Trends In Antibiotic Prescribing Research Articles

Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country—the impact of an antimicrobial stewardship program

BackgroundResistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital.MethodA point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis (http://www.global-pps.com).ResultsA total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%.ConclusionThe indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.

Optimizing Antibiotic Treatment for Diabetic Foot Infections: A Study From a Tertiary Public Healthcare Center in Puducherry, South India.

Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to increased morbidity and mortality. Understanding antibiotic prescribing patterns and microbial susceptibility is crucial for effective management. This study aimed to assess antibiotic prescribing trends and microbial susceptibility patterns in DFIs in a tertiary care center in Puducherry. A prospective observational study was conducted over two months, involving patients with DFIs attending surgery OPD and admitted inpatient wards. Data on demographics, comorbidities, ulcer characteristics, antibiotic prescriptions, and microbial culture results were collected. Descriptive statistics and appropriate statistical tests were used for analysis. Of 110 patients included, most were males (80, 72.7%) aged 51-60 years (43, 39.1%). Common risk factors included poor glycemic control (85, 77.3%), barefoot walking (29, 26.4%), and a family history of diabetes (46, 41.8%). Gram-negative organisms (78, 70.9%) predominated, with Escherichia coli(17, 15.5%), Pseudomonas aeruginosa (12, 10.9%), and Staphylococcus aureus (10, 9.1%) being common isolates. Polypharmacy was observed, with (63) 57.3% receiving multiple antibiotics, mainly via the parenteral route (16, 64.5%). Ceftriaxone (31, 28.2%) and cefotaxime (21, 19.1%) were frequently prescribed. Antibiotic resistance varied among isolates. This study underscores the predominance of gram-negative organisms in DFIs and highlights the need for rational antibiotic prescribing. Cephalosporins were commonly used, emphasizing the importance of empirical therapy. Understanding local microbial patterns and susceptibility is crucial for guiding antibiotic selection and optimizing clinical outcomes. In addition, addressing modifiable risk factors is imperative for preventing DFIs and reducing associated complications. This study provides valuable insights for strengthening antimicrobial stewardship programs and improving patient care in diabetic foot management. Furthermore, the present study highlights the importance of essentially deprescribing the prescriptions both from the patient, their primary carer, and the treating physician/surgeon's perspective.

Temporal trends in antibiotic prescribing and serious and nonserious infections in children presenting to general practice: a registry-based longitudinal cohort study of 162 507 individuals.

It is crucial to understand the trends in paediatric antibiotic prescribing and serious and nonserious infections to improve antibiotic prescribing practices for children in ambulatory care. Assessing trends in paediatric antibiotic prescribing and infection incidence in general practice from 2002 to 2022. In this retrospective cohort study using INTEGO network data from 162 507 patients in Flanders (Belgium), we calculated antibiotic prescribing rates and proportions alongside incidence rates of serious and nonserious infections, stratified by age (0-1, 2-6, 7-12 years) and municipality. We performed autoregressive moving average time-series analyses and seasonality analyses. From 2002 to 2022, antibiotic prescribing rate decreased significantly: 584/1000 person-years (PY) (95% CI 571-597) to 484/1000PY (95% CI 478-491); so did antibiotic overall prescribing proportion: 46.3% (95% CI 45.1-47.6) to 23.3% (95% CI 22.9-23.7) (59.3% amoxicillin and 17.8% broad spectrum). Prescribing proportions dropped significantly for nonserious (45.6% to 20.9%) and increased for serious infections (64.1% to 69.8%). Proportions significantly dropped for acute suppurative otitis media (74.7% to 64.1%), upper respiratory tract infections (44.9% to 16.6%), bronchitis/bronchiolitis (73.6% to 44.1%) and acute tonsillopharyngitis (59.5% to 21.7%), while significantly increasing for pneumonia (65.2% to 80.2%). Nonserious and serious infection incidence rates increased from 785/1000PY and 34.2/1000PY to 1223/1000PY and 64.1/1000PY, respectively. Blood and CRP testing proportions increased significantly. Antibiotic prescribing in general practice for children declined from 2002 to 2022. Further targeted antibiotic stewardship initiatives are needed to reduce the use of broad-spectrum antibiotics and antibiotic prescribing for conditions such as otitis media and bronchitis/bronchiolitis.

Trends in Antibiotic Use in a Large Children's Hospital in London (United Kingdom): 5 Years of Point Prevalence Surveys.

Background: Antibiotics are commonly prescribed in paediatrics. As their excessive use contributes to adverse drug events, increased healthcare costs, and antimicrobial resistance, antimicrobial stewardship initiatives are essential to optimising medical care. These single-centre point prevalence surveys aimed to provide insights into antibiotic prescribing trends and identify targets for paediatric AMS activities. Methods: 14 point prevalence surveys were conducted from March 2016-April 2021, collecting data on antibiotic prescriptions, indication, adherence to guidelines, and route of administration. The UK adapted the World Health Organisation's AWaRe classification-guided antibiotic categorization. Results: 32.5% of all inpatients were on at least one antimicrobial; this remained stable during all surveys (range: 20-44%, p = 0.448). Of all prescriptions, 67.2% had an end- or review-date, and the majority was for agents in the Watch category (46.8-70.5%). Amoxicillin and clavulanate were the most frequently prescribed antibiotics (20.8%), followed by gentamicin (15.3%). Approximately 28.8% of all prescriptions were for prophylactic indications, while 7.6% of the prescriptions were not adherent to the hospital guidelines. Conclusions: This study highlights the importance of ongoing monitoring and robust AMS initiatives to ensure prudent antibiotic prescribing in paediatric healthcare. It underscores the need for tailored guidelines, educational efforts, and targeted interventions to enhance the quality of antibiotic usage, ultimately benefiting both individual patients and public health.

Ten-year trends of antibiotic prescribing in surgery departments of two private sector hospitals in Central India: a prospective observational study

BackgroundInappropriate antibiotic use contributes to the global rise of antibiotic resistance, prominently in low- and middle-income countries, including India. Despite the considerable risk of surgical site infections, there is a lack of antibiotic prescribing guidelines and long-term studies about antibiotic prescribing in surgery departments in India. Therefore, this study aimed to analyse 10 years’ antibiotic prescribing trends at surgery departments in two tertiary-care hospitals in Central India.MethodsData was prospectively collected from 2008 to 2017 for surgery inpatients in the teaching (TH-15,016) and the non-teaching hospital (NTH-14,499). Antibiotics were classified based on the World Health Organization (WHO) Access Watch Reserve system and analysed against the diagnoses and adherence to the National List of Essential Medicines India (NLEMI) and the WHO Model List of Essential Medicines (WHOMLEM). Total antibiotic use was calculated by DDD/1000 patient days. Time trends of antibiotic prescribing were analysed by polynomial and linear regressions.ResultsThe most common indications for surgery were inguinal hernia (TH-12%) and calculus of the kidney and ureter (NTH-13%). The most prescribed antibiotics were fluoroquinolones (TH-20%) and 3rd generation cephalosporins (NTH-41%), and as antibiotic prophylaxis, norfloxacin (TH-19%) and ceftriaxone (NTH-24%). Access antibiotics were mostly prescribed (57%) in the TH and Watch antibiotics (66%) in the NTH. Culture and susceptibility tests were seldom done (TH-2%; NTH-1%). Adherence to the NLEMI (TH-80%; NTH-69%) was higher than adherence to the WHOMLEM (TH-77%; NTH-66%). Mean DDD/1000 patient days was two times higher in the NTH than in the TH (185 vs 90). Overall antibiotic prescribing significantly increased in the TH (β1 =13.7) until 2012, and in the NTH (β2 =0.96) until 2014, and after that decreased (TH, β2= -0.01; NTH, β3= -0.0005). The proportion of Watch antibiotic use significantly increased in both hospitals (TH, β=0.16; NTH, β=0.96).ConclusionTotal antibiotic use decreased in the last three (NTH) and five years (TH), whereas consumption of Watch antibiotics increased over 10 years in both hospitals. The choice of perioperative antibiotic prophylaxis was often inappropriate and antibiotic prescribing was mostly empirical. The results of this study confirmed the need for antibiotic prescribing guidelines and implementation of antimicrobial stewardship programs.

Trends in antibiotic prescribing in primary care out-of-hours doctors' services in Ireland.

Infections are a common reason for patient consultation in out-of-hours (OOH) doctors' services. Surveillance of antibiotic prescribing in OOH settings is important to develop tailored antimicrobial stewardship (AMS) interventions. To evaluate antibiotic prescribing patterns in OOH services in the Cork Kerry region, Ireland to inform future AMS interventions. A retrospective, observational cohort study was conducted of all oral antibiotic prescriptions in OOH doctors' consultations between 1 December 2019 and 31 December 2021 in the region. Data were gathered on age, gender, date and time of consultation, consultation method (in person, remote), antibiotic and its indication. Data were analysed using Microsoft Excel v.2018 and SPSS v.28. Overall, 17% (69 017 of 406 812) of the OOH doctors' consultations resulted in an antibiotic prescription during the study period. This varied from 31% of OOH consultations in December 2019 to less than 2% of OOH consultations in April 2020. Of the antibiotics prescribed, 21% were for children under 6 years old. Respiratory tract infections (RTIs) were the most common indication for antibiotics (59%). Amoxicillin was the most commonly prescribed antibiotic (40% of all prescriptions). Red (reserved) antibiotics accounted for 19% of all prescriptions. During the COVID-19 pandemic period of the study, 66% of 49 421 of antibiotic prescriptions were issued from remote consultations. Low antibiotic prescribing levels during the early stages of the pandemic were not sustained. Antibiotic prescriptions from remote consultations were common. A key opportunity for AMS is addressing the volume of antibiotic prescribing for RTIs, particularly in children.

Outpatient antibiotic prescribing during the first two years of the COVID-19 pandemic: A nationwide register-based time series analysis.

The COVID-19 pandemic has imposed an enormous burden on health care systems around the world. Simultaneously, many countries have reported a decrease in the incidence of other infectious diseases, such as acute respiratory infections, leading to a decline in outpatient antibiotic use. The aim of this study is to assess the impact of the COVID-19 pandemic on outpatient antibiotic prescribing in Finland during the first 2 years of the pandemic. We used nationwide register data, applied descriptive methods, and conducted an interrupted time series analysis (ITSA) using ARIMA modelling. Results from the ARIMA modelling showed that at the baseline, before the pandemic, the level of monthly number of antibiotic prescriptions was 248,560 (95% CI: 224,261 to 272,856; p<0.001) and there was a decreasing trend of 1,202 in monthly number of prescriptions (95% CI: -2,107 to -262; p<0.01). After the COVID-19 pandemic began, there was a statistically significant decline of 48,470 (95% CI: -76,404 to -20,535, p<0.001) prescriptions (-19.5% from the baseline level). The greatest decrease in antibiotic prescribing was observed among children aged 0-17 years. While antibiotic prescribing declined in all antibiotic groups associated with respiratory tract infections, the decrease from 2019 to 2020 was the largest with azithromycin (52.6%), amoxicillin (44.8%), and doxycycline (43.8%). Future studies should continue exploring antibiotic prescribing trends during the COVID-19 pandemic and beyond.

WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance - a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic.

Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO's AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of "Watch" category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.

2267. Evaluation of Antibiotic Prescribing Trends from a Dental Clinic After Implementation of a Dental Antimicrobial Stewardship Initiative

Abstract Background Inappropriate antibiotic prescribing by dentists is as high as 80% and in the U.S., dentists rank third for writing the most antibiotic prescriptions. At NewYork-Presbyterian Brooklyn Methodist (NYP-BMH), the Antimicrobial Stewardship Program (ASP) and Division of Dental Medicine collaborated to create a clinical practice guideline regarding antibiotic use in dentistry that was implemented in May 2021 and is reinforced with annual education to dental prescribers. The purpose of this study is to compare outpatient antibiotic prescribing trends pre- and post-guideline implementation. Methods Patients presenting to NYP-BMH dental clinic for an emergent indication and prescribed an antibiotic from January-April of 2019-2021 (pre) and January-April of 2022 (post) were included. The primary outcome was appropriateness of antibiotic therapy. Secondary outcomes included a comparison of antibiotic selection, dosing and duration of therapy. A subgroup analysis of patients with reported penicillin allergies was conducted to compare alternative agents prescribed. Results A total of 119 patients in the pre and 100 patients in the post-guideline period were included. The primary outcome of appropriate antibiotic prescriptions significantly improved after guideline implementation (pre 45% vs post 64%, p&amp;lt; 0.01). The majority of antibiotic indications were treatment-related and the most common dental diagnosis was caries. The most common antibiotic prescribed in the study was amoxicillin. Compared to pre-guideline, there was significant decreased utilization of penicillin VK (pre 3.4% vs post 0%, p=0.05) and amoxicillin-clavulanate post-guideline (pre 16% vs post 8%, p=0.02). A wide variety of dosing regimens were utilized with more guideline-concordant regimens utilized post-guideline (pre 59% vs post 72%, p=0.04). On average, shorter durations of therapy were prescribed post-guideline (pre 6.8 days vs post 5.7 days, p&amp;lt; 0.02). Penicillin-allergic patients were prescribed less clindamycin after guideline implementation. Conclusion ASP initiatives and collaboration with outpatient dental clinics can improve appropriate antibiotic prescribing. As ASPs look to expand into ambulatory care settings, dental clinics should be prioritized. Disclosures All Authors: No reported disclosures

Prescription Pattern of Different Groups of Antibiotics at Out Patient Department of a Tertiary Medical College Hospital in Dhaka City

Background: Drugs prescription pattern is very important at outpatient department in the tertiary care hospital. Objective: The purpose of the present study was to evaluate the distribution of patients and antibiotic prescribing trends in OPD of a Tertiary Medical College hospital. Methodology: This cross-sectional study was undertaken in the medicine, surgery, gynaecology &amp; obstetrics and paediatrics Out Patient Department of Shaheed Suhrawardy Medical college hospital, Dhaka. The duration of the study period was 5 weeks (25th March, 2017 to 29th April, 2017). The study was designed to obtain information regarding prescribing pattern of drugs by physicians and also to analyze basal information of the prescription. The prescription were observed from the hospital’s OPD and few prescriptions were from each unit. Results: A total 320 prescription were observed from the hospital’s OPD where 80 prescriptions were from each unit. The mean age of the patients was 24.50±14.976 years. The most commonly prescribed antibiotics at medicine OPD was Cephalosporin which was 19(51.4%) cases followed by others antibiotics and azithromycin which was 9(24.3%) cases and 8(21.6%) cases respectively. In surgery OPD, the most commonly used antibiotics were flucloxacillin and cephalosporin which was 66(82.5%) cases and 24(30.0%) cases respectively. In Gynae &amp; obstetrics OPD, the most commonly prescribed antibiotics were quinolones as well as other groups of antibiotics which were 23(46.0%) cases and 27(54.0%) cases respectively. Conclusion: In conclusion most commonly used antibiotic are Cephalosporin, azithromycin and Flucloxacillin in different OPD of the hospital. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):54-58

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.

Presentation and management of insect bites in out-of-hours primary care: a descriptive study

ObjectivesTo describe the population presenting to out-of-hours primary care with insect bites, establish their clinical management and the factors associated with antibiotic prescribing.DesignAn observational study using routinely collected data from...

Changes in antibiotic prescribing by dentists in the United States, 2012-2019.

Dentists prescribe 10% of all outpatient antibiotics in the United States and are the top specialty prescriber. Data on current antibiotic prescribing trends are scarce. Therefore, we evaluated trends in antibiotic prescribing rates by dentists, and we further assessed whether these trends differed by agent, specialty, and by patient characteristics. Retrospective study of dental antibiotic prescribing included data from the IQVIA Longitudinal Prescription Data set from January 1, 2012 to December 31, 2019. The change in the dentist prescribing rate and mean days' supply were evaluated using linear regression models. Dentists wrote >216 million antibiotic prescriptions between 2012 and 2019. The annual dental antibiotic prescribing rate remained steady over time (P = .5915). However, the dental prescribing rate (antibiotic prescriptions per 1,000 dentists) increased in the Northeast (by 1,313 antibiotics per 1,000 dentists per year), among oral and maxillofacial surgeons (n = 13,054), prosthodontists (n = 2,381), endodontists (n = 2,255), periodontists (n = 1,961), and for amoxicillin (n = 2,562; P < .04 for all). The mean days' supply significantly decreased over the study period by 0.023 days per 1,000 dentists per year (P < .001). From 2012 to 2019, dental prescribing rates for antibiotics remained unchanged, despite decreases in antibiotic prescribing nationally and changes in guidelines during the study period. However, mean days' supply decreased over time. Dental specialties, such as oral and maxillofacial surgeons, had the highest prescribing rate with increases over time. Antibiotic stewardship efforts to improve unnecessary prescribing by dentists and targeting dental specialists may decrease overall antibiotic prescribing rates by dentists.

Antibiotic prescribing trends in primary care 2014–2022

Antimicrobial resistance (AMR) is a global healthcare challenge that governments and health systems are tackling primarily through antimicrobial stewardship (AMS). This should, improve antibiotic use, avoid inappropriate prescribing, reduce prescription numbers, aligning with national/international AMS targets. In primary care in the United Kingdom (UK) antibiotics are mainly prescribed for patients with urinary and respiratory symptoms (22.7% and 46% of all antibiotic prescriptions respectively).This study aimed to capture the time-series trends (2014–2022) for commonly prescribed antibiotics for respiratory and urinary tract infections in primary care in England. Trends for Amoxicillin, Amoxicillin sodium, Trimethoprim, Clarithromycin, Erythromycin, Erythromycin ethylsuccinate, Erythromycin stearate, Doxycycline hyclate, Doxycycline monohydrate and Phenoxymethylpenicillin (Penicillin V) were determined. In doing so providing evidence regarding meeting UK antibiotic prescribing rate objectives (a 15% reduction in human antibiotic use 2019–2024).Time series trend analysis of 62,949,272 antibiotic prescriptions from 6,370 General Practices in England extracted from the National Health Service (NHS) Business Services Authority web portal were explored. With additional investigation of prescribing rate trends by quintiles of the Index of Multiple Deprivation (IMD).Overall, there is a downwards trend in antibiotic prescribing for those explored. There is an association between IMD, geographical location, and higher antibiotic prescribing levels (prescribing hot spots). England has a well-documented North-South divide of health inequalities, this is reflected in antibiotic prescribing. The corona virus pandemic (COVID-19) impacted on AMS, with a rise in doxycycline and trimethoprim prescriptions notable in higher IMD areas. Since then, prescribing appears to have returned to pre-pandemic levels in all IMDs and continued to decline.AMS efforts are being adhered to in primary care in England. This study provides further evidence of the link between locality and poorer health outcomes (reflected in higher antibiotic prescribing). Further work is required to address antibiotic use in hot spot areas.

Trends in antibiotic selection pressure generated in primary care and their association with sentinel antimicrobial resistance patterns in Europe.

We studied trends in antibiotic prescribing by primary care and assessed the associations between generated antibiotic selection pressure (ASP) and the prevalence of sentinel drug-resistant microorganisms (SDRMs). The volume of antibiotic prescribing in primary and hospital care expressed in DDD/1000 inhabitants per day and the prevalences of SDRMs in European countries where GPs act as gatekeepers were obtained from the European Centre for Disease Control ESAC-NET. Associations were tested between (i) DDD and (ii) the Antibiotic Spectrum Index (ASI) as a proxy indicator for ASP, and the prevalences of three SDRMs: MRSA, MDR Escherichia coli and Streptococcus pneumoniae resistant to macrolides. Fourteen European countries were included. Italy, Poland and Spain had the highest prevalence of SDRMs and prescribed the highest volume of antibiotics in primary care (average 17 DDD per 1000 inhabitants per day), approximately twice that of countries with the lowest volumes. Moreover, the ASIs of these high antibiotic volume countries were approximately three times higher than those of the low-volume countries. Cumulative ASI showed the strongest association with a country's prevalence of SDRMs. The cumulative ASI generated from primary care was about four to five times higher than the cumulative ASI generated by hospital care. Prevalences of SDRMs are associated with the volume of antimicrobial prescribing and in particular broad-spectrum antibiotics in European countries where GPs act as gatekeepers. The impact of ASP generated from primary care on increasing antimicrobial resistance may be much larger than currently assumed.

An Observational Study on Prescription Pattern of Antibiotics Using WHO Indicators in Primary, Secondary, Tertiary Care–A Need for Antimicrobial Stewardship

Background: Antibiotics have revolutionized modern medicine, playing a pivotal role in treating infectious diseases and preventing life-threatening complications. However, antibiotic misuse and overuse have resulted in the emergence to antibiotic resistance, posing a hazard to global public health. As a result of the rising epidemic, it has become critical to investigate and correct antibiotic prescribing behaviors in primary and secondary care settings. This environment allows for an observational research that evaluates antibiotic prescribing trends using World Health Organization (WHO) indicators and emphasizes the critical need for Antimicrobial Stewardship Programs (ASPs). As assessment metrics, the WHO indicators such as the proportion of antibiotics prescribed by class, the percentage of antibiotics administered without a recognized diagnosis, and the percentage of antibiotics prescribed from the essential medications list were used. Aim: This observative study aimed to assess the prescription patterns of antibiotics in primary and secondary care settings using the World Health Organization (WHO) indicators and to highlight the pressing need for Antimicrobial Stewardship Programs (ASPs) to combat this critical issue. Methods: The study was conducted on total no of 351 patients were included and studied in which 176 patients from primary care setting and 185 patients from primary, secondary and tertiary care setting with their respective prescribed antibiotics for a period of 6 months at apollo hospitals, apex hospitals on those who had age above 20. All prescription records containing antibiotics within a defined time period of will be included in the sample. Results: The inferential statistics results showed that the A p-value of 6.4E-25 is an extremely small p-value in the context of a statistical test, such as a chi-square test. This value represents a highly significant result, which representing there is significant variance in the prescription of antibiotics. The analysis of inpatient antibiotic usage revealed that a substantial proportion of patients (89.3%) received antibiotic treatment during their hospital stay. However, when assessing the appropriateness of antibiotic prescriptions, it was found that only 74.1% of antibiotic-containing prescriptions met the criteria for proper use, suggesting a potential area for improvement in antibiotic prescribing practices within the inpatient and outpatient setting. Conclusion: This observative study sheds light on the suboptimal prescription patterns of antibiotics in primary and secondary care, emphasizing the critical role of Antimicrobial Stewardship Programs in addressing this issue. These programs are essential for preserving the effectiveness of antibiotics, safeguarding public health, and mitigating the looming threat of antibiotic resistance

Gender-based analysis of antibiotic prescribing trends for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore

Respiratory tract infections (RTIs), caused by microorganisms such as bacteria and viruses, are a leading cause of morbidity and mortality in children worldwide. Antibiotic resistance is a serious concern, and proper prescribing practices are necessary to avoid life-threatening situations. Thus, this study aims to conduct a gender-based analysis and compare antibiotic prescribing patterns for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore. This comparative cross-sectional study was conducted at Children’s Hospital in Lahore, Pakistan, for three months and enrolled 250 pediatric patients who met the inclusion criteria, including 155 males and 95 females. Data were collected through face-to-face interviews and reviewing hospital records. The results of the study showed that the average number of drugs per prescription was 3.06 ± 1.29 (male) and 3.12 ± 1.5 (female), while the average number of antibiotics per prescription was 2.25 ± 0.60 (male) and 2.17 ± 0.58 (female). The most prevalent medical conditions were bronchopneumonia (53.55% males and 58.95% females), followed by respiratory distress (20.00% males) and pneumonia (16.13% males and 16.84% females). The most commonly prescribed drugs were J01DD04: Ceftriaxone (78.71% males and 71.58% females), J01CR02: Amoxicillin/Clavulanate (59.35% males and 56.84% females), and J01GB06: Amikacin (41.29% males and 45.26% females). A low percentage of prescriptions had major drug-drug interactions (8.39% males and 10.53% females), while most prescriptions had no drug-drug interactions (81.94% males and 84.21% females). There was no significant difference between male and female patients for caregiver, indications for antibiotic prescriptions, the class of active agent prescribed, and drug interactions. Our study findings indicate that most male and female patients admitted to the hospital with lower respiratory tract infections were prescribed antibiotics alongside analgesics and antipyretics. Furthermore, our analysis revealed minimal drug interactions among the prescribed medications. Importantly, we observed a similar antibiotic prescribing trend among male and female pediatric patients, highlighting the consistency in treatment approaches.

550. Analysis of Staphylococcus aureus resistance patterns and antibiotic prescribing practices in a single tertiary pediatric center in South Florida

Abstract Background Staphylococcus aureus antibiotic resistance in pediatric populations is a dynamic problem that affects the morbidity and mortality of all children. Local efforts to understand its patterns as well as the antibiotic prescribing trends, as well as their relationship, are cornerstone for the development of mitigation strategies. Methods We conducted a retrospective observational study of 11,964 clinical isolates at a tertiary pediatric care center in South Florida collected from 2008 to 2019 to determine the antibiotic susceptibility of Staphylococcus aureus, compare antibiotic resistance patterns between MRSA and MSSA isolates and evaluate antibiotic prescribing practices from 2013 to 2019. Results Methicillin resistance was present in 47.9% (±0.63) isolates with no significant temporal trend. Resistance to clindamycin was on average 24.8% (±1.08), to erythromycin 66.9% (±1.68), to levofloxacin 35.5% (±1.61) and to gentamicin 6.8% (±1.11). MRSA isolates had higher resistance rates to most antibiotics than MSSA (p&amp;lt; 0.05) except for clindamycin for which both had similar rates. Resistance to clindamycin and gentamicin increased significantly from 20% to 25% and from 5 to 15%, respectively, among MRSA and quinolone resistance rose among MSSA from 7% to 13%. Antibiotic prescription rate increased from 56 prescriptions per 1,000 patients to 136 prescriptions per 1,000 patients from 2013 to 2019. There was a positive correlation between erythromycin resistance rate among MRSA and macrolide prescription frequency (p&amp;lt; 0.05). Figure 1.Antibiotic resistance in S aureus isolates from pediatric patients between 2008 and 2019. The trends in erythromycin and gentamicin resistance were statistically significant (p&amp;lt;0.05); all other trends shown were not significant. Figure 2.Comparative annual resistance rate among MSSA and MRSA isolates from pediatric patients between 2008 and 2019 The trend in levofloxacin resistance among MSSA was statistically significant, as well as the trends in erythromycin, clindamycin, and gentamicin in MRSA; all other trends were not significant. Figure 3.Annual antibiotic prescription frequency as a percent of all antibiotics prescribed in outpatient facilities and emergency department at Nicklaus Children’s Hospital between 2013 and 2019Beta-Lactams are expressed as the summation of cephalosporins and penicillins. The frequency at which penicillins, cephalosporins and macrolides were prescribed changed significantly; all other frequencies did not change significantly. Conclusion Pediatric Staphylococcus aureus isolates showed high and stable rates of methicillin resistance during the study period. There is growing clindamycin and gentamicin resistance among MRSA isolates as well as increasing levofloxacin resistance in MSSA isolates. Antibiotic prescribing increased significantly in this population during the study period in South Florida. Disclosures All Authors: No reported disclosures.

1798. Impact and Sustainability of Antibiotic Prescribing Feedback with Peer Comparison to Hospitalists in a Community Hospital

Abstract Background Antibiotic prescribing feedback with peer comparison has been shown to reduce antibiotic prescription rates in the outpatient setting, but data regarding its impact in community hospitals are lacking. We previously developed novel denominator metrics to control for differences between physician practices such as patient volume or workload. Using these metrics, we provided regular antibiotic prescribing feedback with peer comparison to hospitalists in a community hospital over four years and evaluated its impact on targeted antibiotic prescribing. Methods Antibiotic days of therapy (DOT) for all antibacterials and targeted agents (aztreonam, antipseudomonal beta-lactams, vancomycin, and the fluoroquinolones (FQ)) were obtained from electronic medication administration records and linked to the ordering hospitalist. Physician-specific shifts worked data by month were calculated from local administrative datasets. De-identified data were presented in DOT/shifts worked, and trends in facility-wide and hospitalist-specific antibiotic prescribing were evaluated. Results A total of 37,938 antibiotic DOTs were prescribed by hospitalists from January 2018 to March 2022. De-identified feedback was shared in-person (4/2018, 4/2019, 3/2020, 11/2021) or virtually (9/2020) in small group sessions, and education, including local antibiogram data and recommended alternatives, was provided for targeted agents. Of the 31 hospitalists that received feedback, trends in FQ use for 7 hospitalists with longitudinal data are shown (Figure 1). In the month following feedback sessions, hospitalist antibiotic use data demonstrated substantial reductions in FQ prescribing, and similar trends were observed among all targeted agents. A single hospitalist’s prescribing trend for targeted agents is shown in Figure 2. Facility-wide, targeted agent use decreased 31% from 2017 to 2021 and was primarily driven by reductions in use by hospitalists. Conclusion Regular antibiotic prescribing feedback with peer comparison and education was associated with a reduction in targeted agent prescribing by hospitalists at a community hospital. Disclosures All Authors: No reported disclosures.

The Most Common Antibiotic Prescribed Among the Paediatric Population

Objective: To gain a thorough understanding of antibiotic prescribing trends in the pediatric population. Method: The study was designed as a prospective observational study to collect various data from pediatric patients in order to gain a comprehensive understanding of antibiotic prescription trends in pediatrics. Result &amp; conclusion: Data was collected from 90 pediatric patients, 41.1% (n = 37) of whom were male and 58.8% (n = 53) of whom were female. Antibiotics were prescribed to 71.1% (n = 64) of children, 17.7% (n = 16) of adolescents, and 10% (n = 9) of infants for the treatment of various infections. About 24.4% (n = 22) of patients were admitted to the hospital for three days, while 22.2% (n = 20) were only admitted for two days. The most common antibiotic prescribed by pediatricians is penicillin, which accounts for 46.6% (n = 42) of the total, followed by cephalosporin, which is seen in 35.5% (n = 32) of cases. By analyzing the prescription pattern of antibiotic use, it was discovered that the majority of patients, 66.7% (n = 60), received monotherapy, while 33.3% (n = 30) received dual therapy.