Prevalence Of Antibiotic Prescriptions Research Articles

Prescrizione di antibiotici in Pronto Soccorso pediatrico

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

Prevalence of Antibiotic Prescription in Primary Healthcare Settings in the Municipality of Prishtina, Kosovo

Background: Antibiotics remain among the most prescribed drugs in primary healthcare, contributing to increased antibiotic resistance in the community and prevailing as an emerging global health concern. We aimed to quantify the prevalence and quality of antibiotic prescription in primary healthcare settings in the Municipality of Prishtina to identify targets for quality improvement.Methods and Results: This study represents a population-based, retrospective cohort, including data from eight randomly selected family medical centers in the Municipality of Prishtina. Each 150th patient on medical records was assessed for demographic data, diagnosis (ICD-10), antibiotic prescription, antibiotic class, and antibiotic form. In total, the study included 1614 cases reviewed. The antibiotic prescription rate was 16%. The health condition for which most of the cases received antibiotics was J18 - Pneumonia, unspecified organism (67%), followed by J03 - Acute tonsillitis (54%), J42 - Unspecified chronic bronchitis (46%), and N39 - Other disorders of the urinary system (43%) Broad-spectrum antibiotics, such as co-amoxiclav (17.7%), amoxicillin (16.5%), and ceftriaxone (12.6%), featured among the most routinely prescribed antibiotics. The antibiotic prescription rate was the highest for cases in the 3-5 age group, of whom 27% received an antibiotic prescription. In 73% of cases, oral antibiotics were prescribed, 69% of which belong to the WHO AWaRe (Access, Watch, Reserve) essential medicines list. Only 18% of antibiotics were prescribed with their generic names. Conclusion: The prevalence of antibiotic prescription in primary healthcare settings in Prishtina is moderately low. These data cannot be extrapolated to other municipalities in Kosovo or other countries due to different organizational levels. High antibiotic prescription rates for young age groups, prescription of broad-spectrum antibiotics, and high rates of parenteral antibiotics were identified as targets for quality improvement.

In Utero Exposure to Antibiotics and Risk of Serious Infections in the First Year of Life.

Given the high prevalence of antibiotic prescription during pregnancy in France and previous studies suggesting an increased risk of infection in offspring with such exposures, our study aimed to investigate the association between prenatal exposure to systemic antibiotics and serious infections in full-term infants during their first year of life. We conducted a retrospective population-based cohort study on singleton, full-term liveborn non-immunocompromised infants, using the French National Health Data System (SNDS) between 2012 and 2021. Systemic antibiotic dispensing in ambulatory care settings during pregnancy defined the exposure. Outcomes concerned serious infections (i.e., infections requiring hospitalization) in offspring identified between 3 and 12 months of life, hence excluding infections of maternal origin. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariate models to control for potential confounders. Of 2,836,630 infants included, 39.6% were prenatally exposed to systemic antibiotics. Infants prenatally exposed to antibiotics had a higher incidence of serious infections compared with unexposed infants {aOR 1.12 [95% confidence interval (95% CI) 1.11-1.13]}. Similar associations were observed according to the timing of exposure during pregnancy, antibiotic class, and site of infections. The strongest association was observed when infants were prenatally exposed to three or more antibiotic courses during pregnancy [aOR 1.21 (95% CI 1.19-1.24)]. Limitations include residual confounders, such as genetic susceptibility to infections and the role of the underlying pathogen agent. Prenatal exposure to systemic antibiotics is very common and is associated with a weak yet significant associations with subsequent serious infectious events during the first year of life. While our study revealed associations, it is important to note that causation cannot be established, given the acknowledged limitations, including potential confounding by indication.

The Behavior of Primary Healthcare Doctors Toward Antibiotic Prescriptions for Upper Respiratory Tract Infections.

Unnecessary prescription of antibiotics for patients with upper respiratory tract infections (URTIs) carries the potential risk to the development of bacterial resistance. This study aimed to investigate the behavior of primary healthcare (PHC) physicians toward an antibiotic prescription for URTI, Al-Madinah City, Saudi Arabia in 2021. A cross-sectional study was conducted at PHC centers in Al-Madinah City, Saudi Arabia. The study invited all physicians in the randomly selected 28 PHC centers to participate in the study. A master sheet adopted from a researcher done in the Asir region of Saudi Arabia about the pattern of prescription for URTIwas used and included data about socio-demographic characteristics and data about presenting symptoms and signs of URTIs, the clinical diagnosis, type of medication prescribed, and duration of treatment also, included data about the factors that press physicians to prescribe antibiotics and their response. The questionnairewas filled out and returned back by 140 physicians. The collected data were analyzed and tabulated using appropriate statistical tests. The mean age of the studied physicians was 34.4 ± 7.6 years (25-59 years). General practitioners and specialists were 66.4% and 33.6%, respectively. The prevalence of antibiotic prescriptions was 44.3%. The most prescribed antibiotics were amoxicillin (58.6%)and Augmentin(28.6%). Congested tonsils (87.1%), ear discharge (84.2%), and cervical lymphadenopathy (89.3%) were the most clinical factors that affected physicians' decisions to prescribe antibiotics for URTI. The non-clinical factors affecting physicians' decisions include patient request (52.8%) and press (28.5%), with no statistically significant difference detected between general practitioners and specialists. The study findings indicate the need to develop intervention programs targeting physicians as well as the general population to decrease inappropriate antibiotic prescriptions in primary care centers.

Changes in the Prescription of Antibiotics and Phytopharmaceuticals in Children Treated for Acute Upper and Lower Respiratory Tract Infections in Pediatric Practices in Germany in 2013, 2018, and 2022.

Background: Little is known about the recent trends in antibiotic and phytopharmaceutical prescribing for acute upper (URIs) and lower respiratory tract infections (LRIs) in children and adolescents. Therefore, this study investigated changes in the prescription of antibiotics and phytopharmaceuticals in children diagnosed with acute URIs and LRIs in pediatric practices in Germany in 2013, 2018, and 2022. Methods: The present retrospective study included children aged 2-12 years diagnosed with acute URIs or LRIs in one of 180 pediatric practices in 2013, 2018, and 2022. The URIs included nasopharyngitis, sinusitis, pharyngitis, tonsillitis, laryngitis and tracheitis, and upper respiratory infections of multiple and unspecified sites, while the LRIs corresponded to bronchitis. The primary outcomes were the proportion of children being prescribed antibiotics and the proportion of those being prescribed phytopharmaceuticals. Results: A total of 120,894 children were diagnosed with acute URIs or LRIs in 2013 compared to 116,844 in 2018 and 127,821 in 2022. The prevalence of antibiotic prescription decreased for all diagnoses between 2013 and 2022. This decrease was statistically significant for both 2013-2018 and 2018-2022 for nasopharyngitis, pharyngitis, and bronchitis. Meanwhile, there was a significant increase in the use of phytopharmaceuticals for all diagnoses between 2013 and 2018. The prevalence of phytopharmaceutical prescription decreased slightly between 2018 and 2022, but this decrease was generally not statistically significant. Conclusions: The prescription of antibiotics has decreased and that of phytopharmaceuticals has increased in children diagnosed with acute URIs and LRIs in Germany over the last decade. More data are needed to corroborate these findings in other settings.

Antibiotic prescription among children with common cold at a district hospital in Uganda.

Most childhood infections are of viral origin making antibiotics unnecessary. They are, however, the most frequently prescribed drugs dispensed to children, resulting in inappropriate antibiotic prescriptions, which are one of the main drivers of antibiotic resistance. The study aimed to determine the prevalence of antibiotic prescriptions and identify its associated factors among children below 5 years with common cold who attend the outpatient department in Tororo General Hospital. The study was carried out in Tororo General Hospital, Eastern Uganda. A cross-sectional survey using consecutive sampling was performed among children below 5 years with common cold attending the outpatient department. Data were collected using an interviewer-administered, structured questionnaire and analysed using STATA version 14.0. Prevalence of antibiotic prescriptions was calculated. Bivariate analysis using chi-square test and multivariate analysis using logistic regression was performed to establish factors associated with antibiotic prescription. The prevalence of antibiotic prescriptions for common cold among children below 5 years was 23.3%. Factors associated with antibiotic prescription for common cold were duration of symptoms of more than 5 days (OR, 95% CI: 4.49; 1.16-17.23, p = 0.029) and being attended to by a clinical officer (OR, 95% CI: 0.19; 0.04-0.91, p = 0.038). There is inappropriate antibiotic prescription among children with common cold in Tororo General Hospital. There is need for antibiotic stewardship programmes to promote optimal antibiotic use in primary care facilities.Contribution: The study's findings can be used to develop context-specific antibiotic stewardship programmes tailored to promote judicious use of antibiotics in primary care.

Pattern of Antibiotic Use among Hospitalized Patients at a Level One Multidisciplinary Care Hospital.

Antimicrobial resistance is one of the world's most serious health issues. Antibiotic resistance, excessive drug expense, and an increased risk of adverse reactions are all common outcomes of incorrect antibiotic prescribing. The goal of this study was to evaluate the prevalence of antibiotic prescriptions for inpatients to find areas for improvement. A retrospective study at Emergency Clinical County Hospital of Oradea, Romania was performed for five years between 2017 and 2021. Data was collected using medical records of the patients and reports from the pharmacy. Antibiotic consumption was expressed as DDD/100 BD according to the World Health Organization (WHO) by antibiotics, classes, and AWaRe classification. The prevalence of antibiotic prescription was 53.8% during five years evaluated with a significant increase in 2021. A total of 13,677.42 DDD/100 BD antibiotics were prescribed, especially for surgical and medical prophylaxes. The most prescribed antibiotics were ceftriaxone, followed by metronidazole, and cefuroxime but there were some differences between years and wards. The most frequent antibiotic classes prescribed were cephalosporins (43.73%). The use of Watch Group antibiotics was high in all wards (59.69%). The prevalence of antibiotic use was high with cephalosporins being the most prescribed antibiotics. As a result, interventions are required.

ANTIBIOTICS PRESCRIBING IN PEDIATRIC PRACTICE AND OPTIMIZATION WAY THE STUDY OF THE USE OF ANTIBIOTICS IN PEDIATRIC PRACTICE AND WAYS OF OPTIMIZATION

Antimicrobials are the most commonly prescribed drugs in the community and hospital setting. The rational use of antibiotics in Georgia, as in the world is an important issues for health care structures. Global spread is strictly associated  with an inappropriate use of antimicrobials. There are just a few studies describing the real antibiotic consumption in Georgia Aim of our study was To describe the prevalence of antibiotic prescription for prophylaxis and treatment of infections. To evaluate antibiotic prescriptions, indications, number and type of antibiotic agents.3 pediatric or mixed adult-pediatric hospitals were studied in 2015 and 9 hospitals in 2017. In 2015 total number of patients was 95 and 66 (30.52%) of these had an on-going prescription for one or more antibiotics. In 2017 total number was 157 and 107  (31.84%) of these had an on-going prescription.  Our study presented a picture of the situation in Georgia in terms of antibiotic prescriptions in hospitalized neonates and children. Last year there was seen increased use of the third generation cephalosporins. In neonatal and surgical wards the use of broad spectrum antibiotics decreased. Also it is important that there was seen a trend of increased use of oral forms of antibiotics and targeted treatment became a priority. Implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and ameliorate antibiotic prescription patterns in neonatal and pediatric inpatients over time, in order to reduce as much as possible the worrisome emergence of MDR bacteria in this vulnerable population. &nbsp

Prevalence of Antibiotic Prescription in Patients with Acute Rhinosinusitis Treated by General Practitioners and Otolaryngologists in Germany-A Retrospective Cohort Study.

(1) Background: The goal of this retrospective cohort study, based on real-world data and conducted in Germany, was to investigate the prevalence of antibiotic (AB) prescription in patients with acute rhinosinusitis (ARS). (2) Methods: Data from the Disease Analyzer database were used for this cross-sectional study. Patients aged ≥18 years diagnosed with acute sinusitis by general practitioners (GPs) and ear, nose, throat (ENT) specialists between January 2012 and December 2020 were included. The main outcome of the study was the proportion of patients with ARS who received an AB prescription on the day of diagnosis or within three days afterwards. The proportion was estimated separately for patients treated by GPs and ENTs, and also for five age groups, as well as women and men. (3) Results: In total, 308,095 patients were diagnosed with ARS (187,838 by GPs and 120,257 by ENTs). 50.9% of patients treated by GPs and 50.0% treated by ENTs received an AB prescription. AB prevalence increased with age from 46.9% in the age group 18-30 years to 55.5% in the age group > 60 years. (4) Conclusions: We have shown a high prevalence of potentially inappropriate AB prescription for adult patients with ARS in both GP and ENT practices and also among both women and men and in several age groups. There is an urgent need for interventions to reduce inappropriate AB use.

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

ObjectivesThere are limited data on factors influencing antibiotic prescription among insured patients. We assessed for correlates of an antibiotic prescription among insured patients.DesignA cross-sectional study.SettingThe study was conducted at the...

Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients. OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26-10.31) and 61.77% (CI 50.95-70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18). Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Appropriateness of antibiotic prescriptions during hospitalization and ambulatory care: a multicentre prevalence survey in Korea

Antimicrobial resistance is one of the most urgent global health threats. The need for the qualitative evaluation of antibiotic use at the national level is increasing. To identify areas for improvement, we aimed to assess the prevalence and appropriateness of antibiotic prescriptions during hospitalization and ambulatory care in Korea. The prevalence and appropriateness of antibiotic prescriptions on 29 August 2018 were assessed for 20 hospitals in Korea. Infectious disease specialists determined appropriateness. Except for antiviral and anti-tuberculosis agents, all antibacterial or antifungal agent prescriptions during hospitalization or ambulatory care were evaluated. The prevalence of antibiotic prescription was 14.1% (8,400/59 216 patients) on the study date. Antibiotics were prescribed for 50.8% of inpatients (6557/12 902), with two or more antibiotics prescribed for 27.4% (1798/6557) of patients. A total of 10 948 prescriptions (7999 therapeutic, 2105 surgical prophylaxes, and 844 medical prophylaxes) were included in the final analysis, and 27.7% of these were inappropriate. Surgical prophylaxis was inadequately prescribed most frequently (54.4%), followed by medical prophylaxis (29.5%) and therapeutic antibiotics (20.5%). The most common indications for therapeutic antibiotics were respiratory (29.1%, n=2332), gastrointestinal (22.4%, n=1791), and urinary tract infections (13.1%, n=1050). The most frequently prescribed antibiotics were cephalosporins (52.0%, n=5490), followed by beta lactam/beta lactamase inhibitors (13.7%, n=1373), fluoroquinolones (9.1%, n=957), and metronidazole (6.6%, n=699). This was the first nationwide qualitative antibiotic prescription adequacy evaluation in Korea. A significant proportion of antibiotic prescriptions were inappropriate. Therefore, interventions for high-frequency infections and prescription antibiotics are needed.

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: a systematic review and meta-analysis

IntroductionEvidence on prevalence of bacterial coinfection in Coronavirus Disease 2019 (COVID-19) is controversial; previous global viral respiratory pandemics reported high prevalence of bacterial coinfection, which was associated with increased risk of morbidity and mortality (1). Data on Prevalence of antibiotic prescribing in COVID-19 indicates high antibiotic prescribing, causing a potential setback in antimicrobial stewardship and potential increase in antimicrobial resistance (2). The study protocol was registered in the international register of systematic reviews, PROSPERO, under the following ID: CRD42021261734AimTo determine the prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patientsMethodsSystematic review and meta-analysis was conducted using Covidence. Data were extracted by one reviewer. Proportion data was pooled using random effects meta-analysis approach using STATA 17; and stratified based on region and study design. Data Source: OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study Eligibility: English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Participants: Adults with RT-PCR confirmed diagnosis of COVID-19ResultsA total of 1058 studies were screened, of which 22 studies were eligible. Retrospective cohort studies accounted for the majority of the studies involved (n = 18, 81%), whilst prospective cohort studies accounted for the remaining (n=4, 18%). Of the 22 studies included, 3 (13%) studies were pre-prints, whilst the remaining (n=19, 86%) were peer-reviewed. A total of 13 (59%) studies were conducted in multicentre settings, whilst the remaining (n=9, 40%) were conducted in single centre settings. All of the studies included were conducted in hospital setting, whether it be in a normal, isolation or an intensive care ward. Twenty-one out of 22 studies have been rated “Good” rating during the quality assessment process. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26 – 10.31) and 61.77% (CI 50.95 – 70.90), respectively.ConclusionThe prevalence of bacterial coinfection amongst COVID-19 patients is low (5.62%) when compared with previous pandemics, yet antibiotic prescribing in COVID-19 patients was high (61.77%) indicating the need for stronger antimicrobial stewardship to reduce the global threat of AMR. Prescribing of antibiotics in COVID-19 should be based on clinical and/or laboratory evidence of bacterial coinfection. Key strengths of this review, is that it included a comprehensive search strategy spanning over several databases, including both pre-prints and peer-reviewed studies. Limitations in this review was that during the screening process, a significant number of studies have been excluded due to not meeting the inclusion criteria, therefore, bacterial coinfection and antibiotic use may be under- or over-reported. In addition, disproportionate representation from North America and failure to include studies from regions other than Europe and Asia, can limit the generalizability of the results to other regions impacted by COVID-19References(1) Morris DE, Cleary DW, Clarke SC. Secondary bacterial infections associated with influenza pandemics. Front Microbiol. 2017;8:1041.(2) International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC). COVID-19 Clinical data report. 19May 2020.

O02 Antibiotic prescribing practices in primary healthcare in sub-Saharan Africa: a systematic review and our experience on the use of telemedicine in Zambia

BackgroundAntimicrobial resistance (AMR) presents a challenge to clinicians globally, particularly in low- and middle-income countries (LMICs) which often have a high prevalence of infectious diseases, coupled with limited diagnostic, treatment and surveillance capabilities.1,2 To date, there is limited information on antimicrobial prescribing in sub-Saharan Africa, particularly in rural clinics,3 where systematic data gathering can be impacted by the resource-poor nature of these settings. The Virtual Doctors charity (VDrs)4 uses a bespoke smartphone app to give remote telemedical advice to clinicians throughout rural Zambia. This approach links primary healthcare workers with volunteer doctors, predominantly based in the UK. We propose that this approach may be a valuable tool to promote antimicrobial stewardship (AMS) in these locations, and consequently that telemedicine can play a key role in preventing a future AMR pandemic.MethodsWe carried out a systematic review to investigate current antibiotic prescribing practices in LMICs within sub-Saharan Africa, specifically the indications for use, choice of antimicrobial, and prescribing rates. Three Africa-specific databases, EMBASE, MEDLINE, Cochrane Library, Web of Science, Scopus, CINAHL, IRIS and Global Health databases were searched. English language studies evaluating antimicrobial use in primary care in LMICs in sub-Saharan Africa published between January 2010 and July 2021 were included. Data on the prevalence of antibiotic prescription, choice of agent and appropriateness was collated. We then reviewed anonymized prescribing data from the VDrs database, investigating antibiotic prescribing in cases over a period between January 2019 and June 2020. We excluded non-adult (<18 years old) patients, and reviewed cases that had been coded as ‘InfectiousDiseases’, ‘RespiratoryMedicine’ or ‘MedicineGeneral’ to identify those in which antibiotics were prescribed acutely and the impact of consultations on antibiotic prescriptions.ResultsSystematic review: 29 eligible studies from nine countries were identified, with 18 (62%) undertaken in urban settings and 7 (24%) encompassing rural settings. The prevalence of antibiotic prescription was 32.7%–84.4% (median 55.2%, IQR 44.5%–67.7%), with respiratory and genitourinary infections the most common indications. The most prescribed antibiotics were β-lactams (primarily amoxicillin), then quinolones and metronidazole. Only two studies assessed the appropriateness of prescriptions, with 13%–36.4% found to be inappropriate. Retrospective cohort analysis of VDrs database: 502 cases were reviewed. 154 (30.7%) were receiving 1–3 antibiotic agents at the time of consultation. The most prescribed agents were metronidazole and amoxicillin. Following consultation, 53 patients (10.5%) were initiated on antibiotics. Of those already receiving antibiotics, 29.2% had these actively continued, and 45.5% had antibiotics rationalized or stopped based on volunteers’ advice.ConclusionsOur systematic review confirms high rates of antimicrobial prescription in LMICs in sub-Saharan Africa, with a significant proportion being inappropriate. However, data are limited, and mainly from urban settings, hindering the generalizability of results. Our analysis of VDrs data reveals that 45.5% of antibiotic prescriptions were rationalized through our telemedicine-based approach. The VDrs model aims not only to deliver case-based guidance to rural healthcare practitioners, but also provide long-term educational gains to enhance local and global health. We suggest that the appropriate use of telemedicine can have short- and long-term benefits for AMS in LMICs.

Prescription Pattern for Antimicrobials and the Potential Predictors for Antibiotics among Patients with COVID-19: A Retrospective Observational Study

Introduction: Long-term repercussions of Coronavirus Disease2019 (COVID-19) on antimicrobial resistance have been raised as a grave concern due to the rampant use of antibiotics in the management of COVID-19. As per meta-analysis, the prevalence of antibiotic prescribing was 74.6% which was significantly higher than the estimated prevalence of bacterial co-infection. World Health Organisation (WHO) recommended that antibiotic therapy should not be used in patients with mild/moderate COVID-19 unless there is any bacterial suspicion. Also, the guidelines laid down by the Ministry of Health and Family Welfare, Government of India, does not recommend systematic empiric antibiotic therapy in patients hospitalised with COVID-19. Despite not being recommended, antimicrobials are still given in clinical practice. Aim: To analyse prescriptions for antimicrobials and to identify potential predictors for antibiotic prescription. Materials and Methods: A retrospective observational study was conducted at a tertiary care teaching institute. Data (demographic profile, co-morbidities, disease category, prescribed antimicrobials, laboratory investigations, and duration of hospital stay) were collected from case files of patients with laboratoryconfirmed Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. These patients were admitted in the institute from January 2021 to May 2021. Logistic regression was used to analyse factors associated with the empirical use of antimicrobial agents. Results: A total of 184 case files were analysed. The mean age of patients was 55.84±15.72 years, with a male preponderance (70.10%). Among antimicrobials, antivirals were prescribed in 159 (86.41%) patients, and antibiotics in 152 patients (82.6%). Antivirals prescribed include Remdesivir [109(68.55%)] and Favipiravir [70(44.02%)]. Ceftriaxone was found to be the highest prescribed antibiotic, with a median duration of administration of six days. An association was found between disease severity and CRP level with antibiotic prescription. On multivariable analysis, the odds of receiving antibiotics were 6.7 times higher in patients with severe disease. Conclusion: More than 80% of COVID-19 patients received antibiotics. Duration of hospital stay was similar among patients whether they received antibiotics or not. Disease severity and raised CRP level were strong predictors for prescribing antibiotics for COVID-19.

Low rates of antibiotic use among ambulatory patients with coronavirus disease 2019 (COVID-19)

We assessed the prevalence of antibiotic prescriptions among ambulatory patients tested for coronavirus disease 2019 (COVID-19) in a large public US healthcare system and found a low overall rate of antibiotic prescriptions (6.7%). Only 3.8% of positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests were associated with an antibiotic prescription within 7 days.

Point prevalence of antimicrobial prescriptions among inpatient in a tertiary level hospital in Nepal

Introduction: Inappropriate use of antimicrobials increases resistance, morbidity, and mortality. Accurate information on the use of antibiotics is crucial to address the problem of antibiotic overuse and resistance. The aim of this study is to explore the antibiotic prescription pattern at inpatient departments of Dhulikhel Hospital.&#x0D; Method: This prospective point prevalence study was conducted in five inpatient departments by making 25 visits between June 2018 and March 2019. Patient planned to be discharged on the day of visit was included in the study. The details of the patients who received at least one antimicrobial for at least one clinical treatment condition or prophylaxis during the hospital stay was recorded. The data on the antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality were recorded.&#x0D; Result: Out of 179 patients, 125 patients (69.8%) were prescribed one or more antibiotics. There was noticeable variation in prevalence of antibiotic prescription across the departments, ranging from 59.5%-78.9 %. The top three prescribed antibiotics were third generation cephalosporins 63 (38%), broad spectrum penicillin 49 (29.5%), and metronidazole 19 (11.4%). The patients received antibiotic for non-bacteriological proven infection 66 (52.8%) and only 8 (6.4%) patient received antibiotic for bacteriological proven infection. Culture and sensitivity testing were sent in 45(36%) patients and urine was the most frequent specimen&#x0D; Conclusion: Study concluded that there is need to further explore factors contributing to the high prevalence of antibiotic use and develop strategies for appropriate antibiotic use in the hospital.

The prevalence and pattern of antibiotic prescription among insured patients in Dar es Salaam Tanzania.

Introductionhigh prevalence of antibiotic prescriptions may contribute to the problem of antibiotic resistance. Understanding the pattern of antibiotic prescriptions in a country may inform monitoring and stewardship activities, which are crucial in the fight against antibiotic resistance. We aimed to determine the prevalence and describe the pattern of antibiotic prescriptions among National Health Insurance Fund (NHIF) insured patients receiving treatment at health facilities in Ilala Municipality, Dar es Salaam, Tanzania.Methodsa cross-sectional analysis of claim forms of NHIF insured patients. A data extraction form was used to capture data for September, 2019 submitted to the Ilala NHIF offices.Resultsamong 993 insured patients (mean [±SD] age 36.3 [±23.2] years; 581 [58.5%] females; 535 [53.9%] adults) a total of 357 (46.4%, 95% CI, 42.8-50.0) received an antibiotic prescription. Of the 357 patients who received an antibiotic prescription, 71(19.9%) received more than one antibiotic prescription. The most common antibiotic prescribed was amoxicillin/clavulanate (17.1%) followed by amoxicillin (16.5%) whereas the most commonly prescribed antibiotic class was the penicillins (51.3%) followed by the nitroimidazoles (14.0%). Among patients who received more than one antibiotic, the most commonly co-prescribed antibiotics were Ampicillin/Cloxacillin plus Metronidazole (11.4%) followed by Amoxicillin plus Metronidazole (7.1%). According to 2019 WHO Access, Watch, Reserve (AWaRe) Classification of antibiotics, 60.8% of patients received the access antibiotics, 33.3% received the watch antibiotics whereas 17.4% of patients received antibiotics that were not recommended. No patient received an antibiotic from the reserve group.Conclusionthe prevalence of antibiotic prescriptions in Tanzania is high and some antibiotics not recommended by the WHO are still prescribed. We recommend revision of the current Tanzania treatment guideline on antibiotics to reflect WHO recommendations, and further research to address local factors influencing antibiotic prescriptions is warranted.