Trends In Antibiotic Use Research Articles

MP02-04 ANTIBIOTIC STEWARDSHIP FOR AMBULATORY UROLOGIC PROCEDURES: CYSTOSCOPY AND VASECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2018MP02-04 ANTIBIOTIC STEWARDSHIP FOR AMBULATORY UROLOGIC PROCEDURES: CYSTOSCOPY AND VASECTOMY Mark Henry, Dattatraya Patil, Christopher Filson, and Akanksha Mehta Mark HenryMark Henry More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Christopher FilsonChristopher Filson More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.130AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to evaluate physician adherence to the AUA Best Practice Statement on antimicrobial prophylaxis, in order to assess physician interest in antibiotic stewardship. Pre-procedural prophylactic antibiotics are not routinely recommended for uncomplicated cystoscopy and vasectomy, given the low risk of infection associated with these commonly performed procedures. METHODS We used 2009-2015 Truven Health MarketScan Data to identify men who underwent either diagnostic cystoscopy or vasectomy using CPT 52000 and CPT55250/V2652 codes, respectively. Antibiotics associated with a procedure were captured within a 30-day pre-procedural window for oral, and 24 hour pre-procedural window for parenteral medication, respectively. Antibiotics were identified using National Drug Code numbers submitted for pharmaceutical & outpatient service claims. We assessed relevant patient characteristics (age, Charlson Comorbidity Index (CCI), U.S. Census Bureau region, year of procedure, health plan type, and metropolitan service area) that could potentially impact antibiotic use. Trends in antibiotic use, and the impact of covariates on antibiotics use was determined using linear regression models with SAS v9.4 software. Significance was set as two-tailed p-values <0.05. RESULTS 1,060,199 cystoscopy and 433,013 vasectomy claims were processed during the study period. Prophylactic antibiotics were utilized in 38% of all cystoscopies and 16% of all vasectomies. Antibiotic use increased throughout the study period for both cystoscopy (34.9% to 45.2%, p = 0.002) and vasectomy (15.8% to 19.5%, p = 0.032). Increasing age and CCI were associated with decreased likelihood of prophylactic antibiotics for cystoscopy, while increasing age and CCI were associated with an increased likelihood of prophylactic antibiotics for vasectomy. Geographic region was also found to impact the likelihood of antibiotic use; with Northcentral as the reference point, antibiotic use for both cystoscopy and vasectomy was highest is the South (OR 1.21 and 1.44, respectively), and lowest in the Northeast for cystoscopy (OR 0.85) and West for vasectomy (OR 0.89) (p < 0.001). CONCLUSIONS Despite evidence-based recommendations against routine prophylactic antibiotics for uncomplicated office procedures like cystoscopy and vasectomy, antibiotic use has nevertheless increased overtime, with implications for antibiotic resistance and changes in normal microbial flora. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e12-e13 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mark Henry More articles by this author Dattatraya Patil More articles by this author Christopher Filson More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of antimicrobial consumption in a Neonatology Unit: a team work to promote the rational use of antibiotics

Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.

Recent patterns in antibiotic use for children with group A streptococcal infections in Japan.

Antibiotics are the most frequently prescribed medicines for children, however inappropriate antibiotic prescribing is prevalent. This study investigated recent trends in antibiotic use and factors associated with appropriate antibiotic selection among children with group A streptococcal infections in Japan. Records of outpatients aged <18years with a diagnosis of group A streptococcal infection were obtained using the Japan Medical Data Center database. Prescription patterns for antibiotics were investigated and factors associated with penicillin use were evaluated using a multivariable log-binomial regression model. Overall, 5030 patients with a diagnosis of group A streptococcal infection were identified. The most commonly prescribed antibiotics were third-generation cephalosporins (53.3%), followed by penicillins (40.1%). In the multivariable log-binomial regression analysis, out-of-hours visits were independently associated with penicillin prescriptions [prevalence ratio (PR)=1.10, 95% confidence interval (CI) 1.03-1.18], whereas clinical departments other than paediatrics and internal medicine were related to non-penicillin prescriptions (PR=0.57, 95% CI 0.46-0.71). Third-generation cephalosporins were overprescribed for children with group A streptococcal infections. This investigation provides important information for promoting education for physicians and for constructing health policies for appropriate antibiotic prescription.

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies.

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

Associations between a decreased veterinary antimicrobial use and resistance in commensal Escherichia coli from Belgian livestock species (2011–2015)

In this study the possible association between antibiotic use and resistance was explored, focusing on commensal Escherichia coli from livestock (veal calves, young beef cattle, pigs and broiler chickens) in Belgium between 2011 and 2015. A continuous decreasing trend in antibiotic use was observed for all classes, except for the phenicols. Antibiotic resistance of commensal E. coli significantly decreased for several of the tested antibiotics in all livestock species. A more rapidly reverted resistance was seen to 3th/4th generation cephalosporins and fluoroquinolones. Moderate to strong correlations between antibiotic use and resistance were found, except for antibiotic resistance to chloramphenicol and gentamicin and the use of the corresponding antibiotic class. Yet, total antibiotic use was positively correlated with chloramphenicol resistance, showing the potential importance of co-selection for chloramphenicol resistance. These results suggest that national antimicrobial usage reduction campaigns have beneficial effects on the overall resistance levels. Analyses were performed on small datasets, though, and care must be taken while making inference. For more detailed analysis, antibiotic use data at an animal species level are required.

Trends in Antibiotic Use by Birth Season and Birth Year.

We examined 2 birth cohort effects on antibiotic prescribing during the first year of life (henceforth, infancy) in Denmark: (1) the birth season effect on timing and overall occurrence of antibiotic prescribing, and (2) the birth year effect amid emerging nationwide pneumococcal vaccination programs and changing prescribing guidelines. We linked data for all live births in Denmark from 2004 to 2012 (N = 561 729) across the National Health Service Prescription Database, Medical Birth Registry, and Civil Registration System. Across birth season and birth year cohorts, we estimated 1-year risk, rate, and burden of redeemed antibiotic prescriptions during infancy. We used interrupted time series methods to assess prescribing trends across birth year cohorts. Graphical displays of all birth cohort effect data are included. The 1-year risk of having at least 1 redeemed antibiotic prescription during infancy was 39.5% (99% confidence interval [CI]: 39.3% to 39.6%). The hazard of a first prescription increased with age throughout infancy and varied by season; subsequently, Kaplan-Meier-derived risk functions varied by birth season cohort. After rollout of a first vaccination program and new antibiotic prescribing guidelines, 1-year risk decreased by 4.4% over 14 months (99% CI: 3.4% to 5.5%); it decreased again after rollout of a second vaccination program by 6.9% over 3 years (99% CI: 4.4% to 9.3%). In Denmark, birth season and birth year cohort effects influenced timing and risk of antibiotic prescribing during infancy. Future studies of antibiotic stewardship, effectiveness, and safety in children should consider these cohort effects, which may render some children inherently more susceptible than others to downstream antibiotic effects.

Trends in Antibiotic Use by Birth Season and Birth Year

Trends in Antibiotic Use by Birth Season and Birth Year

Antimicrobial Stewardship in the Neonatal Unit: A Quality Improvement Initiative

BackgroundAntimicrobial stewardship is an important component of modern medical practice. Audit and surveillance of antibiotic use with feedback to prescribing clinicains is reccomended as a high-impact core stewardship intervention. The aim of this study was to assess and reduce unnecessary antimicrobial use in a neonatal unit.MethodsA prospective audit was performed to systematically assess compliance of antimicrobial prescribing with local antimicrobial guidelines in September 2016. Following this, educational interventions were applied to improve compliance with the guideline and electronic prescribing was introduced to the neonatal unit. There were two further re-audit periods in December 2016 and March 2017. The primary outcome was a reduction in days of antibiotic therapy per 1,000 patient days (DOT/1,000 patient days). Secondary outcomes were a reduction in prolonged antibiotic courses and improved compliance with the sepsis evaluation guideline.ResultsThere were 312 neonatal admissions throughout the study. The number of admissions per day did not significantly change from the baseline to intervention period and the groups were comparable for gestation, birth weight and admission diagnosis. There was a significant overall reduction in the primary outcome of DOT/1,000 patient days from 572 to 417 DOT from September to March (P < 0.0001). This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment >36 hours in negative PSWU cases were reduced from 82 DOT to 7.5 DOT (P = 0.0004). Similarly treatment courses >5 days for culture negative sepsis were reduced from 46.5 DOT to 7 DOT (P = 0.0009). Compliance with the neonatal sepsis evaluation guideline also improved with a 35% reduction in evaluations for indications not recognized in the guideline.ConclusionAnti-microbial stewardship plays an important role in the neonatal unit in ensuring that the appropriate drug, dose, route and duration of therapy are employed to ensure adequate treatment while minimizing the risks of unnecessary antibiotic use. Monitoring antibiotic prescribing data, as in this audit, can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced.Disclosures All authors: No reported disclosures.

Use of antibiotics among community-dwelling adults in Germany -Results of National Health Interview and Examination Surveys 1997 – 1999 and 2008 – 2011

Background: Antimicrobial resistance is a rising global public health threat. Overuse and inappropriate use of antibiotics are thought to contribute greatly to the emergence of antimicrobial resistance. The WHO and European Commission have initialized action plans on antimicrobial resistance, emphasizing the monitoring of antimicrobial use at national levels [1, 2]. Using data of national health surveys we investigate antibiotic use among community-dwelling adults aiming to identify regional differences and temporal trends in antibiotic use over time.

Trends in antibiotic use and microbial diagnostics in periodontal treatment: comparing surveys of German dentists in a ten-year period

The use of antibiotics and microbial tests in periodontal treatment among German dental practitioners was investigated in 2012-2013 and compared with 2002-2003 data. One thousand four hundred representative German practitioners received a postal questionnaire requesting their prescribing habits concerning type, dose, frequency, and sequence of antibiotics adjunctive to mechanical debridement. Additionally, the use of local antimicrobials and microbial tests were recorded. The response rate was 29.1% (407 reports). Drug combinations, especially amoxicillin plus metronidazole, were prescribed most frequently (32.8%) with an increase of 7.4% during the past decade, followed by clindamycin (29.3%). Amoxicillin monotherapy was used unexpectedly frequently (17.0%) and doxycycline (2.8%) very infrequently. Then, 24.7% prescribed antibiotics prior to mechanical therapy, while most dentists followed the recommended sequence. The use of local antimicrobials increased by 6.2% and of microbial diagnostics by 20.8%. Positive trends regarding position-paper-conform prescribing habits including the scheduling of systemic antibiotics and increasing use of local antimicrobials and microbial tests were observed. However, deficits and malpractice still exist in German practices. Unexpected is the widespread and increasing use of clindamycin. Continuing educational campaigns and strictly expressed real guidelines are needed. Indication and choice of antibiotic agents in causal periodontal therapy among German dentists have changed between 2003 and 2013 toward a more position-paper-based concept, but inappropriate prescriptions of second choice antibiotics still remain conspicuous.

Antibiotic use in dairy herds in the Netherlands from 2005 to 2012

The aim of this study was to examine the variation in antibiotic use and the effects of external factors on trends in antibiotic use at the herd level by using the number of daily dosages as an indicator for antibiotic use. For this purpose, antibiotic use was analyzed in 94 dairy herds in the Netherlands from 2005 to 2012. The herds were divided into 3 groups of farmers: one group was guided in their antibiotic use from 2008 to 2010 as part of the project, whereas the other 2 groups were not actively guided. The farms were located in 10 of the 12 provinces and were clients of 32 of the 300 veterinary practices that treat cattle. Sales invoices from the veterinary practices provided the antibiotic and cost data for the participating farmers. The number of animal-defined daily dosages (ADDD) indicates the number of days per year that the average cow in a herd is given antibiotic treatment. The average ADDD for all farms from 2005 to 2012 was 5.86 (standard deviation=2.14); 68% of ADDD were used for udder health, 24% for clinical mastitis and 44% for dry-cow therapy. Variation in ADDD among herds decreased during the study period. The trend in ADDD can be described as having 3 phases: (1) a period of increasing use coinciding with little public concern about antibiotic use (2005–2007), (2) a period of growing awareness and stabilization of use (2007–2010), and (3) a period of decreasing use coinciding with increasing societal concerns (2010–2012). The greatest reduction in use was for drugs other than those used to treat the udder. Drug use for mastitis treatment fell considerably in the final year of the study period, whereas farmers were reluctant to reduce use for dry-cow therapy. Almost 40% of the herds were given less than 2.5 ADDD for dry-cow therapy, which is equivalent to 2.5 tubes per average cow in the herd, and 20% used more than 3 tubes per cow. Use of third- and fourth-generation cephalosporins and fluoroquinolones dropped from 18% of ADDD during 2005 to 2010 to 1% in 2012, with a shift toward penicillins and broad spectrum drugs. The ADDD was 22% lower in 2012 than 2007, the year of the highest usage. The decrease in ADDD over time varied between the 3 groups of farmers. During the second phase of the study, the guided group began to display a reduction in use, whereas the other groups only displayed a significant reduction in the third phase. The reduction in antibiotic use has resulted in lower veterinary costs per cow in recent years.

Trends in Antibiotic Use and Nosocomial Pathogens in Hospitalized Veterans With Pneumonia at 128 Medical Centers, 2006-2010.

In 2005, pneumonia practice guidelines recommended broad-spectrum antibiotics for patients with risk factors for nosocomial pathogens. The impact of these recommendations on the ability of providers to match treatment with nosocomial pathogens is unknown. Among hospitalizations with a principal diagnosis of pneumonia at 128 Department of Veterans Affairs medical centers from 2006 through 2010, we measured annual trends in antibiotic selection; initial blood or respiratory cultures positive for methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Acinetobacter species; and alignment between antibiotic coverage and culture results for MRSA and P. aeruginosa, calculating sensitivity, specificity, and diagnostic odds ratio using a 2 × 2 contingency table. In 95 511 hospitalizations for pneumonia, initial use of vancomycin increased from 16% in 2006 to 31% in 2010, and piperacillin-tazobactam increased from 16% to 27%, and there was a decrease in both ceftriaxone (from 39% to 33%) and azithromycin (change from 39% to 36%) (P < .001 for all). The proportion of hospitalizations with cultures positive for MRSA decreased (from 2.5% to 2.0%; P < .001); no change was seen for P. aeruginosa (1.9% to 2.0%; P = .14) or Acinetobacter spp. (0.2% to 0.2%; P = .17). For both MRSA and P. aeruginosa, sensitivity increased (from 46% to 65% and 54% to 63%, respectively; P < .001) and specificity decreased (from 85% to 69% and 76% to 68%; P < .001), with no significant changes in diagnostic odds ratio (decreases from 4.6 to 4.1 [P = .57] and 3.7 to 3.2 [P = .95], respectively). Between 2006 and 2010, we found a substantial increase in the use of broad-spectrum antibiotics for pneumonia despite no increase in nosocomial pathogens. The ability of providers to accurately match antibiotic coverage to nosocomial pathogens remains low.

Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam.

Increasing antimicrobial resistance to key antibiotics in Helicobacter pylori has become a main cause of treatment failures in many countries, including Vietnam. For this reason it is advisable to perform antimicrobial sensitivity tests to provide more focused regimens for H. pylori eradication. However, this approach is generally unavailable for H. pylori in Vietnam and the selection of treatment regimens is mainly based on the trend of antibiotic use in the population, resistance development in the region, and history of H. pylori eradication of patients. The aim of this review is to examine the current situation of antimicrobial resistance in Vietnam and suggest management strategies for treatment selection.

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania.

IntroductionAntimicrobial prophylaxis for urologic procedures is a major issue, as potential advantages of antibiotic administration should be carefully weighed against potential side effects, microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic use in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third world environment.MethodsThis was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.ResultsMale patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction. Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or treatment intention.ConclusionAntibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.

Use of fluoroquinolones and third-generation cephalosporins in the emergency department

Fluoroquinolones and third-generation cephalosporins are particularly prone to select bacterial resistance to antibiotics. We aimed to assess the temporal trends of antibiotic use in the emergency department adults unit of an academic hospital between 2002 and 2012. Antibiotic use was converted in defined daily doses (DDD). The total antibiotic consumption tended to decrease, from 53.1±8.5 to 48.6±11.9 DDD/1000 patient visits (estimate decrease per year, -0.9±0.5 DDD/1000 visits, P=0.07). Use of third-generation cephalosporins increased significantly, from 9.7% of total antibiotic use to 22.6% (estimate per year, 1.2±0.2%, P<0.0001), whereas use of fluoroquinolones decreased from 19.5 to 12.3% (estimate per year, -0.7±0.2%, P<0.003). Given their ability to select bacterial resistance, especially extended-spectrum β-lactamases, particular attention should be paid to increasing use of third-generation cephalosporins in the emergency department.

The trends in antibiotic use by general dental practitioners in the Czech Republic (2006–2012)

We assessed antibiotic prescribing in practical dentistry in the Czech Republic, as antibiotics are widely prescribed by dental practitioners and warning signals of their overuse can be observed. The individual antibiotic prescriptions were extracted from the database of the General Health Insurance Company and further analysed. The proportion of dentists' prescription within the whole primary health-care sector and the rate of prescriptions of particular antibiotics were both in defined daily doses per 1,000 insurees and day (DID) and in number of prescriptions calculated. The proportion of antibiotic use in dentistry increased from 0.63 DID in 2006 to 0.75 DID. We found a decline in use of narrow-spectrum penicillins by 4.8%, tetracyclines by 3.5% and macrolides by 3.6%, accompanied by increasing rate of prescription of aminopenicillins combined with beta-lactamase inhibitor by 8.9% and lincosamides by 8.5%. The consumption of clindamycin and amoxicillin combined with clavulanate in DID has increased by approximately 60% since 2006 thanks to the exclusive prescribing of two commercial oral products only. Factors contributing to this unfavourable trend are commercial influence or defensive medicine practice.

The Impact of Policy Guidelines on Hospital Antibiotic Use over a Decade: A Segmented Time Series Analysis

IntroductionAntibiotic pressure contributes to rising antibiotic resistance. Policy guidelines encourage rational prescribing behavior, but effectiveness in containing antibiotic use needs further assessment. This study therefore assessed the patterns of antibiotic use over a decade and analyzed the impact of different modes of guideline development and dissemination on inpatient antibiotic use.MethodsAntibiotic use was calculated monthly as defined daily doses (DDD) per 100 bed days for nine antibiotic groups and overall. This time series compared trends in antibiotic use in five adjacent time periods identified as ‘Segments,’ divided based on differing modes of guideline development and implementation: Segment 1– Baseline prior to antibiotic guidelines development; Segment 2– During preparation of guidelines and booklet dissemination; Segment 3– Dormant period with no guidelines dissemination; Segment 4– Booklet dissemination of revised guidelines; Segment 5– Booklet dissemination of revised guidelines with intranet access. Regression analysis adapted for segmented time series and adjusted for seasonality assessed changes in antibiotic use trend.ResultsOverall antibiotic use increased at a monthly rate of 0.95 (SE = 0.18), 0.21 (SE = 0.08) and 0.31 (SE = 0.06) for Segments 1, 2 and 3, stabilized in Segment 4 (0.05; SE = 0.10) and declined in Segment 5 (−0.37; SE = 0.11). Segments 1, 2 and 4 exhibited seasonal fluctuations. Pairwise segmented regression adjusted for seasonality revealed a significant drop in monthly antibiotic use of 0.401 (SE = 0.089; p<0.001) for Segment 5 compared to Segment 4. Most antibiotic groups showed similar trends to overall use.ConclusionUse of overall and specific antibiotic groups showed varied patterns and seasonal fluctuations. Containment of rising overall antibiotic use was possible during periods of active guideline dissemination. Wider access through intranet facilitated significant decline in use. Stakeholders and policy makers are urged to develop guidelines, ensure active dissemination and enable accessibility through computer networks to contain antibiotic use and decrease antibiotic pressure.

Reduction of antibiotic use in animals “let’s go Dutch”

1 Background Use of antibiotics for animals in the Netherlands has reduced considerably over the last 5 years. This reduction is the result of a change in policy towards the use of antibiotics in veterinary practice and is characterized by a series of coherent political decisions which changed the playing field for farmers and veterinarians considerably. In the years before the reducing trend in use of antibiotics started off, the Netherlands was a relative high consumer of antibiotics in veterinary practice. The trends in antibiotic use will be explored in this paper, in particular focussing on the reducing trends in recent years, and the measures which led to the strong reducing trend which can be observed over a period of more than 3 years now. 2 The years of high use of antibiotics in livestock production

Trends in Antibiotic Treatment of Acute Otitis Media and Treatment Failure in Children, 2000–2011

ObjectivesGuidelines to treat acute otitis media (AOM) were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.Study DesignChildren aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.ResultsWe identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.ConclusionsIn recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

Trends in Antibiotic Use in a Single University Hospital

Kang Il Jun, Hei Lim Koo, Min Kyung Kim, Chang Kyung Kang, Min Jae Kim, Shin Hye Chun, Jung Sook Song, Hyang Sook Kim, Nam Joong Kim, Eui Chong Kim, Myoung Don Oh Department of Internal Medicine, Seoul National University College of Medicine, Infection Control Service, Seoul National University Hospital, Department of Pharmacy, Seoul National University Hospital, Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea