Use Of Antimicrobial Medicines Research Articles

Considerations for vaccination and immunity management

Antibiotic resistance is a global challenge and the need to optimise the use of antimicrobial medicines in animal health is recognised by all. Disease prevention through the use of vaccines that prime the pig's own immune system to cope better when exposed to pathogens later in life is the favoured approach. However the fast pace at which vaccine development has evolved and the huge number of products now available can be disconcerting when designing a vaccine schedule. Along with the clinical considerations of health status and disease dynamics, there are other more practical factors to take into account. Vaccination programmes must be designed specifically for each unit as there is no standard programme that can be followed.

Antimicrobial resistance in animal agriculture: understanding user attitudes and behaviours

Antimicrobial resistance (AMR) is the quintessential planetary One Health challenge, with the problem of injudicious use of antimicrobial medicines in both clinical and veterinary practice attracting increasing regulatory scrutiny.1 As...

Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (\u226412\xa0years) in Kampala city, Uganda

BackgroundMedicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city.MethodsThis was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection.ResultsThe prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68).ConclusionChildren are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.

A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa

The Global Action Plan on antimicrobial resistance calls for the use of antimicrobial medicines in human and animal health to be optimized, in tandem with a strengthening of the knowledge and evidence base through surveillance and research. However, there is a paucity of consumption data for African countries such as South Africa. Determining antimicrobial consumption data in low-resource settings remains a challenge. This article describes alternative mechanisms of assessing antimicrobial consumption data, such as the use of Intercontinental Marketing Services (IMS) data and contract data arising from tenders (an open Request for Proposal, RFP), as opposed to the international norms of daily defined doses per 100 patient-days or per 1000 population. Despite their limitations, these serve as indicators of antimicrobial exposure at the population level and represent an alternative method for ascertaining antimicrobial consumption in human health. Furthermore, South Africa has the largest antiretroviral treatment programme globally and carries a high burden of tuberculosis. This prompted the inclusion of antiretroviral and anti-tuberculosis antibiotic consumption data. Knowledge of antimicrobial utilization is imperative for meaningful future interventions. Baseline antimicrobial utilization data could guide future research initiatives that could provide a better understanding of the different measures of antibiotic use and the level of antibiotic resistance.

A Review on Antibiotic Resistance: Alarm Bells are Ringing.

Antibiotics are the ‘wonder drugs’ to combat microbes. For decades, multiple varieties of antibiotics have not only been used for therapeutic purposes but practiced prophylactically across other industries such as agriculture and animal husbandry. Uncertainty has arisen, as microbes have become resistant to common antibiotics while the host remains unaware that antibiotic resistance has emerged. The aim of this review is to explore the origin, development, and the current state of antibiotic resistance, regulation, and challenges by examining available literature. We found that antibiotic resistance is increasing at an alarming rate. A growing list of infections i.e., pneumonia, tuberculosis, and gonorrhea are becoming harder and at times impossible to treat while antibiotics are becoming less effective. Antibiotic-resistant infections correlate with the level of antibiotic consumption. Non-judicial use of antibiotics is mostly responsible for making the microbes resistant. The antibiotic treatment repertoire for existing or emerging hard-to-treat multidrug-resistant bacterial infections is limited, resulting in high morbidity and mortality report. This review article reiterates the optimal use of antimicrobial medicines in human and animal health to reduce antibiotic resistance. Evidence from the literature suggests that the knowledge regarding antibiotic resistance in the population is still scarce. Therefore, the need of educating patients and the public is essential to fight against the antimicrobial resistance battle.

Antimicrobial stewardship: changing the public's behaviour

In January, NICE introduced its second guideline on antimicrobial stewardship (NG63), this time focusing on increasing awareness and changing behaviour in the general public. The new guideline covers the correct use of antimicrobial medicines and the dangers associated with their overuse, as well as providing guidance on preventing and controlling infection.

The new Korean action plan for containment of antimicrobial resistance.

The Korean national action plan on antimicrobial resistance (AMR) was established on 11 August 2016 by the Korean Ministry of Health and Welfare. This article briefly describes the current status of AMR in Korea and introduces six objectives of the action plan, including the prudent use of antimicrobial medicines, prevention of the spread of AMR, strengthening surveillance programmes, awareness improvement, strengthening research and development, and enhancement of international collaboration. Integrated multisectoral principles are applied to fight AMR more effectively. This 5-year national AMR action plan will be the cornerstone of public health in Korea.

Drug Utilization Study on Acute Poisoning Cases Treated at a Tertiary Care Hospital in Western Part of India

Background: Acute poisoning is a common medical emergency. This study was designed to investigate the pattern of drug utilization, poisoning agents, and outcome in patients with acute poisoning treated at a tertiary care teaching hospital in Vadodara, west of India. Methods: This prospective cross sectional drug utilization study was carried out on patients with diagnosis of acute poisoning admitted to emergency department of Sir Shree Sayajirao General Hospital during October, 2013 to March, 2014. Results:During 6 months, 340 acute poisoning cases were enrolled, out of which 216 cases (63.5%) were men. Mean age of the patients was 31.9 ± 12.7 years. Commonest mode of poisoning was intentional (suicidal), which was observed in 62.1% of cases. Pesticides were the most common cause of poisoning (40%), followed by venomous animal exposures (25.9%). Fifty-six patients (16.5%) died. A significantly higher number of deaths was seen in intentional poisonings compared to accidental poisonings (24.2% vs. 3.9%; P < 0.001). The most common symptomatic treatments given to the patients were antiemetics (97.9%), H2 blockers (89.1%) and antimicrobials (75%s). Atropine (47.7%), pralidoxime (42.4%) and anti-snake venom (15%) were the most commonly prescribed specific antidotes. Median number of drugs per encounter was 8 [range: 1 to 23]. Over half of drugs were prescribed by generic and nearly one-thirds of drugs were prescribed by brand name. Conclusion: Use of antimicrobial medicines for poisoned patients was too high and irrational. Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. Educational programs with emphasis on preventive measures for toxic exposures are necessary to create awareness among the general public.

Surveillance and pharmacoeconomics of antimicrobial use among inpatients in a tertiary care, teaching hospital in New Delhi, India: Assessing need for policy formulation

Objective: Although extensive use of antimicrobial medicines (AMMs) has been reported in India, there are limited data on AMM use and expenditure incurred on the same among inpatients. This study was conducted to determine (i) the pattern of AMM prescribed, (ii) adherence of AMM used with the hospital essential medicine list (EML), and (iii) expenditure incurred on AMM. Materials and Methods: An observational, prospective study was conducted among inpatients in Medicine and Surgery Departments of a tertiary care teaching hospital in New Delhi, India, who were receiving AMM. AMM use characteristics (name, dose, dosage form, frequency, duration, route) and expenditure incurred and ABC analysis was done. Results: AMMs were prescribed to 60.1% of patients. Of these, the indication for prescribing AMM was therapeutic in 76.1% patients. On an average, 2.52 antimicrobials were prescribed per patient. The most common route of antimicrobial administration was parenteral (71.9%). Biological samples were sent for bacterial culture sensitivity testing only in 21.1% cases, of which 23.6% were positive. A total of 46 different antimicrobials were prescribed. The most commonly prescribed AMMs were ceftriaxone, metronidazole, ciprofloxacin, amoxicillin-clavulanic acid, and levofloxacin. The number of AMMs prescribed from EML was 1125 (74.4%). Expenditure on antimicrobials accounted for 52% of the total expenditure on medicines. ABC analysis revealed that the maximum expenditure (72%) was on medicines used in a small (9.82%) percentage of patients. The parenteral use of newer, more expensive antimicrobials, not included in the hospital EML, accounted for a large proportion of expenditure on antimicrobials. Conclusion: There is an urgent need to develop a hospital antimicrobial policy, guidelines for use, and generate awareness among physicians to improve and rationalize the economy of antimicrobial use in the hospital.

The World Health Assembly resolution on antimicrobial resistance.

Antimicrobial resistance is a global problem that can only be tackled successfully through strengthened international partnerships. A concerted political, scientific and media campaign has garnered support for the recent World Health Assembly resolution on antimicrobial resistance, mandating the WHO to develop a global action plan. This resolution has the 'One Health' approach at its core, emphasizing collaboration across human and animal health sectors at the international, national and regional levels, coupled with strong leadership and the political will to act. Key themes are communication, prevention of infection, using knowledge to guide action, sustainability and optimizing the use of antimicrobial medicines and diagnostic devices. Implementation of the global action plan will require member states to make a commitment to developing national action plans and strengthening capacity, building on collaborations between the WHO, the World Organisation for Animal Health, the World Bank, Codex Alimentarius and the Transatlantic Task Force on Antimicrobial Resistance.

Use of Antimicrobial Medicines among University Students in Sierra Leone

Aims: Misuse of antimicrobial medicines is a major contributory factor to development of resistant strains of micro-organisms, therapeutic failure and increased healthcare costs in many countries. To identify pattern of antimicrobial use among undergraduate students of the University of Sierra Leone and to determine possible gaps in their understanding of appropriate use of these therapeutic agents. Study Design: A cross-sectional survey of the students using a structured questionnaire and a stratified random sampling method to obtain the respective number of students from each college. Place and Duration of Study: Registered undergraduates in the three Colleges of the University of Sierra Leone, between March and June 2012. Methodology: A 25-item structured questionnaire was administered on a random sample of four hundred and eighteen (418) undergraduates of the University. The instrument explored respondents’ pattern of self-medication with antimicrobials, knowledge of the indications for use and sources of supply. Results: Most students reported having self-medicated with antimicrobials at various times and there were gaps in their understanding of the medicines; with about 67% having Research Article British Journal of Pharmaceutical Research, 4(1): 101-112, 2014 102 some knowledge of correct indications for use. Majority of them (70%) obtained the medicines on demand from open drug markets without prescriptions and the medicines were used for such ailments as common colds and diarrhea. Previous experiences of treating similar symptoms ranked highest as the factor affecting demand and penicillins topped the list of commonly used antimicrobials. Most of the students did not complete full regimen of the medication for reasons of cost, long duration of treatment and side effects. Conclusion: There were knowledge gaps in the proper use of antimicrobial medicines and unrestricted access to prescription drugs was a major factor of misuse. The existing drug laws in the country should be strengthened to control indiscriminate sale and distribution. Basic courses on rational medicine use may need to be incorporated in the general studies programme of the University; with emphasis on the consequences of indiscriminate use of antimicrobial medicines.