real-world data analysis of socioeconomic and sociodemographic variables at a municipality level.

PurposeThe aim of this study was to analyze the geographic variation in systemic antibiotic prescription at a regional level and to explore the influence of socioeconomic and sociodemographic variables.MethodsThis study was a retrospective analysis of reimbursement pharmacy records in the outpatient settings of Italy’s Campania Region in 2016. Standardized antibiotic prescription rates were calculated at municipality and Local Health Unit (LHU) level. Antibiotic consumption was analyzed as defined daily doses (DDD)/1000 inhabitants per day (DID). Logistic regression was performed to evaluate the association between antibiotic prescription and sociodemographic and socioeconomic determinants at a municipality level.ResultsThe average antibiotic prevalence rate was 46.8%. At LHU level, the age-adjusted prevalence rates ranged from 41.1% in Benevento to 51.0% in Naples2. Significant differences were found among municipalities, from 15.2% in Omignano (Salerno LHU [Sa-LHU]) to 61.9% in Moschiano (Avellino [Av-LHU]). The geographic distribution also showed significant differences in terms of antibiotic consumption, from 6.7 DID in Omignano to 41.6 in San Marcelino (Caserta [Ce-LHU]). Logistic regression showed that both municipality type and average annual income level were the main determinants of antibiotic prescription. Urban municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to rural municipalities (adjusted odds ratio [OR]: 8.62; 95% confidence interval [CI]: 4.06–18.30, P<0.001). Low average annual income level municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to high average annual income level municipalities (adjusted OR: 8.48; 95% CI: 3.45–20.81, P<0.001).ConclusionWe provide a snapshot of Campania’s antibiotic consumption, evidencing the impact of both socioeconomic and sociodemographic factors on the prevalence of antibiotic prescription. The observed intraregional variability underlines the lack of shared therapeutic protocols and the need for careful monitoring. Our results can be useful for decision makers to plan educational interventions, thus optimizing health resources and improving rational drug use.

Potential for reducing inappropriate antibiotic prescribing in English primary care.

To identify and quantify inappropriate systemic antibiotic prescribing in primary care in England, and ultimately to determine the potential for reduction in prescribing of antibiotics. Primary care data from 2013-15 recorded in The Health Improvement Network (THIN) database were used. Potentially inappropriate prescribing events in the database were identified by: (i) comparing prescribing events against treatment guidelines; (ii) comparing actual proportions of consultations resulting in prescription for a set of conditions with the ideal proportions derived from expert opinion; and (iii) identifying high prescribers and their number of prescriptions above an age- and body-system-specific benchmark. Applying the most conservative assumptions, 8.8% of all systemic antibiotic prescriptions in English primary care were identified as inappropriate, and in the least conservative scenario 23.1% of prescriptions were inappropriate. All practices had non-zero reduction potentials, ranging from 6.4% to 43.5% in the middle scenario. The four conditions that contributed most to inappropriate prescribing were sore throat (23.0% of identified inappropriate prescriptions), cough (22.2%), sinusitis (7.6%) and acute otitis media (5.7%). One-third of all antibiotic prescriptions lacked an informative diagnostic code. This work demonstrates (i) the existence of substantial inappropriate antibiotic prescribing and (ii) poor diagnostic coding in English primary care. All practices (not just the high prescribers) should engage in efforts to improve antimicrobial stewardship. Better diagnostic coding, more precise prescribing guidelines and a deeper understanding of appropriate long-term uses of antibiotics would allow identification of further potential for reductions.

Trends in antibiotic prescribing by dental practitioners in Germany

PurposeTo analyze the structure of antibiotic prescriptions by dentists in Germany during a time-period of four years in relation to medical antibiotic prescriptions. Materials and methodsWe collected nationwide data from all statutory health insurances on dental prescriptions of systemic antibiotics from 2012 to 2015. The annual reports of the “Research Institute for Local Health Care Systems” (WIdO, Berlin) provided the basis for this longitudinal data base analysis. The types of antibiotics, the number of prescriptions and the prescribed 'defined daily doses' (DDD) were analyzed. The results were compared to antibiotic prescriptions of German physicians. ResultsAn average of 8.8% per year of all antibiotic prescriptions is issued by dentists. The mostly prescribed antibiotic is amoxicillin. The share of amoxicillin on all dental prescriptions increased from 35.6% in 2012 to 45.8% in 2015 (p < 0.01). About three-quarters of all dentally prescribed DDD can be attributed to amoxicillin and clindamycin. On the part of the physicians the proportion of clindamycin is 18 fold lower than in the dental field. ConclusionsDental and medical antibiotic prescriptions in Germany show statistically significant differences regarding the shares of the prescribed antibiotics. In an international comparison the high proportion of Clindamycin in Germany is noticeable.

Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database

Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice.Design: Retrospective cohort register-based study including the Danish National Prescription Register.Setting: Population-based study of routine electronic antibiotic prescriptions from Danish general practice.Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013).Main outcome measures: Number of prescriptions per clinical indication. Number of antibiotic prescriptions per 1000 inhabitants by age and gender. Logistic regression analysis estimated the association between patient and provider factors and missing clinical indications on antibiotic prescriptions.Results: A total of 2.381.083 systemic antibiotic prescriptions were issued by Danish general practitioners in the study period. We identified three main clinical entities: urinary tract infections (n = 506.634), respiratory tract infections (n = 456.354) and unspecified infections (n = 416.354). Women were more exposed to antibiotics than men. Antibiotic use was high in children under 5 years and even higher in elderly people. In 32% of the issued prescriptions, the clinical indication was missing. This was mainly associated with antibiotic types. We found that a prescription for a urinary tract agent without a specific clinical indication was uncommon.Conclusion: Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable.

Impact of exacerbations on adherence and outcomes of pulmonary rehabilitation in patients with COPD.

Dropout or lack of response is an important issue in pulmonary rehabilitation (PR), which underlines the need to identify predictors of dropout and response. Acute exacerbations (AEs) of COPD may influence dropout rates and PR response. We aimed to assess differences in dropout and outcomes of PR between COPD with and without AEs. Clinically stable patients with moderate-to-very severe COPD (age: 64.1 ± 9.1 years, 55.6% males, forced expiratory volume in 1 s (FEV1 ): 48.6 ± 20.0% predicted) were assessed during PR (inpatient and outpatient). Mild-to-moderate AEs were defined as 'the prescription of systemic glucocorticosteroids and/or antibiotics, following an acute increase in respiratory symptoms'. Severe AEs were defined as 'a hospital admission due to an AE'. Health status was measured by COPD Assessment Test (CAT), COPD-specific version of the St George's Respiratory Questionnaire (SGRQ-C) and Clinical COPD Questionnaire (CCQ). Symptoms of anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS). Exercise capacity was measured with the 6-min walking test (6MWT) and constant work rate test (CWRT). A total of 518 patients were assessed during a pre-rehabilitation assessment. Four hundred and seventy-six patients started PR, of whom 419 (88.0%) completed it. A larger proportion of patients who dropped out had a severe AE during PR (20.0% vs 3.5%, P < 0.001). Completers with severe AE showed a deterioration in 6MWT, while completers without AE and with mild-to-moderate AE improved (-24.8 (95% CI: -94.0 to 44.5) vs 24.2 (95% CI: 16.0 to 32.5) vs 25.1 (95% CI: 14.0 to 36.3) metres, P = 0.042). No other significant differences were observed in outcomes comparing completers with and without AE during PR. Mild-to-moderate AEs do not affect dropout or response of PR, although severe AEs are associated with dropout. AEs should not lead to discontinuation of PR, as response is in general not affected.

Age-specific Distribution of Antimicrobial Use Surveillance using National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Japan) 2011–2013

BackgroundAntimicrobial use (AMU) surveillance is one of the key actions in the Japanese national plan on antimicrobial resistance (AMR). National database of health insurance claims and specific health checkups of Japan (NDB), which archives e-claim big data, is one candidate for their data source, since universal healthcare system is established in Japan and e-claim data covers almost all citizens. However, no study has been performed using NDB for assessing AMU. Our objective was to analyze the quantities and patterns of total systemic antibiotic prescriptions using NDB and to evaluate its utility.MethodsThe data were analyzed in accordance with the Anatomical Therapeutic Chemical (ATC) classification using defined daily dose (DDD) as a measurement unit, as recommended by the WHO Collaborating Centre for Drug Statistics Methodology. The population-weighted total consumption was normalized and expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID). Trend analysis of DID from 2011 to 2013 and subgroup analysis stratified by age group (0–14, 15–64, 65 and above years old), and ATC classification were performed.ResultsThe DID value of oral antimicrobial use in 2013 was 13.2, which was a 1.04-fold increase in comparison with that in 2011. The DID value of parenteral antimicrobial use in 2013 was 0.83, which was a 1.13-fold increase in comparison with that in 2011. The DID value of each antibiotics category calculated using the NDB was comparable to that calculated using sales data in our previous study (J Glob Antimicrob Resist.7:19–23, 2016), suggesting that the NDB is useful for analyzing the quantities and patterns of total systemic antibiotic prescription. AMU in those under 15 years old decreased from 2011 to 2013 regardless of dosage form, although those in the other age groups increased. While third-generation cephalosphorins were the most frequently used oral antibiotic subgroups in those under 15 years old, macrolides were the most frequently used oral antibiotic subgroups in the other age groups.ConclusionThis is the first report evaluating age-specific distribution of AMU in Japan from 2011 to 2013 using the NDB. These results demonstrated the utility of AMU surveillance using the NDB as a tool and benchmark to assess the AMR action plan.Disclosures All authors: No reported disclosures.