Unnecessary Antibiotic Prescribing Research Articles

Antibiotic use in pediatric dental infections: knowledge and awareness levels of dentists

Antibiotics are crucial in treating infections; however, their unnecessary and incorrect use can lead to numerous health issues, notably antibiotic resistance. Evaluating the accuracy and awareness of antibiotic prescription practices among dentists, who play a significant role in antibiotic use, is critical in developing effective health policies and professional training programs. This study assesses dentists’ knowledge levels and practice habits regarding antibiotic use. Using a structured questionnaire, the research employed a cross-sectional design and was conducted with 202 general dentists, 98 pediatric dentists, and 43 oral and maxillofacial surgeons. Data were analyzed using demographic characteristics, antibiotic prescription practices, and scenario-based questions measuring knowledge levels. The results revealed that while most participants were generally knowledgeable about antibiotic use, inconsistencies in prescription practices were evident. Notably, unnecessary antibiotic prescriptions were identified in some cases, contributing to significant health issues such as antibiotic resistance. This study emphasizes the necessity of promoting conscious antibiotic use by evaluating dentists’ practices. Therefore, the urgent need for developing professional training programs and strengthening strategies to combat antibiotic resistance is paramount.

Epidemiological and clinical features of a large blastomycosis outbreak at a paper mill in Michigan.

Blastomycosis is an environmentally acquired fungal infection that can result in severe pulmonary illness and high hospitalization rates. In 2023, a blastomycosis outbreak was detected among workers at a paper mill in Delta County, Michigan. We included patients with clinical and laboratory evidence of blastomycosis who had spent ≥40 hours in Delta County since September 1, 2022 and had illness onset December 1, 2022-July 1, 2023. We assessed epidemiological and clinical features of patients and evaluated factors associated with hospitalization. We performed whole-genome sequencing to characterize genetic relatedness of clinical isolates from eight patients. In total, 131 patients were identified; all had worked at or visited the mill. Sixteen patients (12%) were hospitalized; one died. Compared with non-hospitalized patients, more hospitalized patients had diabetes (p=0.03) and urine antigen titers above the lower limit of quantification (p<0.001). Hospitalized patients were also more likely to have had ≥1 healthcare visits before receiving a blastomycosis diagnostic test (p=0.02) and to have been treated with antibiotics prior to antifungal prescription (p=0.001). All sequenced isolates were identified as Blastomyces gilchristii and clustered into a distinct outbreak cluster. This was the largest documented blastomycosis outbreak in the United States. Epidemiologic evidence indicated exposures occurred at or near the mill, and genomic findings suggested a common exposure source. Patients with diabetes may have increased risk for hospitalization, and elevated urine antigen titers could indicate greater disease severity. Early suspicion of blastomycosis may prompt earlier diagnosis and treatment, potentially reducing unnecessary antibiotic prescriptions and improving patient outcomes.

Carrier rates of group A streptococci in Australian wet tropics and their impact on the clinical usefulness of throat swabs.

Rapid point-of-care tests (POCT) are likely to assist with the detection of group A streptococci (GAS), but their usefulness is determined by the presence of carriers of GAS. This is insufficiently explored in the wet tropics. This study included 77 patients attendingprimary care in the wet tropics complaining of a sore throat, and 49healthy controls. Carrier rates of GAS and the positive and negative etiological predictive values (P-EPV and N-EPV, respectively) of a POCT were calculated. The carrier rates were 8.3% among healthy children and 2.7% for adults. TheP-EPV for children was 71% (95%confidence interval [CI]: 0.0-100%) and for adults it was 85% (95% CI: 0.0-100%). The corresponding N-EPV was99% (95% CI: 95-100%) for children and99% (95% CI: 98-100%) for adults. N-EPV, ruling out GAS, was sufficiently high with narrow CIs to allow for defining a stopping rule to avoid unnecessary antibiotic prescribing.

Carrier rates of group A streptococci in Australian wet tropics and their impact on the clinical usefulness of throat swabs.

Rapid point-of-care tests (POCT) are likely to assist with the detection of group A streptococci (GAS), but their usefulness is determined by the presence of carriers of GAS. This is insufficiently explored in the wet tropics. This study included 77 patients attendingprimary care in the wet tropics complaining of a sore throat, and 49healthy controls. Carrier rates of GAS and the positive and negative etiological predictive values (P-EPV and N-EPV, respectively) of a POCT were calculated. The carrier rates were 8.3% among healthy children and 2.7% for adults. TheP-EPV for children was 71% (95%confidence interval [CI]: 0.0-100%) and for adults it was 85% (95% CI: 0.0-100%). The corresponding N-EPV was99% (95% CI: 95-100%) for children and99% (95% CI: 98-100%) for adults. N-EPV, ruling out GAS, was sufficiently high with narrow CIs to allow for defining a stopping rule to avoid unnecessary antibiotic prescribing.

Appropriateness of antibiotic prescribing among patients treated for dental diseases in Mekelle city, Northern Ethiopia: a cross sectional study

BackgroundLocal operative treatments are generally preferred for most dental diseases, with antibiotics only recommended as an adjunct in specific cases. Misuse and overuse of antibiotics has been shown to significantly contribute to the development of resistant bacteria. However, the antibiotic prescribing practices of dentists in Ethiopia have not been thoroughly studied. This study aimed to assess the appropriateness of antibiotic prescribing for patients with dental diseases at dental clinics in Mekelle City, Northern Ethiopia.MethodsA cross sectional study was conducted in April and May 2020 among patients visiting dental clinics in Mekelle City. Data were collected through patient medical record reviews and dentist interviews. The appropriateness of antibiotic prescription was evaluated based on guidelines from the American Dental Association and the European Society of Endodontology. Data were analyzed using SPSS Statistics, version 29. Binary logistic regression analysis was performed, and the results were presented as odds ratios with 95% confidence intervals. A p value less than 0.05 was considered statistically significant.ResultsTwo hundred and thirty-one patients with dental diseases participated in the study. The mean age was 30.6 years with a standard deviation of 16.1. Most participants had dental pulp related disease. 89% of patients were prescribed antibiotics, with amoxicillin being the most common. Inappropriate antibiotic prescribing was identified in 175 (75.8%) of the study participants. The most common inappropriate prescribing was unnecessary antibiotic prescribing for dental conditions without systemic signs, assessed in 141 (80.1%) participants. Patients diagnosed with pulp related disease without systemic signs and those who had tooth extractions were significantly associated with inappropriate antibiotic prescription (p value < 0.001).ConclusionsThe study findings show that antibiotics are over-prescribed for dental conditions in this resource constrained setting, especially in patients who have had tooth extractions. Dentists need training on appropriate antibiotic use and antimicrobial stewardship interventions should be implemented in dental setting to reduce unnecessary antibiotic prescriptions and prevent antibiotic resistance development.

Can patient education initiatives in primary care increase patient knowledge of appropriate antibiotic use and decrease expectations for unnecessary antibiotic prescriptions?

Healthcare globally is increasingly threatened by antibiotic resistance. Misunderstanding of the appropriate use of antibiotics is common within the general population, therefore patient education could be a useful tool to employ against antibiotic resistance. Patient satisfaction with healthcare is important, and antibiotic awareness is crucial to avoid disappointment when antibiotic stewardship is practiced. This review aims to identify whether patient education is an effective tool to improve knowledge and awareness of the appropriate use of antibiotics and whether it has an effect on expectations of or prescription rates of antibiotics. Embase, Medline, Web of Science, PubMed, and Cochrane Library were searched to identify studies examining the impact of various forms of patient education on awareness of appropriate antibiotic use and antibiotic prescription rates. Reference lists of eligible studies were also screened. Three hundred and fourteen unique studies were identified, of which 18 were eligible for inclusion. All studies were of good quality. Three studies examined public health campaigns, five examined leaflets, two examined posters, three examined videos, four used mixed interventions and one study examined a presentation. The results were too heterogenous to perform a meta-analysis. Patient education is an effective tool to increase public knowledge and awareness of the appropriate use of antibiotics, and can reduce the expectation of or prescription rates of antibiotics. The form of patient education matters, as interventions involving active learning and engagement demonstrate significant positive outcomes, whereas passive forms of learning do not appear to have any effect on understanding or prescriptions.

A step forward in the diagnosis of urinary tract infections: from machine learning to clinical practice

ObjectivesUrinary tract infections (UTIs) are common infections within the Emergency Department (ED), causing increased laboratory workloads and unnecessary antibiotics prescriptions. The aim of this study was to improve UTI diagnostics in clinical practice by application of machine learning (ML) models for real-time UTI prediction. MethodsIn a retrospective study, patient information and outcomes from Emergency Department patients, with positive and negative culture results, were used to design models – ‘Random Forest’ and ‘Neural Network’ – for the prediction of UTIs. The performance of these predictive models was validated in a cross-sectional study. In a quasi-experimental study, the impact of UTI risk assessment was investigated by evaluating changes in the behaviour of clinicians, measuring changes in antibiotic prescriptions and urine culture requests. ResultsFirst, we trained and tested two different predictive models with 8692 cases. Second, we investigated the performance of the predictive models in clinical practice with 962 cases (Area under the curve was between 0.81 to 0.88). The best performance was the combination of both models. Finally, the assessment of the risk for UTIs was implemented into clinical practice and allowed for the reduction of unnecessary urine cultures and antibiotic prescriptions for patients with a low risk of UTI, as well as targeted diagnostics and treatment for patients with a high risk of UTI. ConclusionThe combination of modern urinalysis diagnostic technologies with digital health solutions can help to further improve UTI diagnostics with positive impact on laboratory workloads and antimicrobial stewardship.

De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial

BackgroundAntibiotics are globally overprescribed for the treatment of upper respiratory tract infections (URTI), especially in persons living with HIV. However, most URTIs are caused by viruses, and antibiotics are not indicated. De-implementation is perceived as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excessive or inappropriate antibiotic use for URTI, through the employment of evidence-based interventions to reduce these practices. Research into strategies that lead to successful de-implementation of unnecessary antibiotic prescriptions within the primary health care setting is limited in Mozambique. In this study, we propose a protocol designed to evaluate the use of a clinical decision support algorithm (CDSA) for promoting the de-implementation of unnecessary antibiotic prescriptions for URTI among ambulatory HIV-infected adult patients in primary healthcare settings.MethodsThis study is a multicenter, two-arm, cluster randomized controlled trial, involving six primary health care facilities in Maputo and Matola municipalities in Mozambique, guided by an innovative implementation science framework, the Dynamic Adaption Process. In total, 380 HIV-infected patients with URTI symptoms will be enrolled, with 190 patients assigned to both the intervention and control arms. For intervention sites, the CDSAs will be posted on either the exam room wall or on the clinician´s exam room desk for ease of reference during clinical visits. Our sample size is powered to detect a reduction in antibiotic use by 15%. We will evaluate the effectiveness and implementation outcomes and examine the effect of multi-level (sites and patients) factors in promoting the de-implementation of unnecessary antibiotic prescriptions. The effectiveness and implementation of our antibiotic de-implementation strategy are the primary outcomes, whereas the clinical endpoints are the secondary outcomes.DiscussionThis research will provide evidence on the effectiveness of the use of the CDSA in promoting the de-implementation of unnecessary antibiotic prescribing in treating acute URTI, among ambulatory HIV-infected patients. Findings will bring evidence for the need to scale up strategies for the de-implementation of unnecessary antibiotic prescription practices in additional healthcare sites within the country.Trial registrationISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350

Testing Different Message Styles about Unnecessary Antibiotics Using an Online Platform.

Patients' expectations are a major contributor to the unnecessary prescribing of antibiotics, yet limited research has examined how physicians can calibrate these expectations. The studies we conducted tested how varying messages could impact patients' expectations for antibiotics and their experience of medical appointments. All the participants read a short scenario about an appointment for mild sinusitis symptoms, with the patient's expectation of antibiotics. In Study 1, the participants (n = 1069) were randomly assigned to read a positively framed, neutral, or negatively framed message regarding unnecessary antibiotics. In Study 2, the participants (n = 1073) read a message emphasizing either the societal or personal harms of unnecessary antibiotics, or a message without additional rationale. None of our pre-registered hypotheses were supported, but our exploratory analyses indicated that the societal message increased concern about antibiotic resistance. The participants who were more concerned about resistance were less likely to ask for antibiotics, more satisfied when the physician did not prescribe them, and more likely to recommend the physician to a friend. Discussing the consequences of the different courses of action did not appear to negatively impact physician-patient rapport. These studies demonstrate an inexpensive method with which to pre-test various messages about antibiotic consumption, and suggest that such messages are not negatively received by patients.

Antibiotic Management for Early-Onset Sepsis in Neonates With Gestational Ages of ≥ 34 Weeks: The Kaiser Sepsis Calculator Versus the 2010 CDC Guidelines.

The traditional approach to neonatal early-onset sepsis (NEOS) management, involving maternal risk factors and nonspecific neonatal symptoms, usually leads to unnecessary antibiotic use. This study addresses these concerns by evaluating the Kaiser sepsis calculator (KSC) in guiding antibiotic therapy for NEOS, especially in high-incidence facilities (over 4/1,000 live births), by comparing it against the 2010 Centers for Disease Control and Prevention (CDC) guidelines for neonates ≥34 weeks with suspected sepsis, thereby emphasizing its implications for personalized patient care. This is a prospective observational study. All neonates of 34 gestational weeks or more, presenting with either maternal risk factors or sepsis symptoms within 12 hours of birth, were included in the study. The analysis focused on antibiotic recommendations by the 2010 CDC guidelines versus those by the KSC at presumed (0.5/1,000) and actual (16/1,000) sepsis incidence rates. NEOS was identified in 14 cases (14.1%). Compared to the KSC, at an incidence rate of 16 per 1,000, the KSCresulted in a significant 32.3% reduction in antibiotic treatment (74 cases (74.7%) vs. 42 cases (42.4%), respectively; p < 0.001). The calculator advised immediate antibiotic utilization for 13 out of 14 (92.9%) diagnosed cases, suggesting further evaluation for the remaining cases. When a presumed incidence of 0.5/1,000 was applied, the KSC indicated antibiotics less frequently than when using the actual rate of 16/1,000 (p<0.001) with two missed NEOS cases. Using the KSC led to a decrease of 32 cases (32.3%)in unnecessary antibiotic prescriptions compared to adherence to 2010 CDC guidelines. However, setting a presumed incidence below the actual rate risked missing NEOS. The calculator was effective when actual local incidence rates were used, ensuring no missed cases needing antibiotics.

Greenhouse Gas Emissions Due to Unnecessary Antibiotic Prescriptions for Respiratory Diagnoses

Background: Healthcare accounts for 8.5% of total US greenhouse gas emissions (GHGE), with US healthcare the main contributor. Yet little effort has been made to measure healthcare related GHGE. Specifically, GHGE related to unnecessary antibiotic prescriptions is unclear, and to our knowledge, no one has used estimates of GHGE of unnecessary antibiotics as an antibiotic stewardship tool. We aimed to measure GHGE from solid waste associated with unnecessary antibiotic prescriptions for respiratory conditions. Methods: We calculated emissions for an outpatient prescription including the plastic bottle, paper leaflet, and paper bag (photos) based on the weight of each item multiplied by US Environmental Protection Agency (EPA) GHGE factors. Emission factors depend on waste type and treatment method which we assumed to be landfilled. To estimate unnecessary antibiotic prescriptions for respiratory infections, visits from nine University of Utah Health Urgent Care Centers from 2019-2022 were electronically identified and included if they had an ICD-10-CM code for a respiratory diagnosis where antibiotics are not indicated. Waste emissions of the paper and plastic in an individual prescription were then multiplied by the number of unnecessary respiratory antibiotic prescriptions for designated time periods to arrive at total landfilled waste emissions. We used similar methods applied to published 2014 data from CDC to estimate national waste emissions due to unnecessary antibiotic prescriptions for respiratory infections. Finally, we used the EPA’s GHG Equivalencies Calculator to convert emissions into tangible GHGE for providers and patients. Results: A prescription has 32g of paper and 15g of plastic waste. Among 124,461 urgent care visits (Table 1) in 2019-2022, 18,531 (14.9%) received an antibiotic. This equates to 593 kg of paper waste and 278 kg of plastic waste leading to a total landfilled waste emissions of 0.479 MT CO2e/ton. Using the EPA GHG Equivalencies Calculator, this equates to driving an average gasoline-powered car 1,228 miles. There were 14,482,976 unnecessary antibiotic prescriptions (Table 2) in the US for respiratory infections in 2014. Our estimates suggest these prescriptions led to 375.109 CO2e/ton of GHGE, the same as driving 961,610 miles by an average gasoline-powered vehicle. Conclusion: Unnecessary antibiotic prescriptions are associated with substantial GHGE. This estimate demands further evaluation across diagnoses and care delivery sites, and most importantly action. Additionally, the large GHG contribution of unnecessary antibiotics should be used as a stewardship tool to highlight low-value care that is likely contributing to global climate change.

Implementation of Outpatient Automated Stewardship Information System (OASIS©) Audit and Feedback in Two Healthcare Systems

Background: Combating antibiotic resistance, exacerbated by widespread unnecessary outpatient antibiotic prescriptions, necessitates innovative stewardship solutions. Audit and feedback reports are effective but often resource heavy. We introduced a free, open-source system, Outpatient Automated Stewardship Information System (OASIS©), for automating the creation and distribution of recurring audit and feedback reports to clinicians to improve antibiotic prescribing. Methods: We used mixed methods to evaluate implementation of OASIS© across 11 clinics at Denver Health and Hospital Authority (DHHA) and Children’s Hospital Colorado (CHCO) from July 2022 to August 2023. Both sites host their own Epic® electronic healthcare and enterprise data warehouse systems. R statistical software was utilized to retrieve and process the data needed to create individual[HCM1] clinician audit and feedback reports with peer comparison. Reports were provided for 1) antibiotics prescribed for respiratory diagnoses, 2) antibiotics prescribed for respiratory diagnoses where antibiotics are never indicated, 3) first-line antibiotic prescribing for acute otitis media (AOM), and 4) five-day duration of antibiotics for children two years and older with AOM. Feedback reports for each metric were emailed to clinicians for three consecutive months. The primary outcome was adaptations needed to implement OASIS©. Secondary outcomes included fidelity (measured by email readership), time to set up and maintain the program, and barriers and facilitators to implementation (assessed by four qualitative interviews with OASIS© stakeholders). Results: The most significant adaptations made pertained to the automation of OASIS© reports for organizations not using R for data retrieval and reporting, setting up OASIS© specific email addresses, and validating clinician fidelity via read receipts. Fidelity was higher at DHHA (91-100%) compared to CHCO (10-30%). When interviewed, data analysts expressed that time for initial setup ranged from 1-6 hours. After reporting was automated, the estimated monthly time to send reports was 10 minutes. Views on setup complexity were split, but all recognized the readability of the reports and OASIS©’s value for improving prescribing behaviors. The greatest barriers to implementation included obtaining analytic resources for initial setup and the need to download additional R packages. No interviewee had prior experience creating audit and feedback reports. Conclusions: Implementing OASIS© requires addressing system diversity and knowledge gaps in outpatient informatics and antibiotic stewardship. Despite these challenges, the tool proved efficient and beneficial for monitoring and reporting antimicrobial prescribing. This free tool could likely be effectively disseminated to other health systems given the limited time and resources required for adaptations, setup, and monitoring. [HCM1]I

Appropriateness of Antibiotic Prescriptions in Emergency Departments in the United States, 2016-2021

Background: Inappropriate antibiotic prescribing contributes to antimicrobial resistance, a global health threat. Prior studies have used ICD-9-CM codes to estimate inappropriate prescribing rates in ambulatory settings, including emergency departments (EDs), though the last national estimates date back to 2010-2015 (Hersh et al, CID 2021). Using the most recent publicly available data, we estimated inappropriate antibiotic prescribing rates in EDs across all conditions. For further characterization, we estimated rates of inappropriate antibiotic prescribing with and without codes that could be plausible indications for which antibiotics are prescribed. Methods: We analyzed 2016-2021 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of EDs, subsetting to visits with ≥1 oral antibiotic prescription. Using ICD-10-CM codes (Chua et al, BMJ 2019), we calculated proportions of visits with inappropriate antibiotic prescribing; inappropriate antibiotic prescribing and ≥1 plausible antibiotic-inappropriate indication (e.g., viral infection); and inappropriate prescribing without plausible antibiotic-inappropriate indications. Among visits with plausible antibiotic-inappropriate indications, we subcategorized these further (e.g. viral infection, ophthalmologic conditions). Among visits without plausible antibiotic-inappropriate indications, we determined the most common diagnosis codes. We conducted analyses overall and separately among children (0-17 years), adults (18-64 years), and older adults (≥65 years). Results: Demographic characteristics by age group are shown in Table 1. Antibiotic prescription rates overall and for children, adults, and older adults were 18.6%, 17.8%, 19.1%, and 18.0%, respectively. Inappropriate prescription rates were 27.6%, 23.7%, 29.8%, and 24.6%, respectively. Inappropriate antibiotic prescription rates with plausible indications were 14.9%, 16.7%, 15.0%, and 12.6%, while inappropriate antibiotic prescription rates without plausible indications were 12.7%, 7.0%, 14.9%, and 12.0%, respectively (Figure 1). Rates of subcategories of inappropriate prescribing with plausible antibiotic indications overall and by age group are shown in Figure 2, with the most common diagnoses for potential signs and symptoms of infection in Table 2. The most common diagnoses for inappropriate prescribing without plausible indications are in Table 3. Conclusions: Inappropriate antibiotic prescriptions in EDs are common with a substantial proportion without plausible conditions. Most inappropriate prescriptions with plausible antibiotic-inappropriate indications are associated with potential signs and symptoms of infection without a more definitive diagnosis code, suggesting either diagnostic uncertainty or poor coding quality. Future work should distinguish between these two possibilities to determine whether stewardship efforts should focus on educational strategies to avoid unnecessary empiric antibiotic prescribing in the setting of diagnostic uncertainty, improving coding quality, or both.

Mailed feedback to primary care physicians on antibiotic prescribing for patients aged 65 years and older: pragmatic, factorial randomised controlled trial

ObjectivesTo evaluate whether providing family physicians with feedback on their antibiotic prescribing compared with that of their peers reduces antibiotic prescriptions. To also identify effects on antibiotic prescribing from case-mix...

Bacteriuria and phenotypic antimicrobial susceptibility testing in 45 min by point-of-care Sysmex PA-100 System: first clinical evaluation

PurposeThis study compared the results of the new Sysmex PA-100 AST System, a point-of-care analyser, with routine microbiology for the detection of urinary tract infections (UTI) and performance of antimicrobial susceptibility tests (AST) directly from urine.MethodsNative urine samples from 278 female patients with suspected uncomplicated UTI were tested in the Sysmex PA-100 and with reference methods of routine microbiology: urine culture for bacteriuria and disc diffusion for AST.ResultsThe analyser delivered bacteriuria results in 15 min and AST results within 45 min. Sensitivity and specificity for detection of microbiologically confirmed bacteriuria were 84.0% (89/106; 95% CI: 75.6–90.4%) and 99.4% (155/156; 95% CI: 96.5–100%), respectively, for bacterial species within the analyser specifications. These are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus, which are common species causing uncomplicated UTI. Overall categorical agreement (OCA) for AST results for the five antimicrobials tested in the Sysmex PA-100 (amoxicillin/clavulanic acid, ciprofloxacin, fosfomycin, nitrofurantoin and trimethoprim) ranged from 85.4% (70/82; 95%CI: 75.9–92.2%) for ciprofloxacin to 96.4% (81/84; 95% CI: 89.9–99.3%) for trimethoprim. The Sysmex PA-100 provided an optimal treatment recommendation in 218/278 cases (78.4%), against 162/278 (58.3%) of clinical decisions.ConclusionThis first clinical evaluation of the Sysmex PA-100 in a near-patient setting demonstrated that the analyser delivers phenotypic AST results within 45 min, which could enable rapid initiation of the correct targeted treatment with no further adjustment needed. The Sysmex PA-100 has the potential to significantly reduce ineffective or unnecessary antibiotic prescription in patients with UTI symptoms.

A situational analysis of antibiotic prescription, dispensing practices and resistance pattern in Nepal: Are we losing the battle?

Background: Antibiotics are widely utilized to treat infections and provide preventative and therapeutic benefits in animal and human healthcare. However, because of the emergence and spread of resistance mechanisms, which cause bacteria to become less susceptible to antibiotics and other treatments and less effective, antimicrobial resistance (AMR) has grown to be one of the most significant worldwide public health concerns. Low- and middle-income countries (LMICs) such as Nepal have a high rate of infectious illnesses and antibiotic resistance, which can lead to both human and financial losses. Methods: The information for the scenario analysis was acquired through a review of published and grey literature, as well as interviews with important stakeholders from all sectors. Conclusion: Besides knowing all the challenges of antibiotic resistance, the programs assuring towards AMR is conducted in Nepal in very infrequent way. The antibiotic use should be optimize by giving various personalized treatment approaches and accurate diagnosis which plays vital roles in minimizing unnecessary antibiotic prescriptions. We can organize different awareness programs to reduce antibiotic resistance that may enhance the proper use of antibiotic with proper dose and prescription in accordance health care professionals. Interpreting all the problems, government should give more priority to antibiotic resistance and should be able to minimize the problems. If antibiotic resistance is not taken in a very serious way by all the healthcare workers like doctors, nurses, pharmacists, lab technicians, etc. then the battle we are fighting leads to be defeated and problem will never end.

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices-5-Year National Study.

Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period. This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient's and prescriber's characteristics. The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications. The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary.

Epidemiological Characterization of Respiratory Pathogens Using the Multiplex PCR FilmArray™ Respiratory Panel.

Various pathogens can cause upper respiratory tract infections, presenting challenges in accurate diagnosis due to similar symptomatology. Therefore, rapid and precise diagnostic tests are crucial for effective treatment planning. Traditional culture-based methods for diagnosis are limited by their reliance on skilled personnel and lengthy processing times. In contrast, multiplex polymerase chain reaction (PCR) techniques offer enhanced accuracy and speed in identifying respiratory pathogens. In this study, we aimed to assess the efficacy of the FilmArray™ Respiratory Panel (RP), a multiplex PCR test capable of simultaneously screening 20 pathogens. This retrospective analysis was conducted at Dankook University Hospital, South Korea, between January 2018 and December 2022. Samples from patients with upper respiratory tract infections were analyzed. Results revealed adenovirus as the most prevalent pathogen (18.9%), followed by influenza virus A (16.5%), among others. Notably, a 22.5% co-infection rate was observed. The FilmArray™ RP method successfully identified 20 pathogens within 2 h, facilitating prompt treatment decisions and mitigating unnecessary antibiotic prescriptions. This study underscores the utility of multiplex PCR in respiratory pathogen identification, offering valuable insights for epidemiological surveillance and diagnosis.

Overview of Community Knowledge about The Use of Antibotic in Blungkan Hamlet, Sendangrejo Village, Lamongan Sub-district, Lamongan District

Antibiotics are medications that combat bacterial illnesses. There are several negative health outcomes associated with the current epidemic of antibiotic resistance, including higher rates of illness and death, higher healthcare expenditures, and treatment failures. In 2015, there were an increase of 50 million unnecessary antibiotic prescriptions (Unnescecery prescribing) from 150 million, and this number continues to increase every year. Thus, the number of bacteria that are resistant to antibiotics is increasing. This study aims to determine the extent of public awareness on the utilization of antibiotics in Dusun Blungkan, Sendangrejo village, Lamongan district. The design of this research is descriptive research and data collection using questionnaires with Cronbach's alpha value of 0.83 (&gt;0.60) then the questionnaire is declared reliable that covers 7 domains of knowledge namely understanding antibiotics, antibiotic examples, antibiotics use, dosage, contraindications, side effects, and antibiotic resistance. The results showed that in Dusun Blungkan, Sendangrejo Village, Lamongan District, and Lamongan Province there are 21 (70%) people who are aware of the use of antibiotics. Out of 30 respondents, 21 people (70%) have sufficient knowledge, 7 people (23.3%) have less knowledge, and 2 people (6.7%) have good knowledge. Controlled use of antibiotics can prevent resistance. Therefore, accurate information about the importance of antibiotics and how to use antibiotics properly and correctly is needed, as well as more wisdom in using them to avoid unexpected side effects.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019.

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts. Cross-sectional analysis of 2019 Veterans' Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing. In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition. More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.