Study Of Antibiotic Use Research Articles

A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units.

We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. Admitted children in each unit who received the first 15 new antibiotic courses each month. Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.

Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

BackgroundAs concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare...

The effect of antibiotic prophylaxis on infection rates in mohs micrographic surgery: a single-institution retrospective study.

As data and recommendations regarding antibiotic prophylaxis in dermatologic surgery vary, we tried to describe the effect of antibiotic prophylaxis (AP) in Mohs micrographic surgery (MMS) on infective endocarditis, prosthetic joint infection, and surgical site infection using a single-institution retrospective cohort study of antibiotic use (pre-/intra-operative, post-operative or none) among 2,364 patient encouters treated with MMS. Bivariate logistic regression was evaluated for associations between patient and operative characteristics, antibiotic use, and infectious complications. 85.8% of patients received no AP, 10.0% received post-operative AP, and 4.1% received pre-/intra-operative AP. The overall surgical site infection (SSI) rate was 1.3%. SSI did not differ between patients who received pre-/intra-operative prophylaxis, post-operative prophylaxis or no antibiotics. One patient receiving pre-/intra-operative prophylaxis developed SSI. Repairs involving porcine xenografts and interpolation/pedicle flaps were associated with increased SSI. In addition, there were no patients who post-operatively experienced an infected joint or infective endocarditis. Limitations include selection bias, use of observational retrospective data, low infection rates, single institution analysis, and possible omission of explanatory variables or confounders. There was no difference in rates of SSI when comparing MMS patients who received pre-/intra-operative, post-operative or no AP. There were no cases of infective endocarditis or infected prosthetic joint.

Antibiotic consumption study in two hospitals in Asmara from 2014 to 2018 using WHO's defined daily dose (DDD) methodology.

This study compares the antibiotic consumption rates over a period of five years in two hospitals in Eritrea, Orotta National Referral and Teaching Hospital (ONRTH) and Hazhaz Zonal Referral Hospital (HZRH). Antibiotic consumption is an important parameter in the study of antibiotic use. However, no published data on consumption rates exist for these two hospitals, thus the aim of the study is to measure and compare a five year antibiotic consumption trends of the two hospitals' medical wards using Defined Daily Dose per 100 bed-days (DDD/100-BD). Antibiotics dispensed from January 2014 to December 2018 were considered. Non-parametric Pearson's correlation coefficient was used for comparison of consumption, while non-parametric Friedman's test measured annual rates. The total antibiotic consumption in the HZRH was almost double that of ONRTH. The analysis showed that antibiotic consumption in ONRTH was significantly decreased from 2014 to 2018 while there was no significant difference in consumption in HZRH. Benzyl penicillin was the most consumed antibiotic in HZRH and ONRTH throughout the study period at 87.8DDD/100-BD and 35.4 DDD/100-BD respectively. Ceftriaxone and ciprofloxacin were among the most commonly consumed antibiotics in both hospitals. Establishment of Antibiotic stewardship program would benefit both hospitals greatly, and further studies need to be done to establish the national antibiotic consumption baseline.

Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study.

Antibiotic use associated with Mohs surgery is increasing. To understand variation in practice patterns and factors associated with antibiotic use. The authors conducted a retrospective cohort study of antibiotic use among patients treated with Mohs micrographic surgery between July 1, 2013, and June 30, 2017, at an academic medical center. Multivariate logistic regression was used to evaluate for associations between antibiotic prescribing and the surgeon, site, reconstruction, and patient characteristics. The odds of prescribing antibiotics differed significantly between each surgeon evaluated; 3.35-fold variation in postoperative antibiotic use was observed. Increasing number of surgical sites (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.09-1.41), number of Mohs stages required (OR 1.18; 95% CI 1.08-1.28), and defect area (OR 1.31; 95% CI 1.25-1.37), as well as patient female sex (OR 1.14; 95% CI 1.03-1.27), were associated with increased postoperative antibiotic use, whereas age >80 was associated with decreased use (OR 0.75; 95% CI 0.64-0.87) compared with age <60. Antibiotics are more commonly prescribed for repairs that are considered higher risk for infection. However, significant variation exists between surgeons, even within a single institution, suggesting a need for prospective trials and consensus guideline development.

Patients without records and records without patients: review of patient records in primary care and implications for surveillance of antibiotic prescribing in rural China

BackgroundWe need to monitor patterns of antibiotic prescribing in order to develop and evaluate antibiotic stewardship interventions in rural China. As part of a multidisciplinary study of antibiotic use in Anhui Province we assessed the validity of electronic records (e-records) as a source of surveillance data.MethodsOne township healthcare centre and one village clinic were selected in each of three different counties. Patients with symptoms of Upper Respiratory Tract Infection (URTI), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) or Urinary Tract Infection (UTI) were recruited consecutively. Researchers observed and documented clinic consultations and interviewed each of the study participants. E-records were compared to clinic observations and patient interviews.ResultsA total of 1030 patients were observed in clinic. Antibiotics were prescribed in 917 (89%) of consultations. E-records were created only for individuals with health insurance, with considerable between-site variation in completeness (0 to 98.7% of clinic consultations) and in the timing of documentation (within-consultation up to weeks afterwards). E-record accuracy was better in relation to antibiotics (82.8% of e-records accurately recorded what was prescribed in clinic) than for diagnosis and symptoms (45.0 and 1.1% accuracy). Only 31 participants (3.0%) presented with UTI symptoms.ConclusionsWe have confirmed very high rates of outpatient antibiotic prescribing in rural Anhui province. E-records could provide useful information to inform stewardship interventions, however they may be inaccurate and/or biased. Public Health authorities should focus on improving technical infrastructure and record-keeping culture in outpatient settings. Further research is needed into community treatment of UTIs.

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Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital.

Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship.Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS).Methods: We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days).Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02–6.89) compared to the DH (4.98, 95% CI 4.82–5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH.Conclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.

1137. Variability of Antibiotic Use in Neonatal Intensive Care Units in the United States

BackgroundAlthough antibiotics are often indicated to treat early-life infections, such exposure may lead to serious adverse outcomes. Few studies have characterized patterns of antibiotic use among neonatal intensive care units (NICUs).MethodsWe performed a cross-sectional study of antibiotic use in 51 NICUs participating in the Pediatric Health Information System (PHIS), a database that includes clinical and resource utilization data for standalone children’s hospitals in the United States. Assessments were conducted on a single mid-week day of 2017. We examined the use of any antibiotic and broad-spectrum antibiotics using charge data in children admitted in each NICU on the study day. We compared antibiotic use among NICUs and geographical regions, and assessed its association with the NICU median case mix index (CMI) (as a surrogate for clinical complexity).Results2813 infants were hospitalized in NICUs on the study day; the median number of patients at each study site was 47 (IQR = 34 – 62). 90% were <1 month old, 56% were male, 46% were white, and 62% were extremely/very preterm. Overall, 23% received at least one antibiotic and 6% received broad-spectrum antibiotics. Broad-spectrum antibiotic use was twice as prevalent in surgical compared with medical patients. Antibiotic use prevalence varied by region, ranging from 19% in the Midwest to 26% in the West (table). Ampicillin, gentamicin and vancomycin were the most common antibiotics used (25.2%, 18.8% and 9.9%, respectively). Antibiotic use prevalence varied substantially across NICUs (Figure 1). There was a moderate but significant positive correlation between overall or broad-spectrum antibiotic use and median NICU CMI (Figure 2).ConclusionThere is substantial variability in antibiotic use among US NICUs, which seems partially explained by patient case-mix. Additional studies are needed to identify drivers of unwarranted variability in antibiotic use among NICUs. DisclosuresRitu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.

1007. A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts

BackgroundAntibiotic overuse remains a significant problem in inpatient and outpatient settings. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system in order to prioritize antibiotic stewardship efforts.MethodsWe conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly-selected days between October 1, 2017 and September 30, 2018. Inpatients and perioperative patients were recorded as having received an antibiotic if they were administered ≥1 dose of a systemic antibacterial agent. Outpatients were recorded as having received an antibiotic if they were prescribed ≥1 systemic antibacterial agent.ResultsOn the study days, 10.9% (95% CI 10.6–11.3%) of patients received an antibiotic. Of all antibiotics administered or prescribed, 54.1% were from ambulatory care (95% CI 52.6–55.7%), 38.0% were from the hospital, (95% CI 36.6–39.5%), and 7.8% (95% CI 7.1–7.8%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards accounted for 26.4% (95% CI: 25.0–27.7%), 23.8% (95% CI: 22.6–25.2), and 23.9% (95% CI 22.7–25.3) of antibiotic use, respectively. Only 9.2% (95% CI: 8.3–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of Gram-negative activity accounted for 30.4% (95% CI: 29.0–31.9%) of all antibiotics prescribed. Infections of the respiratory tract were the leading indication for antibiotic use.ConclusionIn an integrated healthcare system, nearly three-quarters of antibiotic use occurred in the emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards. Antibiotics with a broad spectrum of Gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.Disclosures All authors: No reported disclosures.

The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia

ABSTRACT Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method can produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.

"Without antibiotics, I cannot treat": A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India.

BackgroundMisuse of antibiotics is a well-known driver of antibiotic resistance. Given the decentralized model of the Indian health system and the shortage of allopathic doctors in rural areas, a wide variety of healthcare providers cater to the needs of patients in urban and rural settings. This qualitative study explores the drivers of antibiotic use among formal and informal healthcare providers as well as patients accessing care at primary health centers across Paschim Bardhaman district in West Bengal.Materials and methodsWe conducted 28 semi-structured, in-depth interviews with four groups of healthcare providers (allopathic doctors, informal health providers, nurses, and pharmacy shopkeepers) as well as patients accessing care at primary health centers and hospitals across Paschim Bardhaman district. Qualitative data was analyzed using the framework method in an inductive and deductive manner.ResultsOur results indicate that patients demand antibiotics from healthcare providers and seek the fastest cure possible, which influences the prescription choices of healthcare providers, particularly informal health providers. Many allopathic doctors provide antibiotics without any clinical indication due to inconsistent follow up, lack of testing facilities, risk of secondary infections, and unhygienic living conditions. Pharmaceutical company representatives actively network with informal health providers and formal healthcare providers alike, and regularly visit providers even in remote areas to market newer antibiotics. Allopathic doctors and informal health providers frequently blame the other party for being responsible for antibiotic resistance, and yet both display interdependence in referring patients to one another.ConclusionsA holistic approach to curbing antibiotic resistance in West Bengal and other parts of India should focus on strengthening the capacity of the existing public health system to deliver on its promises, improving patient education and counseling, and including informal providers and pharmaceutical company representatives in community-level antibiotic stewardship efforts.

A Novel Approach to Evaluate Antibiotic Utilization Across the Spectrum of Inpatient and Ambulatory Care and Implications for Prioritization of Antibiotic Stewardship Efforts

Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system to prioritize antibiotic stewardship efforts. We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly selected days from 2017 to 2018. For inpatients and perioperative patients, administrations of antibiotics were recorded, whereas prescriptions were recorded for outpatients. On the study days, 10.9% (95% confidence interval [CI], 10.6%-11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95% CI, 52.6%-55.7%), 38.0% were from the hospital (95% CI, 36.6%-39.5%), and 7.8% (95% CI, 7.1%-8.7%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult non-critical care inpatient wards accounted for 26.4% (95% CI, 25.0%-27.7%), 23.8% (95% CI, 22.6%-25.2%), and 23.9% (95% CI, 22.7%-25.3%) of antibiotic use, respectively. Only 9.2% (95% CI, 8.3%-10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of gram-negative activity accounted for 30.4% (95% CI, 29.0%-31.9%) of antibiotics. Infections of the respiratory tract were the leading indication for antibiotics. In an integrated healthcare system, more than half of antibiotic use occurred in the emergency department/urgent care centers and outpatient clinics. Antibiotics with a broad spectrum of gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.

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.

Study of Antibiotic Use in a Tertiary Care Hospital in Tabuk City, Northern West, Saudi Arabia

Background: Inappropriate use of antibiotics is known as an important risk factor in the development of antibiotic resistance, which increases the morbidity and mortality. We aimed to determine the prevalence and characteristics of antibiotic use in a Tertiary Care Hospital in Tabuk city, Northern Saudi Arabia. Methods: A cross sectional study was conducted in a Tertiary Care Hospital in Tabuk city, during October 2017. Results: A total of 120 participants, 107 of them had antibiotics in their prescriptions with antibiotic use prevalence 89.2%. Most of patients were males (62.6%) and children and adolescents (0-19 years) constituted 4.8%. The most attended department was internal medicine (32.7%). 21 diseases were identified, upper respiratory tract infection (URTI), followed by urinary tract infection (UTI) 8.4%. Among the antibiotics, ampicillin, cephalosporin and metronidazole were the most prescribed antibiotics as each of them was found in 16.8% of cases, followed by quinolones in 12.1% and macrolides in 11.2%. In addition, Augmentin (9.3%), aminoglycosides (7.5%) and chloramphenicol (1.9%). Regarding the combined therapy, 31.8% of patients received combination of two antibiotics, 4.7% received three antibiotics and only one antibiotic was prescribed in 68% of patients. The most common route of administration was the oral tablets in 48.6% and syrup in 14% of patients. Conclusion and recommendations: The prevalence of antibiotic use in Tabuk Tertiary Care hospitals was very high (89.2%) which could be a risk factor for the development of antibiotic resistance. We advocate public health measures targeting healthcare providers on the use and misuse of antibiotics.

ANTIBIOTIC USE AT PRIMARY HEALTHCARE CENTERS IN SURABAYA: A SURVEILLANCE STUDY

Objective: Antibiotics are considered to be overprescribed in primary health care centers. This study aimed to investigate the defined daily dose (DDD) of antibiotics per 1000 patients visit in a year in primary health care centers, the prevalence of upper respiratory infections (URI) and diarrhea, the percentage of antibiotic prescription for URI and diarrhea in Surabaya.Methods: A surveillance study of antibiotic use was done from the reports and use of drug demand sheet, which called laporan pemakaian dan lembar permintaan obat (LPLPO), outpatient medication card, and health care information and management system of primary health care center, which called sistem informasi manajemen manajemen puskesmas (SIMPUS) in Surabaya. DDD/1000 patients were calculated for describing the antibiotics usage level in each primary health care centers. Three primary health care centers selected based on its antibiotic use or its population density to recognize its antibiotic prescribing percentage for non-pneumonia respiratory tract infection and nonspecific diarrhea.Results: The DDD antibiotic systemic per 1000 patients visit primary health care centers in Surabaya is relatively low. The results found higher prevalence URI does not correlate to the frequent antibiotic prescribed. The prevalence of URI at one primary healthcare center (25% cases) was less than at the other (44%), but the percentage of antibiotic prescription and the total antibiotic usage were higher (73%; 1006 DDD/1000 patients vs. 21%; 675 DDD/1000 patients). The prevalence of diarrhea at primary health care center 2 (2,84%) was less than at primary health care center 1 (4,95%), but the percentage antibiotic prescription and the total antibiotic usage were higher (43%; 1006 DDD/1000 patients vs 18%; 675 DDD/1000 patients).Conclusion: The antibiotic usage at primary healthcare centers in Surabaya was shown to vary widely. Eighty-seven percent (55/63) primary health care centers antibiotic usage was less than 4 DDD/1000 patients day, only two primary health care centers antibiotic usage 6 DDD/1000 patients day. Further research to investigate antibiotic usage and the differences in usage between primary health care centers in treating URI is required.

A national pharmacoepidemiological study of antibiotic use in Korean paediatric outpatients

BackgroundInformation on the use of antibiotics in Eastern Asian children is limited. The objectives of this study were to evaluate in Korean paediatric outpatients (1) the nationwide pattern of prescribing...

A prospective study of the use of antibiotics in the Emergency Department of a Chinese University Hospital.

Antibiotics are one of the most widely misused group of medicines. The aim of this study was to investigate the use of antibiotics in one of the paediatric emergency departments in China. We performed a prospective, cross-sectional study of antibiotic use in the paediatric emergency room of West China Second University Hospital. A total of 500 consecutive patients from March 25 to April 3 2013 were included. Clinical details of the patients were also collected in order to analyse antibiotic use. The median age of patients was 2years 2months. The five most common conditions seen in the emergency department were wheezy bronchitis, upper respiratory tract infections, tonsillitis, pneumonia and diarrhoea. A total of 311 children (62%) received antibiotics. The antibiotics prescribed were predominantly cephalosporins and penicillins. More than one antibiotic was used in 51 patients. In total, 75% of the antibiotics prescribed were cephalosporins. More than three-quarters of the young children with wheezy bronchitis received antibiotics. Antibiotic use for children with an upper respiratory tract infections or tonsillitis was greater than the 20% maximum recommended by the European Surveillance of Antimicrobial Consumption. The majority of children attending the emergency department received antibiotics. For many of the conditions, the use of antibiotics was inappropriate.

Study of antibiotic use in children

Inappropriate use of antibiotics is of special concern globally.Nevertheless, antibiotic over use in children remains common.Overall, antibiotic use has decreased during recent years.However, prescription rates of antibiotics were still high and there is a substantial increase of broad-spectrum antibiotic prescribing.Several factors exist in antibiotic use of children, including vaccination, guideline, clinical pathway management, prescribers, and parents' perceptions of antibiotics, et al.Therefore, the significant evaluation of antibiotic rational use in children needs further studies in detail. Key words: Child; Antibiotic; Rational use

Evaluation of The Antibiotic Use for Surgical Prophylaxis in Paediatric Acute Appendicitis

Introduction: The aim was to evaluate antibiotic use for surgical prophylaxis in paediatric acute appendicitis before and after introduction of the hospital guidelines. Materials and Methods: Retrospective – observational study of antibiotic use in 68 patients with acute appendicitis in the Paediatric Surgery clinic at the University Children Hospital. Duration of this study was four months: July/August and November/December 2013. All data, such as patients’ demographic details, information on antibiotic use and surgery, were collected from the patients’ medical records. Results: Total number of patients: 30 in July/August and 38 in November/December. Surgery had 28 (93.3%) patients in July/August, 33 (86.8%) in November/ December. 2 patients in July/August and 5 in November/December were treated with ampicillin and gentamicin. 2 (8.7%) patients received a single dose in July/August, 4 (12.9%) in November/December; receiving multiple doses within 24h: 1 (4.3%) patient in July/August, 2 (6.5%) in November/December; prophylaxis >1 day: 20 (87%) patients in July/August, 25 (80.6%) in November/December. Prophylaxis was too early in 7 (30.4%) patients in July/August, 9 (29%) in November/ December; on time: 2 (8.7%) in July/August and 8 (25.8%) in November/December, too late: 12 (25.2%) in July/August, 14 (45.2%) in November/December. One (3.2%) patient in November/December received antibiotics in accordance with the guidelines. Conclusion: Although the guidelines were discussed and accepted by surgeons and there was two month introduction period as well, only few positive trends were observed with the antibiotic treatment guidelines not having major impact on antibiotic use. There is a need for new ways of promoting adherence to the guidelines and appropriate antibiotic use. Key words: Acute appendicitis, antibiotic guidelines, hospitalized children, surgical prophylaxis .