Trends In Antibiotic Prescribing Research Articles

Trends in antibiotic use in a UK secondary care prior to and during the COVID-19 pandemic: a cross-sectional retrospective study

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge. To address this, the UK Government developed a 5-year action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use.1 The World Health Organisation (WHO) promotes antimicrobial stewardship (AMS) and developed the AWaRe classification system to guide global AMS implementation. The defined daily dose (DDD) standardises antibiotic use comparisons.2 The COVID-19 pandemic significantly impacted health services, particularly in secondary care, potentially exacerbating AMR due to increased antibiotic use.3 Aim To evaluate changes in antibiotic use in a UK secondary care setting following the onset of the COVID-19 pandemic in 2020 compared to 2019. Methods This cross-sectional retrospective study evaluated antibiotic use among adult patients admitted to an NHS Foundation Trust in England. The focus was on those prescribed antibiotics for respiratory tract infections (RTIs) and pneumonia in 2019 and 2020. Data from 640 patient records were extracted using a validated tool based on the WHO AWaRe classification, with antibiotic use measured using the Defined Daily Dose (DDD). The study included patients aged 25 and above, immunocompromised individuals, pregnant women, and those treated for RTIs. It was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA). The Citizens Senate reviewed the study protocol, ensuring public and patient involvement. Results The results show a notable increase in the Defined Daily Dose (DDD) of several antibiotics during the COVID-19 pandemic. In the "Access" category, amoxicillin usage rose from 1.33 DDD pre-pandemic to 4.33 DDD in 2020. Co-amoxiclav remained nearly constant at around 15 DDD but showed a marked increase compared to other antibiotics. In the "Watch" category, azithromycin increased from 3 to 9 DDD, and clarithromycin from 32 to 35.5 DDD. Levofloxacin usage doubled from 13 to 26 DDD. The "Reserve" category showed no significant increase, indicating stable consumption. Discussion and conclusion Understanding trends in antibiotic prescribing during the COVID-19 pandemic is pivotal for effective management in secondary care settings. The significant increase in the "Watch" category of antibiotics, particularly macrolides like azithromycin and clarithromycin, highlights the need for stringent antimicrobial stewardship. This rise may reflect changes in prescribing behaviour due to the pandemic. Monitoring antibiotic use is vital to mitigate the AMR challenge. Additionally, the increased use of levofloxacin during the pandemic, despite MHRA safety alerts about its potentially severe side effects, highlights the importance of cautious antibiotic prescribing and prompt discontinuation at the first signs of adverse reactions. The COVID-19 pandemic has significantly influenced antibiotic prescribing trends, highlighting the urgent need for sustainable antimicrobial stewardship in secondary care. This study reveals a notable increase in "Watch" category antibiotics, particularly azithromycin and clarithromycin, underscoring the need for stringent stewardship. Optimised antibiotic use is crucial for patient safety, improving treatment quality, and saving lives. The increased reliance on levofloxacin, despite known risks, emphasises the importance of careful prescribing. Prioritising responsible antibiotic use is essential to combat antimicrobial resistance, necessitating enhanced monitoring and stewardship efforts.

Healthcare workers' views on antibiotic prescribing and stewardship during the COVID-19 pandemic at an NHS Foundation Trust in England: a cross-sectional survey

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge, projected to cause 10 million deaths annually by 2050.1 In response, the UK Government developed a five-year national action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use and implementing antimicrobial stewardship.2 The COVID-19 pandemic has significantly impacted the healthcare system, jeopardising public health and causing millions of deaths worldwide. The pandemic has exacerbated AMR due to increased antimicrobial therapy and misuse.3 Aim This study explores healthcare workers’ (HCWs) views towards antibiotic prescribing, AMS and AMR during the COVID-19 pandemic in a UK secondary care setting. Methods This cross-sectional study employed an online questionnaire survey conducted at an NHS Foundation Trust in the East of England, targeting doctors, nurses, and pharmacists. The total eligible participants comprised 5,636 doctors, 2,140 nurses, and 206 pharmacists. Data collection was carried out using Qualtrics XM from 12 June to 13 September 2023. Inclusion criteria required healthcare workers (HCWs) to be adults aged 25 or older, registered with relevant professional bodies, and employed during the pandemic. Data analysis involved both descriptive statistics and qualitative methods to interpret participants’ open-ended responses to the question, “What lessons have been learnt during the COVID-19 pandemic?” This study was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC reference number 22/EM/0161). The Citizens Senate reviewed the study protocol to ensure public and patient involvement. Results A total of 23 HCWs completed the survey, including 12 pharmacists, nine doctors, and two nurses. The survey included an open-text section where respondents shared lessons learned during the COVID-19 pandemic. Among pharmacists, 75% (9 out of 12) identified inappropriate antibiotic use without clinical justification as a significant issue, and 67% (8 out of 12) reported an increase in healthcare-associated infections (HCAIs). Additionally, 83% (10 out of 12) noted the positive impact of technology platforms and antibiotic reviews on implementing effective and sustainable AMS. Among doctors, 89% (8 out of 9) emphasised the need for reliable information dissemination, observing that social media often overshadowed evidence-based guidelines. Additionally, 78% (7 out of 9) stressed the importance of staying informed about resistance patterns and antibiotic prescribing trends. All nurses highlighted the significance of AMR awareness and reported that mental fatigue affected decision-making during the pandemic. Discussion/Conclusion This study highlights the essential role of technology platforms in enhancing antimicrobial stewardship practices and the necessity of disseminating reliable information to counter misinformation. The pandemic highlighted the need for clear guidelines and robust communication strategies to support clinical practices. However, this study has limitations, including a small sample size of 23 participants, which may affect the generalisability of the findings. Future research should include larger, more diverse samples to validate these findings and assess specific AMS interventions. The study also revealed the importance of resilient AMS implementation to optimise antibiotic use and improve patient outcomes. Achieving this requires ongoing AMS education, interdisciplinary collaboration, and adaptive strategies to effectively mitigate antimicrobial resistance.

Rising trend of dentist-prescribed antibiotics in Brazil: 2011-2021.

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil. This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing. Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome. In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

The Uncharted Patterns of Antibiotic Prescribing in Urology Ambulatory Practices: A Four-Year Analysis

Background: Urinary tract infections (UTIs) represent a prevalent indication for outpatient antibiotic usage, yet limited data exist regarding antibiotic prescriptions within urology specialties. This study aimed to assess antibiotic prescribing patterns in urology offices over a four-year period, providing insights for potential stewardship interventions. Methods: The analysis focused on antibiotic prescribing trends in adults between 2018 and 2021 during both visit and non-visit (e.g. telephone and chart messages) encounters across 15 ambulatory Urology clinics in an academic medical center in Western New York. Exclusions were made for antivirals, antiparasitics, antifungals, oral suspensions, selected non-UTI antibiotics, duplicate orders on the same day or week, and prescriptions exceeding 28 days. Prescriptions were categorized into single doses administered in the clinic and those prescribed for 2-28 days, with descriptive statistics and trend analyses conducted using SAS v9.14. Results: Over the four-year period, 54,282 prescriptions were analyzed. Of these, 26,944 (49.7%) were single doses administered in the clinic, predominantly for pre-procedure prophylaxis. The most commonly prescribed antibiotics for prophylaxis were fluoroquinolones (FQ) (47.5%), followed by ceftriaxone (19.2%), nitrofurantoin (13.2%), trimethoprim/sulfamethoxazole (8.6%), and gentamicin (4.2%). Among the 27,288 prescriptions for 2-28 days, 72.3% were from non-visit encounters, with 61.6% prescribed by advanced practice providers (APPs) (Figure 1). The mean number of prescriptions per patient was 2.07, with women receiving more prescriptions than men (2.39 vs. 1.88, P &lt; 0.001). FQ remained the most commonly prescribed antibiotics during all encounters (23.7%), followed by nitrofurantoin (23.0%) (Figure 2). The antibiotic duration was longer for visit-based compared to non-visit-based prescriptions (mean 10 vs. 7 days, P &lt; 0.001). Notably, there was a significant decrease in fluoroquinolone use between Q1 2018 and Q4 2019 for both male and female patients, followed by insignificant changes thereafter. Conclusions: Antibiotic use in urology outpatient settings is substantially underestimated if only prescriptions made during visit encounters are considered. More than two-thirds of prescriptions for 2-28 days were from non-visit encounters, with the majority originating from APPs. The average therapy duration exceeded guideline recommendations. Moreover, approximately half of the antibiotics were administered in the office for pre-procedure prophylaxis. To enhance antibiotic prescribing in these specialized clinics, interventions should focus on non-visit prescriptions and provide education for APPs, alongside adjustments to default durations in electronic orders. Further evaluation is essential to assess the appropriateness of single doses for pre-procedure prophylaxis.

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 utilization for patients hospitalized with COVID-19 with and without signs of sepsis

Abstract Objective: To assess trends in antibiotic prescribing for patients hospitalized with COVID-19 with and without sepsis. Design: Retrospective cohort study using electronic health record (EHR) data. Setting: Five hospitals in eastern Massachusetts. Patients: Adults (≥18 years) hospitalized with community-onset SARS-CoV-2 infections between March 2020 and November 2022. Methods: We assessed quarterly trends in the use of prolonged initial antibiotic therapy (≥4 antibiotic days within one week of admission, including discharge antibiotics) amongst COVID-19 patients with and without sepsis, defined using clinical signs of organ dysfunction before hospital day 3. Poisson regression models were used to adjust for baseline characteristics and severity of illness. Results: Of 431,017 hospitalizations in the study period, 21,563 (5.0%) had community-onset COVID-19. 4,769/21,563 (20.5%) presented with sepsis. Prolonged antibiotics were prescribed in 2,323/4,769 (48.7%) COVID-19 patients with sepsis and 2,866/16,794 (17.1%) without sepsis despite low rates of positive bacterial cultures on admission (15.0% vs 6.3%, respectively). Quarterly rates of prolonged antibiotics declined between the first and second pandemic quarters for both sepsis (66.8% to 43.9%) and no-sepsis (31.8% to 24.4%) groups. However, there was no significant change thereafter through November 2022 in either group (quarterly aORs 1.02, 95% CI 0.99–1.05 and 1.01, 95% CI 0.99–1.03, respectively). Conclusions: Prolonged antibiotics were common in hospitalized COVID-19 patients with and without sepsis during the first 33 months of the pandemic despite low rates of proven bacterial infection. Decreases in antibiotic utilization occurred primarily between the first and second pandemic quarter with no further reduction thereafter.

Antibiotic utilization trends in Veterans Affairs patients with Stenotrophomonas maltophilia bloodstream infections.

Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus that can cause serious infections but has limited treatment options. This study aims to establish trends in the treatment of S. maltophilia bloodstream infections (BSI) across the United States in Department of Veterans Affairs (VA) facilities. Data was evaluated over a 10-year timeframe (2012 to 2021) in this retrospective cohort study. Veterans with ≥ 1 blood culture with S. maltophilia within a VA medical encounter were included. Microbiology, pharmacy, and patient information were collected through national VA data sources and chart review. Descriptive statistics and Poisson regression were used to summarize patient demographics, facility characteristics, microbiologic data, and treatment trends. A total of 374 blood cultures positive for S. maltophilia were identified across 75 VA facilities. Of 282 unique patients with BSI, the majority were male (93.6%), white (67.4%), with a mean age of 64 ± 13.1 years. Of those patients, 78% received treatment, 12.8% had a polymicrobial blood culture, and 5.3% had a documented sulfa allergy. Susceptibility results were most reported for trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin, and ceftazidime, with 4.5%, 4.3%, and 44.4% resistant isolates, respectively. Antibiotics most prescribed included TMP-SMX (41.5%) and levofloxacin (39.4%), followed by ciprofloxacin (13.8%) and ceftazidime (12.4%). Combination therapy was prescribed in 33% of patients. No significant trends were found with antibiotic utilization over time. TMP-SMX and levofloxacin were the most prescribed antibiotics for S. maltophilia BSI treatment. No significant changes were seen with antibiotic prescribing trends in Veterans from 2012 to 2021.

Derivation of a risk-adjusted model to predict antibiotic prescribing among hospitalists in an academic healthcare network

Abstract Background: Among inpatients, peer-comparison of prescribing metrics is challenging due to variation in patient-mix and prescribing by multiple providers daily. We established risk-adjusted provider-specific antibiotic prescribing metrics to allow peer-comparisons among hospitalists. Methods: Using clinical and billing data from inpatient encounters discharged from the Hospital Medicine Service between January 2020 through June 2021 at four acute care hospitals, we calculated bimonthly (every two months) days of therapy (DOT) for antibiotics attributed to specific providers based on patient billing dates. Ten patient-mix characteristics, including demographics, infectious disease diagnoses, and noninfectious comorbidities were considered as potential predictors of antibiotic prescribing. Using linear mixed models, we identified risk-adjusted models predicting the prescribing of three antibiotic groups: broad spectrum hospital-onset (BSHO), broad-spectrum community-acquired (BSCA), and anti-methicillin-resistant Staphylococcus aureus (Anti-MRSA) antibiotics. Provider-specific observed-to-expected ratios (OERs) were calculated to describe provider-level antibiotic prescribing trends over time. Results: Predictors of antibiotic prescribing varied for the three antibiotic groups across the four hospitals, commonly selected predictors included sepsis, COVID-19, pneumonia, urinary tract infection, malignancy, and age &gt;65 years. OERs varied within each hospital, with medians of approximately 1 and a 75th percentile of approximately 1.25. The median OER demonstrated a downward trend for the Anti-MRSA group at two hospitals but remained relatively stable elsewhere. Instances of heightened antibiotic prescribing (OER &gt;1.25) were identified in approximately 25% of the observed time-points across all four hospitals. Conclusion: Our findings indicate provider-specific benchmarking among inpatient providers is achievable and has potential utility as a valuable tool for inpatient stewardship efforts.

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.