Prescribing Trends Research Articles

Current Trend of Antibiotic Prescription for Oral Implant Surgery among Dentists in Central India

Current Trend of Antibiotic Prescription for Oral Implant Surgery among Dentists in Central India

Trends in drug treatment of benign prostatic hyperplasia in Japan based on the National Database Open Data.

This study examined prescription trends for benign prostatic hyperplasia (BPH) drug therapy in Japan over the past decade, focusing on drugs rated as grade A according to Japanese clinical guidelines. Using the National Database Open Data, this study analyzed prescription data from the fiscal years of 2014 to 2021, tracking α1-blockers, 5α-reductase inhibitors, and phosphodiesterase type 5 inhibitors. We adjusted for demographics and calculated medication costs to determine prescribing patterns and changes in drug utilization. Prescriptions for α1-blockers increased from 9898 per 1000 males in 2014 to 12 613 in 2021. Prescriptions for 5α-reductase inhibitors rose from 1441 per 1000 males in 2014 to 2310 in 2021. Tadalafil prescriptions saw a significant increase, from 900 in 2015 to 2520 in 2021. Despite these increases, the overall market size for BPH drugs decreased from 664 million dollars in 2014 to 279 million dollars in 2021, indicating a shift toward generic medications driven by healthcare policies. Although BPH medication prescriptions are increasing, driven by Japan's aging population and clinical guidelines, market dynamics are shifting owing to generic and government price adjustments. This analysis underscores the changing BPH treatment landscape in Japan, highlighting the importance of continuous evaluation of treatment efficacy and cost-effectiveness in evolving healthcare policies and demographics.

Impact of COVID-19 on Antibiotic Stewardship, Antimicrobial Resistance, and Prescribing Habits at Two General Hospitals in Abu Dhabi: A Retrospective Analysis.

Introduction The COVID-19 pandemic has overwhelmingly affected healthcare systems, particularly in the area of antibiotic management. The surge in antimicrobial use to address secondary bacterial infections in COVID-19 patients has heightened concerns about overuse and antimicrobial resistance (AMR). This study examined the pandemic's effect on the antibiotic stewardship program (ASP) at two general hospitals in Abu Dhabi, focusing on changes in prescribing practices, adherence to stewardship guidelines, resistance trends, and overall health system impact. The present retrospective study evaluated shifts in antibiotic consumption, compliance with stewardship practices, and broader healthcare implications. The aim is to assess the pandemic's impact, identify improvement areas, and provide insights to enhance the ASP in addressing the global AMR crisis. Methods This retrospective review assessed electronic medical records from two general hospitals in Abu Dhabi over a 24-month period, from January 2019 to December 2020. It included pre-COVID-19 data from 2019 and data from 2020 during the COVID-19 surge. The study focused on patients aged 25 to 40 years with respiratory tract infections, urinary tract infections, ventilator-associated pneumonia, and nosocomial infections, identified using predefined ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes. Patients with COVID-19 diagnoses and those undergoing surgical procedures were excluded. Key metrics compared data from 2019 and 2020 to assess changes in clinicians' prescribing practices, antibiotic usage, ASP interventions, and their impact on the healthcare system. Results The COVID-19 pandemic influenced antibiotic use and resistance trends, leading to longer hospital stays (3.86 days in 2019 vs. 4.29 days in 2020) and increased use of duplicate anaerobic therapy (4.58% in 2019 vs. 5.71%in 2020). From 2019 to 2020, the average duration of antibiotic therapy decreased from 6.23 days to 5.24 days, but empirical therapy without sufficient evidence rose. The average length of treatment increased (2.87 days in 2019 vs. 3.28 days in 2020), and there was a rise in the use of antibiotics for viral and fungal infections, with cases growing from 17.08%in 2019 to 22.38%in 2020. Despite modest improvements in stewardship practices in 2020, AMR challenges persisted. These results underscore the need for enhanced stewardship programs and continued research to address the ongoing impacton antibiotic prescribing and resistance. Conclusion The COVID-19 pandemic increased antibiotic use and altered resistance patterns. Although stewardship practices improved, AMR challenges remained. Enhanced stewardship programs and ongoing research are essential to mitigate these effects and improve antibiotic management. Recommendation To address changes in antibiotic use and resistance during the COVID-19 pandemic, it is recommended to strengthen ASPs to adapt to new prescribing trends, ensure adherence to evidence-based practices, provide ongoing education for clinicians, invest in research on long-term resistance impacts, and enhance data tracking and monitoring systems.

Impact of the COVID-19 pandemic on psychotropic prescribing: a systematic review

ObjectivesThe global prevalence of mental health disorders has risen significantly since the beginning of the COVID-19 pandemic. The pandemic has additionally caused disruption to mental health services, leading to a...

United States opioid prescribing trends after shoulder surgery and their correlation with opioid misuse

BACKGROUNDOrthopedic surgery has been highlighted as a contributor to the opioid epidemic. There is a paucity of literature focused specifically on opioid prescribing trends following shoulder surgery. Our aims were to describe national and regional trends in opioid prescribing following total shoulder arthroplasty (TSA), proximal humerus fracture fixation, and rotator cuff repair (RCR), and to correlate opioid prescribing trends after shoulder surgery with regional heroin use and new opioid misuse diagnoses. METHODSThis is a retrospective study of 218,577 patients from a commercial insurance dataset who had undergone orthopedic shoulder procedures from 2014-2020. Opioid prescription data within 90-day postop were converted to morphine milligram equivalents (MME). Multivariate modelling was used to evaluate independent associations between MME’s prescribed and subsequent new postoperative diagnosis of opioid dependence. Additionally, longitudinal mixed effects modeling was employed to understand aggregated prescriber habits by state over time and the subsequent effects on estimates of state heroin use and drug overdose deaths. RESULTSFrom 2014 to 2020, the mean number of MMEs prescribed nationally decreased by over 50% for TSA, proximal humerus fracture fixation, and RCR. Over the study period, most states demonstrated an overall downtrend of 90-day opioid prescribing for these procedures.Individuals with a new opioid misuse diagnosis following shoulder surgery were found to be younger (SMD=0.27, p<0.001), have increased comorbidities (SMD=0.38, p<0.001), and increased MME’s prescribed (SMD=0.94, p<0.001). Increased comorbidity score (OR=3.28, p<0.001) and increased 90-day MME’s prescribed (OR=1.05, p<0.001) were all found to increase the odds ratio of a postoperative opioid misuse diagnosis in patient’s undergoing shoulder surgery, while increased age (OR=0.97, p<0.001) and patient’s undergoing RCR (OR=0.79, p=0.001) were found to have a decreased odds ratio of developing a new opioid misuse diagnosis.The predictors of regional heroin use included the within-state 90-day MMEs prescribed (p=0.002). The predictors of drug overdose death included year (p<0.001), but did not include type of surgery or 90-day MMEs. CONCLUSIONOrthopedic surgeons successfully reduced the number of opioids prescribed nationally after shoulder surgeries by over 50% during our study period with similar trends seen at the state level. Our data indicate a relationship between increased opioid prescribing after shoulder surgery and heroin use. This study highlights that while progress has been made, there is evidence that opioid prescribing following shoulder surgery is associated with the more widespread opioid epidemic, and that more research is needed to further lower postoperative opioid misuse in the future.

Medication prescribing trends and its associated adverse drug reactions among hospitalized stroke patients from a main stroke center in Penang, Malaysia: A retrospective 5-year study

Adverse drug reactions (ADRs) are one of the major threats in our healthcare system, which profusely affects health, transience, and quality of life, especially among hospitalized patients. This 5-year study was conducted to determine the incidence and analyze the pattern of ADRs among stroke patients at Hospital Seberang Jaya (HSJ), Malaysia which is the main stroke center for all tertiary healthcare institutions in Penang, Malaysia. A total of 1,993 patients were hospitalized for stroke during the study period of 5 years out of which only 30 of them were reported to experience ADRs during hospitalization. The study patients had a mean (SD) of 61 (±11.8) years, Modified Rankin Score (mRS) score of 1.8 (±1.6), NIH Stroke Scale (NIHSS) score of 3.0 (4.0) with median (IQR) duration of adverse drug reaction of 3.0 (7.0) days. The majority of the patients were Malay (66.7%); female (50.0%); experienced ischemic stroke (90.0%); with first episode of stroke (93.3%); with comorbidity dyslipidemia (60.0%); and mostly recovered post ADRs (80.0%). The major drug classes that contributed to ADRs were vaccines, anti-infective, anti-epileptic, anti-platelets, and others. Evaluation of the causality of ADRs indicated majority were possible (50.0%) ADRs based on the Naranjo scale. The evaluated incidence of ADRs among stroke patients is low in this study. This low incidence rate could be possibly due to active clinical interventions by healthcare professionals during hospitalization. ADR monitoring is highly warranted among the sub-population of stroke patients due to the existence of multiple risk factors and their state of vulnerability.

Abstract P304: A Prescription Trend Analysis of Antihypertensive Pharmacotherapy across Different Specialties in India

Objective: To evaluate the temporal trends in the prescription patterns of antihypertensive medications among healthcare practitioners in India. Methods: The prescription audit data utilized in this study, sourced from IQVIA, originated from a panel comprising 6000 clinicians practicing within the private sector. These prescriptions encompassed various classes of antihypertensive drugs, namely beta-blockers (BB), calcium channel blockers (CCB), angiotensin receptor blockers (ARB), angiotensin-converting enzyme (ACE) inhibitors, and diuretics. The analysis spanned the period from 2014 to 2022. The study also included an examination of combinations involving two or three medications from these drug classes. Results: Cardiologists' prescription rates for antihypertensive medications stood at 21% in 2017 and decreased to 19% by 2023. In 2023, the highest rate of prescribing antihypertensive drugs was observed among consultant physicians, with a rate of 30%, followed by general practitioners at 27%. Among anti-hypertensive medications, the prescription rates for BBs were highest (32%), followed by ARBs &amp; CCBs (25% &amp; 24% respectively); which remained almost constant throughout the study period. Single-drug formulation of antihypertensive medications was the most preferred (60%) among Indian clinicians. Prescription shares of fixed-dose combinations (FDC) of two antihypertensive drugs showed a slight decline (36% in 2017 to 34% in 2023) &amp; FDCs of triple-drug exhibited an upward trend (3% in 2017 to 5% in 2023). Among the two drug FDCs, ARB &amp; diuretics were most preferred (25% prescription share) &amp; triple drug FDCs, CCB, ARB &amp; diuretics were most preferred (76% prescription share). Conclusions: Antihypertensive drugs are the most commonly prescribed medication in the cardiology segment. Consultant physicians and general practitioners manage the majority of hypertension cases. Notably, there has been an observed rise in the preference for triple-drug combinations of antihypertensive medications, indicating a trend toward a more aggressive approach to hypertension management among Indian clinicians. The insights gleaned from this investigation can further assist healthcare professionals in crafting tailored treatment strategies for individuals grappling with hypertension. Such personalized approaches hold promise in enhancing treatment adherence and ultimately improving the quality of life for patients.

Patterns of Antipsychotic Use in Belgian Nursing Homes 2017-2022: Admission is a Decision Point

ObjectivesChronic antipsychotic use among nursing home (NH) residents carries risks with uncertain benefits. Despite guidelines recommending restricted use, these agents remain widely prescribed. This study investigates chronic antipsychotic use in Belgian NHs. DesignWe examined the evolution of chronic antipsychotic use, associated NH resident profiles, impact of NH admissions, and variation among Belgian NHs in a retrospective dynamic cohort study between 2017 and 2022. Setting and ParticipantsAntipsychotic dispensation rates were extracted for members of the Independent Health Insurance Funds in NHs. Prescription trends and resident profiles were evaluated for around 15,000 residents yearly (n = 14,733-15,451) from 2017 to 2022 and variation was assessed among 59 NHs. The impact of NH admission was analyzed for 9647 admissions between 2020 and 2022, and variation was evaluated among 22 NHs. MethodsFor 22 antipsychotics identified at the ATC3 level, chronic use was defined as ≥80 defined daily doses (DDD) and/or ≥16 weekly dispensations per year. We analyzed changes in the 4 most frequently used antipsychotics (haloperidol, olanzapine, quetiapine, risperidone) on NH admission, with chronic use defined as ≥80 minimal prescribed doses (MPD) annually. ResultsThe prevalence of chronic antipsychotic use among NH residents decreased from 24% in 2017 to 22.5% in 2022 (P = .002). Factors associated with higher antipsychotic use included younger age, greater dependency, and lower socioeconomic status. Upon NH admission, 30% (n = 818 of 2723) of residents discontinued treatment, while in 33% (n = 949 of 2854) treatment was initiated, predominantly with quetiapine or risperidone. This led to a small but significant increase of 1.4% after admission (P < .001). Defining chronic use as ≥80 MPD annually appeared to be more sensitive in measuring chronic antipsychotic use. Conclusions and ImplicationsChronic antipsychotic use remains widespread in Belgian NHs, with care transition as an important decision point. Further research should explore effects of safer (de)prescribing strategies on patient well-being.

A multicenter retrospective study of antidepressant use in outpatient clinics in China pre- and post-COVID.

Analyzing antidepressant prescribing in real-world settings can provide clinicians and health policymakers valuable information. This epidemiological study examined the status and trends in antidepressant prescribing among the Chinese population from July 1, 2017, to June 30, 2022. A retrospective study was conducted in three hospitals. Data were collected 2.5 years before and 2.5 years after the onset of the COVID-19 pandemic. We analyzed the number of patients diagnosed with depression and their corresponding antidepressant prescriptions. Using the chi-square test, stratified analyses were performed to explore the characteristics of these prescriptions in different ages and sexes. The study included 124,355 patients and 400,840 antidepressant prescriptions. We observed fluctuating upward trends in the number of patients and antidepressant prescriptions. Post-COVID-19, the number of patients increased by 37.1% compared to the pre-pandemic period, and the number of antidepressant prescriptions rose by 88.3%. The three most frequently prescribed antidepressants for adolescents were sertraline, citalopram, and escitalopram. Among adults, citalopram, escitalopram, and sertraline were most common, while in older adults, citalopram, escitalopram, and mirtazapine were predominant. Male patients used mirtazapine, venlafaxine, paroxetine, bupropion, fluvoxamine, vortioxetine, and clomipramine more frequently compared to female patients, who were more likely to be prescribed citalopram, flupentixol/melitracen, agomelatine, and fluoxetine. Antidepressant monotherapy represented 76.6% of prescriptions, with the most common combination being antidepressants and anxiolytics. Over the past 5 years, both the number of patients and antidepressant prescriptions have shown upward trends, and the COVID-19 pandemic has impacted prescribing. Understanding the changes in antidepressant prescriptions can identify adherence to national guidelines.

Opioid use after surgical treatment in the Danish population-Protocol for a register-based cohort study.

Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. This register-based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer-related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quarters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD-10 codes. Opioids will be identified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non-opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. The study will use extensive national register-based data, ensuring consistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high-risk populations for long-term opioids and provide information to support opioid prescribing guidelines and public health policies.

Trends in megestrol acetate prescription among Korean patients with biliary-pancreatic cancer and their impact.

85 Background: Chemotherapy-induced anorexia poses a significant challenge for cancer patients, particularly in biliary tract cancer (BTC) and pancreatic ductal adenocarcinoma (PDAC), known for their poor response to treatment. Megestrol acetate (MA), a commonly prescribed appetite stimulant, is associated with concerns regarding thrombosis and polypharmacy. Understanding the trends in MA prescription and its cascade effects is essential for optimizing cancer care. Methods: We conducted a retrospective cohort study using data from the Health Insurance and Review Assessment Service (HIRA) database in South Korea. The study included patients diagnosed with BTC and PDAC between 2008 and 2017. Prescription trends for MA, thrombosis events, anticoagulant prescriptions, and total parenteral nutrition (TPN) were analyzed. Statistical analysis included Chi-square tests and Kaplan-Meier estimates. Results: In our analysis of 41,670 patients with BTC and PDAC between 2008 and 2017, MA prescriptions increased notably, with PDAC patients rising from 7.85% to 51.84%. TPN prescriptions remained consistently high, especially among patients prescribed MA. For instance, in 2008, 94.71% of BTC patients prescribed MA received TPN, compared to 70.34% without MA. Similarly, in 2017, 87.56% of those prescribed MA received TPN, compared to 61.63% without MA. Among BTC patients with long-term MA prescriptions, 16.34% received anticoagulants, compared to 4.92% without MA (p&lt;0.001). Among PDAC patients, 18.3% with long-term MA prescriptions received anticoagulants, compared to 7.12% without MA (p&lt;0.001). Conclusions: The study highlights the escalating trend in MA prescriptions among BTC and PDAC patients, along with increased thrombosis diagnoses and anticoagulant prescriptions. These findings underscore the importance of understanding and managing the cascade effects of MA use and associated polypharmacy in optimizing cancer care and improving patient outcomes.

Impact of new antifungal medications on onychomycosis prescriptions and costs in Japan: A nationwide claims database study.

Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%-10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real-world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well-established oral medication, experienced a substantial decrease in prescription volume. The sex- and age-adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019-2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first-line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost-effective treatment strategies. This study provides valuable insights into the real-world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.

Trends in Opioid Prescribing and New Persistent Opioid Use After Surgery in the United States.

To define recent trends in opioid prescribing after surgery and new persistent opioid use in the United States. New persistent opioid use after surgery among opioid-naïve individuals has emerged as an important postoperative complication. In response, initiatives to promote more appropriate post-operative opioid prescribing have been adopted in recent years. However, current estimates of opioid prescribing and new persistent opioid use following surgery remain unknown. A retrospective cohort study of opioid-naïve privately insured adult patients undergoing 17 common surgical procedures between 2013 and 2021 was conducted utilizing multi-payer claims data from the Health Care Cost Institute (HCCI). Initial opioid prescription size in oral morphine equivalents and new persistent opioid use were the outcomes of interest. Trends in opioid prescribing and rates of new persistent opioid use were evaluated across the study period. Mixed effects logistic regression was performed to evaluate independent predictors of new persistent opioid use while adjusting for patient-level factors and year. Among 989,354 opioid-naïve individuals, the adjusted initial opioid prescription size decreased from 282 mg OME to 164mg OME, a reduction of 118mg OME (95% CI: 116-120). The adjusted incidence of new persistent opioid use decreased from 2.7% in 2013 (95% CI: 2.6%-2.8%) to 1.1% in 2021 (95% CI: 1.0%-1.2%). For every 30 OME increase in initial opioid prescription size, new persistent opioid use increased by 3.1%. Other predictors of new persistent opioid use included preoperative non-opioid controlled substances fills (31-365 days: aOR=1.78, 95% CI: 1.70-1.86; 0-30 days: aOR=2.71, 95% CI: 2.59-2.84) and undergoing orthopedic procedures (total knee arthroplasty (aOR=3.43, 95% CI: 3.15-3.72); shoulder arthroscopy (aOR=2.39, 95% CI: 2.24-2.56)). Both opioid prescription size after surgery and new persistent opioid use decreased over the last decade, suggesting that opioid stewardship practices had favorable effects on the risk of long-term opioid use.

The emergence of bromazolam in Jefferson County, AL: a case series.

Postmortem toxicology is an ever-changing landscape presenting challenges for toxicologists and medical examiners. Trends can vary for certain benzodiazepines. While diazepam use tends to remain constant, alprazolam and clonazepam ebb and flow depending on prescription trends and street popularity. Novel benzodiazepines like etizolam vary in casework depending on legal restrictions and black market availability. In May 2022, the first case of the designer benzodiazepine, bromazolam, was detected in Jefferson County Coroner/Medical Examiner's Office casework. Between then and December 2023, an additional nine cases have been observed. Bromazolam is the brominated analog of the low-dose benzodiazepine, alprazolam, and is likely similar in potency. As bromazolam is a potent benzodiazepine, low concentrations of this novel drug are likely to contribute to central nervous system depression in opioid overdose cases. We present 10 cases in which bromazolam was detected in postmortem samples at the University of Alabama at Birmingham toxicology laboratory. The decedents ranged in age from 20 to 41 years. Most of the decedents were White (n = 8; 80%) and male (n = 7; 70%). Bromazolam concentrations ranged from 21 to 3220 ng/mL (mean 401 ng/mL). All but one case were polydrug, and all deaths were related to drug toxicity. Fentanyl was detected in 8 of the 10 decedents, with concentrations ranging from <2.5 to 97 ng/mL (mean 30 ng/mL). Additional drugs detected were methamphetamine, ethanol, oxycodone, methadone, cocaine, amphetamine, morphine, and diphenhydramine. While all manners of death were ruled as accidental, bromazolam was included in the cause of death statements in 9 of the 10 cases. Capturing important emerging drug trends in the death certificate is critical to help inform public health and medical colleagues for preventive measures and treatment in the continued drug epidemic.

Analysis of Prescription Trends for Narcotic Appetite Suppressants: Utilizing the Narcotics Information Management System.

The aim of this study was to systematically analyze the prescription trends of medical narcotic appetite suppressants in South Korea. Data was extracted from the Narcotics Information Management System dataset from 2020, which encompasses nationwide information concerning the use of medical narcotics. The selected variables for this study included the types of prescribed medical narcotic appetite suppressants, gender, age, region, and the category of medical institution. Regional prescription trends were compared by utilizing the defined daily doses for statistical purposes (S-DDD). The prescription of medical narcotic appetite suppressants was predominantly for females (94%), with the highest prescription rates identified in the 30-40 age group. The majority of these prescriptions were dispensed by clinics. Within the category of narcotic appetite suppressants, phentermine and phendimetrazine were found to have higher prescription rates. Notably, the region of Daegu recorded the highest S-DDD value (12.66) in phentermine consumption. Our findings underscore the need for governmental policy and guidance to address the risks linked to the long-term use of medical narcotic appetite suppressants. This is crucial to ensure their safe and efficacious prescription and administration.

Chronic amoxicillin shortage led to alternative broad-spectrum antimicrobial use in pediatric clinics

This study aimed to clarify changes in antimicrobial prescribing trends in pediatric clinics before and after the chronic shortage of amoxicillin and amoxicillin-clavulanic acid from 2023 in Japan. Amoxicillin and amoxicillin-clavulanic acid have been in chronic short supply since May 24, 2023 due to increased demand. It is unclear whether this situation has changed the type of oral antimicrobials prescribed by clinics. A retrospective observational study was conducted to analyze antimicrobial prescriptions in pediatric clinics between January and December 2023. The data was collected using information available on a new platform, the Online Monitoring System for Antimicrobial Stewardship at Clinics (OASCIS). The period from March to May was defined as the pre-shortage period, and the period from June to August was defined as the post-shortage period. Antimicrobials were classified using the AWaRe classification proposed by the World Health Organization. The average prescription rate per AWaRe classification in the three months before and after the shortage was compared. A total of 28,888 oral antimicrobial prescriptions were collected. Due to the chronic shortage, the proportion of Access antimicrobials decreased from 53.9 % in the pre-shortage period to 46.8 % in the post-shortage period (p < 0.001). The proportion of Watch antimicrobials increased from 45.9 % to 52.8 % (p < 0.001). Among the Watch antimicrobials, prescriptions for third-generation cephalosporins increased from 18.8 % to 24.7 % (p < 0.001). The chronic shortage of amoxicillin and amoxicillin-clavulanic acid has led to the use of broad-spectrum antimicrobial agents for patients in pediatric clinics.

Five-year trend in secondary prevention medication prescription and risk factor control among patients with diabetes mellitus and cardiovascular diseases in Perak health clinics.

Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events, particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics. Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control. Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of ≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities. SPM prescription has increased over time, but the achievement of treatment targets, particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases.

Brief communication: temporal trends of chronic diseases medications prescriptions among HIV-infected patients in Belgium: a 4-year population-based study using pharmacy claims data

The Objective of this study was to examine change over time of prevalence of chronic diseases medications (CDM) prescriptions among People living with HIV (PLWH) in Belgium, using Pharmanet database from 2018 to 2021. We identified 13,570, 14,175, 14,588 and 14,813 PLWH in 2018, 2019, 2020 and 2021, respectively. Prescriptions of cardiovascular diseases (CVD) medications (31.7–37.2%) and antidiabetics (7.4–9.0%), increased significantly (p for trend < 0.001 for all), while the prescription of neurological and mental disorders medications (18.0–19.3%) remained stable (p for trend = 0.11) and the prescription of chronic respiratory diseases (CRD) medications decreased from 12.2 to 10.6% (p for trend < 0.001), between 2018 and 2021. It is imperative to ensure that these medications are used appropriately.

Surgery and pain relief: A closer look at opioid prescription trends

BackgroundPublished guidelines to reduce the use and misuse of opioids in pediatrics are limited. After the implementation of an opioid stewardship program, we aimed to investigate the prescribing patterns in pediatric surgery. MethodsA retrospective chart review of pediatric patients who underwent general pediatric surgery procedures at a single institution between July 2021 and July 2023 was conducted. Demographics, procedure details, and opioid prescriptions at discharge were collected. The Texas Prescription Monitoring Program was cross-referenced for prescription-filled data. Descriptive statistics were performed. ResultsOf the 4,323 patients included, 9% (391) received an opioid prescription at the time of discharge. Among these, 82% were for burns, 7% for trauma, and 4% for pectus excavatum. Appendectomy, inguinal hernia repair, umbilical hernia repair, and circumcision did not receive any opioid prescriptions. In those who received a prescription, the median age was 4.2 years (interquartile range (IQR) 1.6, 10.4), with 58.6% being male. A total of 82.6% of patients also received prescriptions for nonopioid analgesics. The median number of prescribed doses was 13 (IQR 7, 15) for burns, 12 (IQR 9, 15) for trauma, and 12 (IQR 10, 12) for pectus excavatum. In total, 87% of prescriptions were filled. ConclusionA small proportion of pediatric patients who underwent general surgery received opioid prescriptions at the time of discharge and were limited to a few conditions. Common pediatric operations received no opioid prescriptions in the 2-year study period. A total of 13% of the written prescriptions were unfilled. Future studies are needed to optimize the target pediatric patient population for opioid prescribing.

Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.