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Objective Microbial resistance due to antibiotic misuse is a worldwide problem. This study aimed to examine the trends in antibiotic prescription after tooth extraction in Korea. Methods From the database of National Health Insurance Sharing Service, patients who underwent tooth extraction from 2002 to 2018 were selected as subjects, and 10% of them were selected via stratified sampling based on sex and age. Overall, 15,838,529 cases were observed for annual antibiotic prescription and broad-spectrum antibiotic prescription patterns. Additionally, standardized annual antibiotic use was calculated using a defined daily dose. Results Prescriptions were issued in 13,429,770 (84.8%) of the tooth extraction cases, of which 12,179,185 (90.7%) included antibiotics. Logistic regression analysis revealed that the likelihood of prescribing antibiotics after tooth extraction decreased in 2003 compared to 2002 (odds ratio, 0.95) but increased from 2004 to 2018. In the case of the broad-spectrum antibiotic prescription rate, there was no clear trend between 2002 and 2012 (odds ratio, 0.89-1.07); however, over the last 5 years, the likelihood of broad-spectrum antibiotic prescription has steadily increased. The value of antibiotics based on the defined daily dose of 1000 patients per day was calculated to be 4.39 in 2002, exhibiting a steady increase later and reaching 6.97 in 2018, whereas that of broad-spectrum antibiotics was 1.68 in 2002 and has since been on the rise; the highest was 3.82 in 2018. Conclusions Antibiotic use after tooth extraction increased over the last 17 years; additionally, the rate of prescribing broad-spectrum antibiotics has increased over the last 5 years.

Background: Medicines play a crucial role in the healthcare delivery of a hospital. The appropriate use of medicines gives us assessment of the quality of health services being provided in a particular region. Aim: To evaluate the prescribing practices and antibiotic utilization patterns so that the extent of irrational use can be assessed by comparing them with published ideal values set by WHO. Study design: Retrospective, cross-sectional study. Place and duration of study: Teaching Hospital of Faisalabad: Independent University Hospital (IUH), from Jan 2018 to June/July 2018. Methodology: 200 cases were selected through systematic random sampling from medicine/surgery wards and pharmacy registers. The standard World Health Organization prescribing indicators and AWaRe categorization of antibiotics were used to assess the prescribing practices of physicians/surgeons. Published ideal standards for each of the indicators were compared with study findings to identify extent of irrational drug use. Results: Most of the facility indicators were met with. The Drug and Therapeutic Committee (DTC) was functional. The Standard treatment guideline booklets (STGs) and Essential Drugs List (EDL) of the hospital were available. 88% of the key drugs listed in EDL were available in stock. The expenditure on antibiotics compared to total medicines was 17%. Regarding prescribing indicators: the average number of drugs prescribed per encounter was 6 (optimal value 1.6–1.8). Average no of antibiotic per prescription amounted to almost 1 (0.925). % prescriptions with an antibiotic amounted to 72% (optimal value 20-26.8%).72% antibiotics were prescribed from the EDL formulary of the hospital (optimal value 100%). Conclusion: Regarding compliance with prescribing indicators and AWaRe categorization of antibiotics by WHO, significant deviation was observed. Education and training of physicians according to WHO parameters is required to ensure rational prescribing. Keywords: Prescription pattern, WHO Prescribing Indicators, AWaRe Categorization

 Objectives: The purpose of this survey is to investigate the knowledge, attitudes and practices related to antibiotic prescription patterns in a group of dentists in Egypt.  Materials and Methods: A cross-sectional survey was conducted electronically using online google forms. It included inquiries in the form of close-ended questions to be answered in tick-box format, the questions mainly uncovered, the participants’ “Knowledge” about the problem of antibiotic resistance and its association with professional mal practices, and also their “Attitudes and practices” concerning antibiotic prescriptions in different clinical conditions. 500 participants answered the questionnaire over a period of three months.  Results: Most of the participants prescribed Amoxicillin or Amoxicillin + clavulanic acid in conditions that warrant antibiotics usage. A comparable proportion preferred a treatment duration of 5-7 days. Although, 96% of the responses came in favor of antibiotic prescription in serious clinical conditions as facial cellulitis, still variable proportions of the sample chose to prescribe antibiotics for conditions that do not necessitate their usage as “localized intra-oral abscesses”, “sinus tracts and fistulas”, “luxation injuries” and “managing viral infections”.  Conclusions: Although the participants showed considerably adequate knowledge of the bacterial resistance problem, their practices showed varying degrees of deviation from the guidelines of antibiotic prescriptions set by the AAPD.

Background: Antibiotic resistance makes to the top ten threats to global health in 2019. It is important for dental faculty to make efforts to improve the quality of services provided; As a result the study of awareness of the dental faculty regarding antibiotic resistance and antibiotic stewardship program was undertaken. Objectives: Assessment of the knowledge, attitude and practices of the dental faculty towards Antibiotic stewardship program through a questionnaire study in Maharashtra. Methodology: The dental faculty in dental institutes located in Maharashtra will be the study participants. The questionnaire will be sent to all the faculty members as an online questionnaire survey. Expected Results: Evaluating the need of Implementation of antimicrobial stewardship program in institutions which will reduce the profuse use of unnecessary antibiotic prescription and improve the appropriateness of the antibiotic use by the dental health faculty working in a dental college without compromising the clinical patient outcome. Conclusion: The present study will assess the knowledge, attitude and practices of the dental faculty towards Antibiotic stewardship program.

Background: The emergence of bacterial resistance caused health authorities to attempt to implement strict regulations for rational antibiotic prescription. However, supervision is often neglected in low- and middle-income countries, leading to inappropriate administration of antibiotics. The objective of our study is to highlight the lack of monitoring in the community setting of a middle-income country. Material and methods: We asked 68 patients presenting to an infectious diseases consultation office to report the antibiotic courses they had taken in the three months preceding their visit. We assessed for treatment indication, molecule choice, dosing and duration, as well as microbial cultures, demographics and specialty of the prescriber. Results: Among the 68 patients included in our study, we counted a total of 95 outpatient antibiotic courses, mostly composed of quinolones (36%), followed by amoxicillin-clavulanate (21%). The prescriber was most commonly a primary care physician, but we reported several cases of auto-medication and dispensation of antibiotics by pharmacists. Only 30% of cases had true indications for antibiotics. Conclusion: In sum, our results indicate an evident lack of regulation over the administration of antibiotics. This easy accessibility needs to be promptly addressed as we run the risk of inevitable bacterial resistance.

Background Acute otitis media (AOM) is a common cause for antibiotic prescription. Most guidelines endorse abstaining from immediate antibiotic treatment (‘watchful waiting’, WW) in mild–moderate episodes. We studied adherence rates to the latest AOM guidelines (2013), in terms of antibiotic type and prescription options. Methods In this population-based study, AOM episodes were identified in Clalit Health Services-insured children aged 0–10 years between 2011 and 2018, using a data-sharing platform. After identifying the index, prescription and issuing dates for antibiotics for each AOM episode, treatment was categorized as immediate (≤2 days after diagnosis) or WW (antibiotic not prescribed/issued; prescribed ≤2 days after diagnosis but issued on Days 2–7; or prescribed/issued on Days 2–7). Guideline adherence was measured according to age. Results Of the 491 106 episodes, 361 518 (73.6%) were treated with antibiotics. Following the 2013 guidelines, the ratio of episodes in children aged ≤6 months that were adherent (immediate treatment) was higher (OR = 1.22; 95% CI 1.15–1.29; P Conclusions Improved adherence to the 2013 guidelines was observed only in children aged ≤6 months and over-treatment with antibiotics was still high.

Prescriptions for 6.8% of cases suggests a need for greater antimicrobial stewardship., During 2013–2018, antimicrobial drugs were prescribed for 6.8% of cases of acute gastroenteritis encountered in general practice in Australia, including 35.7% of Salmonella infections and 54.1% of Campylobacter infections. During that time, prescriptions for acute gastroenteritis decreased by 2.0%. Managing infectious gastroenteritis in general practice will require greater antimicrobial stewardship.

Objectives: This study aimed to describe patterns of prescribing co-amoxiclav to children aged ≤5 years at a polyclinic in Oman and to assess level of adherence to the antibiotic prescription guidelines outlined by the Omani Ministry of Health (MOH). Methods: This cross-sectional retrospective study was conducted between June and December 2017 at Ibri Polyclinic (IPC) in Ibri, Oman. A random sample of 399 children aged ≤5 years who were prescribed a suspension of co-amoxiclav over the four winter months of 2016 were included in the study. The children’s electronic medical records were reviewed to determine whether the prescription complied with MOH guidelines. Results: The majority of the children were 2–3 years old (52.4%). Overall, 73.9% of prescriptions were written by general practitioners, while 26.1% were written by specialists. Co-amoxiclav therapy was the first line of management in 90.5% of cases, regardless of category of prescriber. Culture tests were ordered in only 43 cases (10.8%), of which five (11.6%) were found to be sensitive to the prescribed co-amoxiclav. Conclusion: Unnecessary antibiotics were prescribed to many paediatric patients attending IPC. Strict enforcement of the MOH antibiotic guidelines is needed to reduce irrational or discretionary prescription of this type of antibiotic. Healthcare providers should receive additional training in evidence-based methods of prescribing antibiotics. KEYWORDS Antibiotics; Children; Co-Amoxiclav; Inappropriate Prescribing; Antibiotic Resistance; Oman.

Background Antimicrobial resistance is an increasingly serious threat to global public health and patient safety. Overuse of antibiotics has aggravated this issue. Around 7% of all antibiotics in Scotland are prescribed by dentists. Audit and feedback has been shown to decrease these prescriptions, but there is evidence that dentists still prescribe unnecessarily. Our aim is to compare the effectiveness of a theory-informed in-practice training session (TiPTAP) in addition to individualised audit and feedback, with audit and feedback alone for reducing antibiotic prescribing by NHS dentists working in NHS primary care dental practices. Methods We will conduct a 2-arm parallel cluster randomised trial: out of 228 practices, 114 will be randomised to the theory-informed in-practice training session targeting antibiotic prescribing and individualised audit and feedback; 114 practices will be randomised to audit and feedback alone. The theory-informed session will include (a) an introductory session including several behaviour change techniques; (b) problem solving discussion, setting and recording action plans; (c) practice-level prescribing feedback discussion. The primary outcome is the number of antibiotic items per 100 NHS treatment claims over a 1-year period post-randomisation for each dentist. Secondary outcomes are the number of amoxicillin 3 g and broad spectrum antibiotics prescribed per 100 NHS treatment claims over a 1-year period; amoxicillin 3 g and broad spectrum antibiotics defined daily doses of antibiotics per 100 claims. Process measures include fidelity, knowledge, and confidence. Primary and secondary outcomes will be obtained using routine data. Discussion This study provides the opportunity to robustly assess the effect of adding an in-practice training co-intervention to audit and feedback. Its behaviour change theory-informed content will allow replication of the different components and can inform future training interventions. Trial registration ISRCTN, ISRCTN12345678. Registered 18 June 2020.

Objectives: To evaluate the awareness of interns, post graduates and general dental practitioners on antibiotic prescribing for endodontic conditions. Materials and Methods: A questionnaire was conducted among 20 General Dental Practitioners, 40 Postgraduate students and 60 Interns of Mamata Dental College, Khammam. Questionnaire consisted a total of 20 questions.It recorded general information such as dental school where they were graduated, number of patients seen each working day, number of endodontic emergency patients and awareness of available antibiotic prescribing guidelines for endodontic therapies. Results: Amoxicillin was the most prescribed antibiotic for patients without allergic towards penicillin.The first choice for patients allergic towards penicillin was clindamycin. The combination of amoxicillin and clavulanic acid was considered to be the first antibiotic of choice for more serious acute apical abscess cases, including life threatening conditions. General dental practitioners were aware of the guidelines for prescribing antibiotics for endodontic conditions when compared to the post graduate students and interns. Conclusion: The dental professionals should be aware of rationalization of antibiotic use and antibiotic prescription for endodontic infections, consequences of their overuse and antibiotic resistance. Keywords: Questionnaire, Amoxicillin, Clindamycin, Clavulanic acid, Rationalization, Antibiotic resistance.

Antibiotic resistance is a part of bacterial evolution and therefore unavoidable. Scarcity of novel treatment options requires prudent use of available antibiotics in order to decelerate the spread of resistance. This is the aim of antibiotic stewardship (ABS) programmes. The implementation of strategies that optimize antibiotic prescription and therapy necessitates the deployment of personnel as well as of structural resources. Necessary requirements for staff and strategies based on their evidence are described in the updated German S3 ABS Guideline. In the future, patients with infectious diseases will benefit from accelerated microbiological diagnostics as early adequate treatment not only reduces antibiotic consumption but also improves patient outcome. In addition, training of infectious disease specialists will substantially contribute to enhanced quality of care of patients with infectious disease.

Background/ Objectives: The use of antibiotics in all kinds of medical treatments has increased tremendously in the past few years. Many tertiary care hospitals have developed guidelines and protocols on antibiotic usage but are unable to achieve targeted compliance and the desired outcome. This study aims to assess the status of antibiotic prescription and compliance with the hospital antibiotic policy during surgical cases. Methods: A retrospective study was carried out for a period of 2 months by passive file auditing of the patients’ record. Findings: The results obtained show 84.8 % compliance with respect to the choice of antibiotic, 90.4 % to indication, and prophylactic antibiotic was given in only 51.2 % amongst the 122 surgical cases. With respect to the time within which antibiotics were given it was found that in 10.4 % it was given more than 2 hours of surgery being started, in 26.4 % it was given in less than one hour and for the remaining 63.2 % that data was not recorded properly. The mean duration of administering the antibiotic was 6.29 hours with SD of 5.20 hours with a median of 4 hours. Novelty: The study highlights the lacunae and flaws amounting to the non-compliance to the antibiotic policy in surgical cases and suggests that most of the tertiary care hospitals too need an implementable policy than a perfect policy. Keywords: Antibiotic; assessment; compliance; prescription; surgical cases

Antibiotics are commonly prescribed by almost all dental practitioners. The prescription habits of dentists vary among different groups of practitioners which can lead to various complications. This study aims in assessing the knowledge and practice on antibiotic prescription among the undergraduate students of a private dental college in Chennai. This study was conducted as a questionnaire based online survey in a private dental institute in Chennai. The data collection was done through google forms. Data was analysed using SPSS software.A correlation test and chi square analysis was done. On chi square analysis, the results showed p value 0.692. (> 0.05), does not have significant association. Most of the dentists preferred amoxicillin as their choice of antibiotics (82.35%). Majority of the dentists prescribed antibiotics for a period of 3-5 days (52.94%) and they prescribed antibiotics based on the symptoms of the patients. Thus, it can be concluded that the dentists had good knowledge on antibiotic prescription which is in contrary to many other studies, which may be attributed various limitations.

Background Self-medication with antibiotics (SMA) is one of the most dangerous inappropriate antibiotic use behaviors. This study aims to investigate the impact of parental SMA for children before a consultation on their doctor’s subsequent antibiotic prescribing behavior, including intravenous (IV) antibiotic use in the clinical setting of China. Methods A cross-sectional survey was conducted between June 2017 and April 2018 in three provinces of China. A total of 9526 parents with children aged 0–13 years were investigated. Data from 1275 parents who had self-medicated their children and then visited a doctor in the past month were extracted and analyzed. Results One-third (410) of the studied children had parental SMA before the consultation and 83.9% of them were subsequently prescribed antibiotics by doctors. Children with parental SMA were more likely to be prescribed antibiotics (aOR = 7.79, 95% CI [5.74–10.58]), including IV antibiotics (aOR = 3.05, 95% CI [2.27–4.11]), and both oral and IV antibiotics (aOR = 3.42, 95% CI [2.42–4.84]), than children without parental SMA. Parents with SMA behaviors were more likely to request antibiotics (aOR = 4.05, 95% CI [2.59–6.31]) including IV antibiotics (aOR = 2.58, 95% CI [1.40–4.76]), and be fulfilled by doctors (aOR = 3.22, 95% CI [1.20–8.63]). Conclusions Tailored health education for parents is required in both community and clinical settings to discourage parental SMA for children. The doctors should not prescribe unnecessary antibiotics to reinforce parents’ SMA behaviors. We recommend expanding the current IV antibiotics ban in outpatient settings of China to cover outpatient pediatrics.

Fil: Karaben, Viviana Elizabeth. Universidad Nacional del Nordeste. Facultad de Odontología; Argentina. Fil: Pomarada, María Eugenia. Universidad Nacional del Nordeste. Facultad de Odontología; Argentina. Fil: Rea, Ana Eloísa. Universidad Nacional del Nordeste. Facultad de Odontología; Argentina. Fil: Morales, Sergio Daniel. Universidad Nacional del Nordeste. Facultad de Odontología; Argentina. Objetivo: analizar y mejorar las prescripciones de antibióticos por parte de odontólogos, a través de una intervención educativa. Método: se realizó un estudio analizando las recetas de prescripción de medicamentos antes y después de la intervención educativa, en el Instituto de Servicios Sociales de la Universidad Nacional del Nordeste. El estudio comprendió tres etapas; en la etapa Ase identificaron problemas de prescripción, que fueron socializados con los profesionales durante la intervención educativa como parte de la etapa B, cuya modalidad consistió en dos entrevistas presenciales, con talleres de discusión y debate. En esta se trabajó, además, con el informe de los resultados obtenidos en el análisis de situación de la etapa A. En la etapa C se analizó el impacto de la intervención educativa. Resultados: en la etapa A se observaron 417 recetas con 202 prescripciones de antibióticos, los más indicados fueron azitromicina (31%), amoxicilina con clavulánico (10%) y amoxicilina (8%). La adecuación de prescripción en relación a la indicación fue del 26%. En la etapa C, de un total de 191 recetas, se analizaron 107 recetas con prescripción de antibióticos. La amoxicilina fue el medicamento más prescripto (37%); la prescripción de azitromicina disminuyó a 14% y su adecuación fue del 46%. Ello evidenció una mejoría del 20%, la cual fue validada a través del test ch¡2 (p=0,00). Conclusión: por medio de la intervención educativa presencial es posible mejorar las prescripciones de antibióticos, no obstante se desconoce si el cambio de conducta prescriptiva se mantiene en el tiempo. Objective: Analyze the antibiotic prescriptions by dentists and improve their prescription through an educational intervention. Method: This study was carried out with an educational intervention, in a Social Services Institute analyzing prescriptions for antibiotics pre- and post-intervention. The study included three stages, the flrst to ¡dentify prescription problems to were presented to professionals during the educational intervention, which included of two face-to-face interviews, with discussion and debate workshops. In the last stage, the ¡mpact of the educational intervention was analyzed. Results: Stage A: 417 prescriptions with 202 antibiotic prescriptions were observed, the most ¡ndicated were azithromycin (31%); amoxicillin with clavulanic (10%) and amoxicillin (8%). The adequacy of prescription concerning the ¡ndication was 26%; stage B corresponded to the educational intervention, through discussion and analysis of the situation. In step C of 191 recipes, 107 prescriptions with antibiotic prescription were analyzed, ¡t was observed that the most prescribed was amoxicillin (37%) and the azithromycin prescription decreased to 14%. The adequacy was 46%, evidencingan ¡mprovement of 20%, validated through the ch¡2 test (p = 0.00). Conclusion: lt was observed that through an educational intervention for prescribing professionals, antibiotic prescriptions could be ¡mproved, however, ¡t ¡s unknown ¡f the change in prescriptive behavior is maintained over time.

Antibiotic prescription is a common practice among dental practitioners. Unjustified antibiotic prescription is leading to antibiotic resistance. The purpose of this survey is to analyze the most commonly prescribed antibiotics, conditions in which antibiotics are being prescribed, either the dental surgeons prescribe the antibiotics in the conditions where they are not recommended and awareness of antibiotic resistance among the dental practitioners of Lahore. The aim of the study was to identify the prevalence of unjustified prescription of antibiotics so we can take measures to teach the dental students about this wrong and unjustified prescription in undergraduate studies. It was an observational study, a cross-sectional study. Among dental practitioners of Lahore, 380 were selected through a non-probability convenience sampling technique Standardized; a previously validated questionnaire was used containing 18 questions, about the most commonly prescribed antibiotic, conditions where antibiotics are indicated and antibiotic resistance. Data was coded in SPSS version 20. Results are indicative that studied sample of dental practitioner tends towards over-prescription of antibiotics. Dentists should prescribe Antibiotics only according to the latest guidelines, where it is indicated. It should not be a first-line treatment modality.

Background: Antibiotics are the most widely utilized therapeutic agents. Inappropriate use causes increase cost and antibiotic resistance. The World Health Organization recommends assessment of antibiotics use to guide prescribing practices. Objective: To describe the pattern of antibiotic usage among paediatric inpatients aged > 1 month to 15 years in a tertiary hospital in Sokoto, Nigeria. Methods: Febrile children were recruited prospectively by systematic random sampling from January to October 2018. Socio-demographics, diagnosis, antibiotics administered were obtained from case notes. The WHO indicators of use of antibiotics were employed for evaluation. Data was analysed with SPSS version 23. Results: Out of 352 children, 318 (90.3%) received antibiotics; commonest being Ceftriaxone in 155/318 (48.7%), Cefuroxime in 74 (23.2%), and Metronidazole in 29 (9.1%). Average number of antibiotics per patient was 2.3±1.1 with treatment duration of 4.3±1.4days. Antibiotic consumption was 937.2 days of antibiotic therapy/1000 patient days (DOT/PD). Generic name was used in 92.3% while 100% of the drugs were on the essential medicine list. Frequent diagnoses were severe malaria 98/352 (27.8%), respiratory infections 39 (11.1%) and severe malnutrition in 38 (10.8%). Only 6 (1.7%) patients had microbiologic evidence of infection. Conclusion: Utilization of antibiotics is higher than recommended. There is need for improved diagnostic facilities to avoid antibiotic overuse and its consequences. Keywords: antibiotics, prescription, utilization, children, inpatients, DOT

Aim: The aim of this study was to describe the seasonal variations in dispensing antibiotic prescriptions in the outpatient setting of a public hospital in Alkharj. Methodology: A retrospective cross-sectional study was conducted. The outpatient prescriptions in 2017 and 2018 were collected from medical records in a public hospital in Alkharj. The data include the number of prescribed antibiotics in general, the number of prescribed antibiotics in different months and seasons in the outpatient setting. Results: In the outpatient setting in 2017 and 2018, antibiotics were prescribed excessively in most of the months. About 27.84 %of the prescriptions in 2017 were in spring season and about 26.64% of the prescriptions in 2018 were in autumn. Total number of antibiotics prescriptions in 2017 and 2018 were 5348 in spring followed by 5097 in autumn. Conclusion: The results of the present study showed the widespread use of antibiotics by practitioners that was associated with season of prescribing. In general, there are excess use of antibiotics in all months. It is important to understand how the prescribing of antibiotic varies throughout the year to design an appropriate intervention to decrease incorrect antibiotic use.

Objective: The objective of this study was to explore the knowledge, attitudes, and practices concerning antibiotic prescriptions to children with URTIs among pediatricians and to identify barriers...

Most patients with chronic obstructive pulmonary disease (COPD) experience exacerbations [1]. >80% of the exacerbations are treated ambulatorily. Treatment consists of inhaled bronchodilator therapy and oral corticosteroids, whereas the contribution of antibiotics is less clear. A meta-analysis [2] recently reported less treatment failure within 4 weeks in outpatient exacerbations treated with antibiotics: 21.2% in the group treated with antibiotics versus 29.2% in the placebo group. This means that 12–13 patients must be treated with antibiotics to prevent one treatment failure (number needed to treat: 12.5)., No clinical characteristics, particularly not sputum characteristics, can guide antibiotic prescription in patients with mild to severe COPD exacerbations https://bit.ly/3e1JV8o

Kerala, the southern Indian state piloted Lung Health Care Project (LHCP) which is a locally adopted version of WHO recommended Practical Approach to Lung health (PAL). The current study assessed the impact of the project on the prescribing practices of doctors and consumption of antibiotics and other drugs.This study compared performance of primary health care institutions with regard to drug prescriptions and consumptions before and after the implementation of the project. Chronic respiratory disease (CRD) patients in institutions implemented the project were interviewed in the OPD at exit and their prescriptions were documented at baseline and after six months. Focus group discussions were conducted with doctors to explore the reasons behind changes in drug consumption pattern.In the project implementing institutions, mean number of drugs prescribed for CRDs was 3.88 (SD 1.50) and 2.73 (SD 1.18) at baseline and after six months respectively (p 0.001). Adjusted odds ratio for prescribing an antibiotic and injection to a CRD patient during impact assessment at institutions implementing project was 0.34 (95% CI 0.15-0.75 p 0.008) and 0.39 (95% CI 0.20-0.74 p 0.004) respectively, as compared to baseline. The factors which helped in reducing antibiotic and injection use as felt by the doctors were presence of a protocol, good quality trainings, supportive supervision and monitoring, availability of alternate drugs and good participation of staff nurses especially in-patient education.Strict adherence to diagnostic and management algorithms of Lung health care project in a primary health care setting in India helped in reducing pill burden to patients and prescription of antibiotics and injections.

Background: Community acquired pneumonia (CAP) is a leading cause of morbidity and mortality in Bangladesh. There is difficulty in identification of the causative organism due to lack of facility of sputum culture and sensitivity test in many hospitals of Bangladesh. So targeted anti microbial therapy is not possible and empirical antibiotic prescription is done. The choice of empirical selection of antibiotic should be the best effective drug for the treatment of CAP. Objective: To assess the efficacy of selected empirical antibiotic selection for the treatment of CAP. Methods: This prospective observational study involves 82 patients with CAP admitted in medicine ward of Khulna medical college hospital, Khulna, Bangladesh. Patients were selected by inclusion and exclusion criteria. Diagnosis of CAP was confirmed by chest x-ray. Empirical selection of antibiotic was based on clinical experience. Most of the patients were treated with combined antibiotic except a few with monotherapy. Evaluation of the empirical choice of ant biotic was done by the outcome. Data of different parameter were recorded during study in preformed proforma. Statistical analysis was done by using SPSS. Result: Out of 82 patients 62 (76%) were male and 20 (24%) were female. Mean age was 54.4 (± 9.6) years. Duration of antibiotic treatment was 7 days. No drug related adverse effect was observed. One patient developed paraneumonic effusion and none of the patient developed lung parenchymal damage or lung abscess. All the patient recovered completely. Conclusion: CAP is treated in many hospitals of Bangladesh by selecting the antibiotic empirically. Improvement of hospital laboratories to perform sputum for culture and sensitivity test is necessary for selecting an effective anti biotic. Bang Med J (Khulna) 2019; 52 : 25-29

Objectives: Ensuring the rational drug use has become one of the primary targets of health policies of countries. The drug use, which may be affected by many factors, should be regularly followed up by using scientific methods. In this context, determining the prescribing practices of physicians is the first step to define the measures to be taken against irrational drug use. In this study, we aimed to determine the rational use of antibiotics by family physicians in all provinces of Turkey for evaluation of current antibiotic pattern of family physicians across the country and between provinces. Methods: This was a retrospective descriptive study in which e-prescription data of family physicians during 2017 were obtained through the Prescription Information System (PIS). The number and percentage of prescriptions including antibiotics were determined, and the mostly preferred antibiotics in terms of number of items/boxes/costs were listed. Ten most commonly prescribed antibiotics were given for Turkey and its provinces. Results: In 2017, 22,778 family physicians entered at least one protocol (procedure) into the database through PIS across Turkey. The total number of protocols entered was 282,044,546 of which 50.21% (141,625,433) was prescription protocols. Of all the prescriptions written by family physicians in Turkey, 24.97% includes at least one antibiotic. When provinces were compared according to antibiotic prescription rates, Mardin was the first with 38.09% (357,950/939,856) followed by 35.72% (637,640/1,785,088) in Sanliurfa and 35.23% (2,109,931/5,988,772) in Adana. The three provinces with the lowest antibiotic prescription rates were Edirne (16.05%; 169,955/1,058,960), Yozgat (16.25%; 100,216/616,531) and Artvin (16.37%; 40,358/246,497). Antibiotics constituted 7.43% (n=29.284.158) of all of the drugs items in prescriptions, and total antibiotic cost is 3.45% (554.866.690 TL) of the total drug cost. Based on the number of items in the prescriptions, the most commonly prescribed antibiotics were amoxicillin and enzyme inhibitor, clarithromycin, and cefuroxime. Conclusion: This is the most comprehensive study examining the prescriptions of all family physicians for a year across Turkey. The results of the study showed that one fourth of prescriptions written by family physicians contain antibiotics. This rate is even higher in the south and southeastern regions. Mostly, broad-spectrum antibiotics are prescribed. Further research and training activities are needed to achieve the objectives of rational drug use for antibiotic prescribing in Turkey.Giriş: Akılcı ilaç kullanımı, ülkelerin sağlık politikalarının öncelikli hedeflerinden birisi haline gelmiştir. Pek çok faktörden etkilenebilen ilaç kullanımı sürecinin, bilimsel araştırmalarla düzenli olarak takip edilmesi gerekir. Bu kapsamda hekimlerin yazdıkları reçetelerde kullandıkları ilaçların izlenmesi, akılcı olmayan ilaç kullanımına karşı alınacak tedbirlerin belirlenmesi için gereklidir. Bu araştırmada, Türkiye’nin tüm illerindeki aile hekimlerince yazılmış olan reçetelerdeki antibiyotik içerikleri değerlendirilerek mevcut akılcı antibiyotik kullanım profilinin, ülke geneli ve illere göre dağılımının belirlenmesi amaçlanmıştır.Yöntem: Bu retrospektif tanımlayıcı çalışmada, Türkiye’deki aile hekimlerinin 2017 yılı boyunca yazdıkları reçete verileri, Reçete Bilgi Sistemi (RBS) üzerinden incelenmiştir. Tüm reçeteler arasından antibiyotik yazılanlar bulunarak, kalem/kutu/maliyet açısından en sık reçetelenen antibiyotikler tespit edilmiştir. En sık reçetelenen 10 antibiyotiğin dağılımı, Türkiye geneli için ve illere göre sunulmuştur. Bulgular: 2017 yılı boyunca Türkiye genelinde protokol üreten (işlem yapan) aile hekimi sayısı 22.778’dir. Aile hekimleri tarafından veri tabanına girilen 282.044.546 toplam protokolün %50,21’inde (n=141.625.433) reçete oluşturulmuştur. Türkiye genelinde aile hekimleri tarafından yazılan reçetelerin %24,97’si (35.364.710 reçete) ilaç olarak en az bir antibiyotik içermektedir. Antibiyotik bulunan reçete yüzdelerine göre iller karşılaştırıldığında, %38,09 oranıyla (357.950/939.856) Mardin’in ilk sırada yer aldığı, Şanlıurfa’nın %35,72 (637.640/1.785.088) ve Adana’nın %35,23 (2.109.931/5.988/772) oranlarıyla takip ettiği görülmüştür. En düşük antibiyotik içeren reçete yüzdesine sahip üç il ise Edirne (%16,05; 169.955/1.058.960), Yozgat (%16,25; 100.216/616.531) ve Artvin’dir (%16,37; 40.358/246.497). Reçetelerdeki toplam antibiyotik kalem sayısı, tüm ilaç kalem sayısının %7,41’i (n=29.284.158), toplam antibiyotik maliyeti ise tüm ilaç maliyetinin %3,45’idir (554.866.690 TL). Kalem sayısına göre en sık reçetelenen antibiyotikler, amoksisilin ve beta-laktamaz inhibitörü kombinasyonu, klaritromisin ve sefuroksim aksetil olmuştur. Sonuç: Sunulan çalışma, tüm Türkiye’de aile hekimlerinin bir yıl boyunca ürettikleri reçete verilerinin incelendiği en kapsamlı çalışmadır. Çalışma verilerine göre, ülkemizde aile hekimleri tarafından yazılan her dört reçeteden biri antibiyotik içermektedir. Ülkemizin güney ve güneydoğu bölgesinde bu oran daha da yüksektir. En çok geniş spektrumlu antibiyotikler reçete edilmektedir. Ülkemiz genelinde akılcı ilaç kullanımı hedeflerine ulaşılması için ileri araştırma ve eğitim faaliyetlerine ihtiyaç vardır.

Lai San Kong,1 Farida Islahudin,1 Leelavathi Muthupalaniappen,2 Wei Wen Chong1 1Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia; 2Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, MalaysiaCorrespondence: Wei Wen ChongFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, MalaysiaTel +60 3-9289-7118Email weiwen@ukm.edu.myBackground: Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia’s general public’s knowledge and expectations on antibiotic use.Purpose: To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia’s general public.Materials and Methods: A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.Results: Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57± 4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26± 4.40 versus had engaged: 8.11± 4.00, p< 0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03± 4.25 versus neutral: 6.62± 3.91 versus disagree/strongly disagree: 8.29± 4.00, p< 0.001).Conclusion: Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.Keywords: antibiotic use, antibiotic resistance, knowledge, expectation, inappropriate practice, general public

Background Development of new antibiotics has been slow in the past decades, despite the urgent need. Final-year undergraduate students, interns, and postgraduate students are future prescribers of antimicrobials. It is important they have proper knowledge and attitude toward antibiotic prescription, so that antibiotic resistance could be dealt wisely. Aims The aim of this study was to assess the knowledge and attitude of undergraduate, interns, and postgraduate medical students regarding antimicrobials, antibiotics resistance, and associated factors. Methodology A total of 150 final-year medical students, interns, and resident doctors were included, 50 in each group. Participants were contacted individually and were asked to fill a prevalidated questionnaire. Information was collected on three broad categories: basic information about antimicrobials, knowledge regarding treatment of common infections, and belief and attitude toward antimicrobials. Percentages were calculated for the categorical data and chi-squared test was used for univariate analysis of the categorical data, where p-value less than 0.05 was considered to be significant. Results Precisely, 80.67% were able to answer which type of infections need antibiotics; 19.33% responded that both viral and bacterial infections need antibiotics; 44.67% preferred using broad-spectrum antibiotics for definitive treatment; 28.66% answered macrolides as most commonly used for upper respiratory tract infection; 56% considered fluoroquinolones are most commonly used for urinary tract infection with p-value less than 0.05 between the groups; 43.33% were unaware of the infection control program; while 72.66% were unaware about the antibiotic policy in their institute. Conclusion The majority had sufficient basic knowledge about antibiotics, yet there were areas for concern. Study findings may help to formulate new learning objectives for medical students to inculcate proper knowledge and attitude toward antibiotic prescription.

OBJECTIVE: Pregnant women with asthma have increased frequency of respiratory viral infections and exacerbations. Because of these risks, women with asthma may be subject to increased surveillance during pregnancy and may, therefore, be at increased risk of antibiotic receipt. The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. METHODS: We included women who delivered a singleton, term, non-low birthweight, and otherwise healthy infant enrolled in the Tennessee Medicaid Program. Maternal asthma and prenatal antibiotic fills were ascertained from healthcare encounters and outpatient pharmacy claims. We examined the association between maternal asthma and prenatal antibiotic fills using modified Poisson regression. RESULTS: Our study population included 168354 pregnant women, 4% of whom had asthma. Women with asthma had an increased risk of filling at least one prenatal antibiotic prescription (adjusted risk ratio [aRR] 1.27, 95% confidence interval [CI] 1.25–1.28) and had an increased number of fills during pregnancy (aRR 1.54, 95% CI 1.51–1.57) compared to women without asthma. Among those who filled at least one antibiotic prescription, women with asthma had earlier first prenatal antibiotic prescription fill and increased likelihood of filling at least one course of broad-spectrum antibiotics during pregnancy (versus narrow-spectrum). CONCLUSIONS: Pregnant women with asthma had more outpatient antibiotic prescription fills than pregnant women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy, providing data that may inform antibiotic stewardship.

Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.

Current methods for the diagnosis of urinary tract infections with antimicrobial susceptibility testing take 2–3 days and require a clinical laboratory. The lack of a rapid, point-of-care antibiotic susceptibility test (AST) has contributed to the misuse of antibiotics when treating urinary tract infections (UTIs) and consequently to the rise of multi-drug-resistant organisms. The current clinical approach has led to reduced treatment options and increased costs of diagnosis and therapy. To address this issue, novel diagnostics are needed for the timely determination of antimicrobial susceptibility. We present a rapid, point-of-care, phenotypic AST device that can report the antibiotic susceptibility/resistance of a uropathogen to a panel of antibiotics in as few as 3 h by utilizing fluorescent-labelling chemistry and a highly sensitive particle-counting instrument. We analysed 744 urine samples from the outpatients and inpatients of two Italian hospitals. The 130 UTI-positive patient urine samples we found were measured using a panel of six common UTI antibiotics plus a growth control. By comparing our results to hospital laboratory urine cultures, we obtained an overall sensitivity = 81%, a specificity = 83%, an SPV (sensitivity predicted value) = 95%, and an RPV (resistance predicted value) = 54%. According to our preliminary data, the sensitivity predicted value for a single antibiotic agent was 95%, thus allowing (in the vast majority of cases) an early (within 3 h) recognition of an effective agent for a single patient.

Background: The antimicrobial susceptibility testing (AST) report has guiding significance for physicians to prescribe antibiotics. This study aims to examine the effect of the AST report information complexity on physician’s intention to prescribe antibiotics based on the AST report, as well as the mediating role of information overload and attitude.Methods: A cross-sectional study conducted on 411 physicians in a general hospital in China in July 2021. Data were collected by a self-reported questionnaire. A serial multiple mediation model was tested to explore the sequential causality between the information complexity of the AST report, information overload, attitude, and behavior intention to prescribe antibiotics based on the AST report by using the SPSS macro PROCESS program.Results: Information complexity, information overload, attitude and behavior intention were significantly correlated (p < 0.01). Information complexity can not only have a direct positive impact on the intention to prescribe antibiotics based on the AST report (effect = 0.173; SE = 0.044; Boot95%CI: LL = 0.089, UL = 0.260), but also have an indirect impact on behavior intention through the independent mediating role of information overload (effect = 0.025; SE = 0.011; Boot 95%CI: LL = 0.008, UL = 0.050) and the independent mediating role of attitude (effect = 0.130; SE = 0.025; Boot 95%CI: LL = 0.086, UL = 0.180), while the chain of information overload and attitude played a masking effect between information complexity and behavior intention (effect = −0.013; SE = 0.004; Boot 95%CI: LL = −0.023, UL = −0.005).Conclusion: The increase in information complexity can encourage physicians to prescribe antibiotics based on the AST report, information overload and attitude can promote this effect. It is necessary to provide physicians with sufficient information to prescribe antibiotics without increasing the burden on them. At the same time, publicity and standardized training should be conducted for physicians to interpret the AST report better and faster.

Aim To review the current antibiotic prescribing practice for patients with acute uncomplicated diverticulitis against the NICE guidelines November 2019, to avoid unnecessary/overuse of antibiotics. Method A retrospective review of patients presenting with lower abdominal pain between 1/11/2019 -31/1/2020. All patients with suspected diverticulitis were included. Patients who were subsequently diagnosed with complicated diverticulitis/alternate diagnosis were excluded from the analysis. Results 22/27 (81.5%) of the patients were admitted. 26 out of 27 (96.3%) patients with acute uncomplicated diverticulitis were administered antibiotics. Antibiotics were indicated as per NICE guidelines in 17 patients (62.97%) and not indicated in 9 patients (33.34%). Admission was not indicated in 20 patients (90.91%) according to NICE guidelines. Conclusions Our adherence to NICE guidelines is 66.67% in terms of antibiotic administration, however the drug and duration of antibiotic administration needs to be reviewed. NICE guidelines recommend that acute uncomplicated diverticulitis can be managed as an outpatient. Antibiotics should be administered only if patient is systemically unwell, is immunosupressed or has significant co morbidities

Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.

Background Upper respiratory tract infections (URTI) are one of the main reasons for consultation in primary care. Approximately 60% of all antibiotic prescriptions aim at the treatment of URTI, even without a laboratory-based diagnosis. Delayed antibiotic prescription in primary care has shown to reduce antibiotic consumption, without increasing risk of complications, yet is not widely used. Rapid tests to confirm the etiology of URTI are available at pharmacies, but not purchased routinely. In this context, the aim of this study is to assess the knowledge of rapid tests for the diagnosis of URTI, and the awareness of strategies to decrease antibiotic use. Methods A team of experts in the field developed a questionnaire specifically for the purpose of this study. The Pharmacy graduate students of ESTESC-Coimbra Health School (Portugal) answered the questionnaire online. Results Over 90% of the respondents with a URTI stated that the general practitioner prescribed the antibiotic without a lab test. When given the option, 58% are willing to pay up to 50 Euros for a rapid test, yet are not familiar with any brand. Although the respondents aren’t familiarized with the concept, when asked, the majority (87%) are more likely to choose a delayed than an immediate prescription. Conclusions Pharmacy graduates are willing to support the use of delayed prescription, to give time for the lab confirmation of the diagnosis. A broader dissemination of the clinical evidence supporting the use of rapid tests and of delayed prescription is necessary to help managing URTI.

ObjectivesUnderstanding the current state of antibiotic treatment guidelines and prescribing practices for bacterial enteric infections is critical to inform antibiotic stewardship initiatives. This study aims to add to the current understanding through three objectives: (i) to identify and summarize published treatment guidelines for bacterial enteric infections; (ii) to describe observed antibiotic prescribing practices for bacterial enteric infections across three sentinel sites in Canada; and (iii) to assess concordance between observed antibiotic prescribing and treatment guidelines.MethodsAn environmental scan of treatment guidelines for bacterial enteric infections was conducted and recommendations were collated. A descriptive analysis of cases of bacterial enteric illnesses captured in FoodNet Canada’s sentinel site surveillance system between 2010 and 2018 was performed. Antibiotic-use data were self-reported by cases via an enhanced questionnaire.ResultsTen treatment guidelines were identified in the environmental scan. There was substantial variation between guidelines for both when to prescribe antibiotics and which antibiotics were recommended. Of the 5877 cases of laboratory-confirmed bacterial enteric illness in the three sites, 49% of cases reported having received an antibiotic prescription. Of particular significance was the finding that 21% of verotoxigenic Escherichia coli cases received a prescription. Of the 17 antibiotics recommended in the guidelines, 14 were used in practice. In addition to these, 18 other antibiotics not included in any of the guidelines reviewed were also prescribed.ConclusionsOur study suggests that a substantial proportion of enteric bacterial infections in Canada are prescribed antibiotics. These findings highlight the need to standardize treatment guidelines for enteric illnesses and could be used to inform future stewardship programme development.

Juvenile hyaline fibromatosis (JHF) is an unknown hereditary disorder with variable penetrance. The characterizations of this disease consist of different signs and symptoms such as multiple tumorous (tumor-like) muco-cutaneous proliferation, gingival hypertrophy, perianal lesions, articular contractures, and osteolytic lesions. A 3-year-old girl with numerous painless nodular masses on her gingival, ear and anal areas is presented in this case report. Based on characteristic histological features, the diagnosis of JHF was made. The patient underwent surgery following general anesthesia and the above areas were surgically operated with appropriate laser parameters, and the patient was able to eat and wash away after a day and was discharged with an antibiotic prescription after one day in the hospital and returned to normal after a week. The recurrence occurred in other areas a year later, especially in the cheek, the ears and the anal area. Therefore, this rare case is presented with recurrence.

Background: Over-prescription and overuse of antibiotics are a major cause of concern in terms of healthcare and economic implications, as well as the emergence of microbial resistance worldwide. So far, efforts have been administered by many countries to regulate the consumption of antibiotics and overcome the rapid emergence of resistant bacteria. Assessment of the perspectives and behavior of physicians can play a major role in achieving this objective. Objectives: The objective of the present study was to assess the perspectives on the antibiotic prescription practice of physicians and evaluate their tendency to receive feedback on their performance in outpatient settings. Materials and methods: Attitudes and practices of 330 physicians on antibiotics prescription were evaluated using a validated questionnaire in 2014 in Mashhad, Iran. Results: 94% of physicians asserted that the prescription rate of antibiotics in Iran is higher than the global average. Physicians noted that “patients’ tendency to prescribe antibiotics“ is the primary reason of excessive prescription of antibiotics. Approximately, 84% of physicians were keen on receiving performance feedback. More than 71% of participants specified Short Message Service (SMS) notification as their preferred medium for receiving feedback. Conclusions: The dominant viewpoint of physicians was that the rate of antibiotics prescription in Iran is larger than the global average, which can lead to adverse economic and bacterial resistance consequences. Interventions such as ‘performance feedback’ have the potential to reduce antibiotics over-prescription.

Background: Resistance to antibiotics is spreading rapidly around the world with its associated morbidity and mortality. Infections are becoming increasingly difficult to treat resulting in increased cost of medical care. In low income countries with high infectious disease burden, antibiotic resistance is reported to be accelerated by irrational prescriptions in health facilities. In the absence of adequate resources, many clinicians engage in empirical antibiotic prescriptions some of which their appropriateness is questionable. There is need for laboratory evidence to justify empirical antibiotic use in the light of increasing resistance to commonly prescribed antibiotics. Aims: This study aims to determine empirical antibiotic prescription pattern and to determine rationality using resistance profile of common bacterial isolates in hospitals. Methods: Antibiotic prescriptions in the NHIS department and antibiogram records were obtained from pharmacy and laboratory records respectively. Analysis was carried out using descriptive statistics and comparison between antibiotics prescribed and their respective resistance pattern were compared to determine rationality. Results and Discussion: The Penicillins and Quinolones were the most prescribed class of antibiotics and resistance range between 30 – 90% and 3 – 23% respectively. Resistance to other antibiotics was high thus making empirical prescriptions irrational in most of the cases. These findings have been consistently reported in several studies so widespread empirical antibiotic prescriptions are not in tandem with principles of rational drug use. Conclusion: Antibiotic resistance is common among hospital isolates, so there is need to emphasize that prescriptions be based on laboratory evidence of microbial sensitivity.

Background Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more easily identified, limiting antibiotic use in this population. The primary objective of our study was to investigate if availability of the RVP decreased antibiotic prescription at discharge among patients with AECOPD. Methods This is a single center, retrospective, before (pre-RVP) - after (post-RVP) study of patients admitted to a tertiary medical center from January 2013 to March 2016. The primary outcome was antibiotic prescription at discharge. Groups were compared using univariable and multivariable logistic-regression. Results A total of 232 patient-episodes were identified, 133 following RVP introduction. Mean age was 68.1 (pre-RVP) and 68.3 (post-RVP) years respectively (p = 0.88). Patients in pre-RVP group were similar to the post-RVP group with respect to gender (p = 0.54), proportion of patients with BMI

BACKGROUND This study aimed to evaluate risk factors for oral antibiotic prescription in the first six weeks after primary TKA, particularly whether the wound closure method (staples or sutures) and two-week follow-up clinician (surgeon or general practitioner (GP)) altered antibiotic use. METHODS Four thousand eight hundred forty-six TKAs from January 2013 to December 2016 at three tertiary hospitals in Auckland, New Zealand were analysed by manual review of patient electronic records and a national prescription database. Surgeon preference dictates the method of wound closure and whether wound review is followed up by the operating surgeon or by the patient's GP. Univariate and multivariate analysis was carried out to identify significant patient and surgical risk factors for oral antibiotic prescribing. RESULTS Oral antibiotics were prescribed in 24% of patients following primary TKA. Twenty-six percent of patients closed with staples were prescribed oral antibiotics versus 19% with sutures (adjusted OR = 1.4, p

International audience; PURPOSE: Giving advice about antibiotic prescription through dedicated consultations is a cornerstone of antibiotic stewardship programmes. Our objective was to explore practices, organisation, and regulatory requirements related to antibiotic advising.METHODS: We performed an international, exploratory, Internet-based, cross-sectional survey targeting infectious diseases and clinical microbiology specialists. It was disseminated through ESCMID and ESGAP networks.RESULTS: Answers from 830 participants (74 countries, 77% of participants from Europe) were collected. Consultations were mostly given on demand (81%, 619/764), while unsolicited consultations targeting specific conditions (e.g., positive blood culture) were less frequent (66%, 501/764). Consultations usually included indications on diagnostic work-up and follow-up (> 79%). Curbside consultations (i.e., without examining the patient) were reported by 82% (598/733) of respondents, mainly by phone (89%, 531/598). The referring physician was considered authorised not to follow the advice by 57% (383/676). Direct consultations (i.e., after examining the patient) were recorded in the medical file more frequently than curbside consultations (69%, 472/689 vs 35%, 206/592). Concerning legal liability, the majority of respondents considered that it is shared between the adviser and the referring physician, who, however, is considered primarily responsible. The advisers' liability was considered to be lower in cases of curbside and unrecorded consultations. Significant inter-countries and intra-country variability were identified, suggesting that the setting markedly influenced practices.CONCLUSION: Significant variability exists in the practice of antibiotic advising. This concerns both the organisation of care and how advisers perceive regulatory requirements. These elements must be taken into account when implementing antibiotic stewardship programmes and when training stewards.

Objectives: The aim of this study was to describe antibiotic prescription for management of urinary tract infections (UTIs) in daily clinical practice in the Arabian Gulf and to compare prescription patterns with the recommendations of different recent guidelines. Method: This was a multicentre, cross-sectional, observational study evaluating antibiotic prescription in the management of UTIs in five countries from the Arabian Gulf. Randomly selected physicians who routinely treat patients with UTIs enrolled consecutively adult patients prescribed an antibiotic for treatment or prophylaxis of a UTI. Data were collected on UTI symptoms, antibiotic prescription, co-medications and relevant diagnostic laboratory tests. Results: Fifty physicians enrolled 522 eligible patients. The reason for antibiotic prescription was treatment of a UTI in 502 patients, and prophylaxis in 20 patients. The most frequent types of UTI documented were cystitis (301 cases) and urethritis (143 patients). Overall, the most frequently prescribed antibiotics for treatment of active UTIs were levofloxacin (344 patients; 68.7%), ciprofloxacin (69 patients; 13.8%) and ceftriaxone (34 patients; 6.8%). The pattern of antibiotic prescription was essentially similar irrespective of the indication. Only six patients with uncomplicated acute cystitis received the treatment recommended as first choice in the European Association of Urology or Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Disease guidelines (nitrofurantoin or trimethoprim/sulfamethoxazole). Conclusions: We observed pronounced divergence from international practice guidelines for the use of antibiotics for the treatment or prophylaxis of UTIs in the Arabian Gulf, even though most participating physicians, and essentially all urologists, claimed to be familiar with them. In this context, the development and diffusion of regional practice guidelines may be particularly useful. Level of evidence: Not applicable for this multicentre audit.

AIM To characterise paediatricians' antibiotic-prescribing behaviour when managing community acquired pneumonia. METHODS We conducted a knowledge and attitudes survey of paediatric doctors practicing at a regional provincial hospital in central Vietnam over a 2-week period (from 12 December 2017 to 29 December 2017). RESULTS Of 79 eligible paediatric doctors, 69 (87.3%) completed the questionnaire, of whom 65 (94.2%) thought that antibiotics were overused in Vietnam. Thirty-eight doctors (55.1%) indicated that they routinely hospitalised children with pneumonia to provide intravenous antibiotics. Most doctors reported discharging children with non-severe pneumonia after 5 days (76.9%) and those with severe pneumonia after 7-10 days (88.4%); older doctors generally continued intravenous antibiotics for longer. The two most important factors driving discharge decisions were clinical assessment (95.6%) and completion of the full course of intravenous antibiotics (80.0%). Antibiotic prescription was influenced by local guidelines (62.3%), drugs used before admission (50.0%) and the opinion of senior clinicians (37.7%). Most doctors believed antibiotic stewardship was necessary (98.6%) and that over-the-counter use of antibiotics should be restricted (97.1%). CONCLUSIONS Paediatricians recognised an urgent need for more effective regulation and antibiotic stewardship in Vietnam. Routinely completing a full course of intravenous antibiotics leads to unnecessary and prolonged hospitalisation.

Objectives: Objectives of this study were to evaluate the pattern of antibiotic prescription for endodontic infections (EIs) among Italian dental practitioners (DPs), and to explore the role of potential predictors of antibiotic over-prescription. Methods: A nationwide cross-sectional survey was conducted between 1st April to 30th October 2019 using a structured questionnaire. Information was gathered on demographics and professional characteristics, and practices regarding antibiotic prescription both for therapeutic and prophylactic purposes. Results: Of the 1250 invited DPs, 563 answered the general questionnaire (response rate 52.6%). The proportions of DPs who prescribed an antibiotic without indication for therapeutic and prophylactic purposes is 33.3% and 30.2%, respectively. The acute alveolar abscess without systemic involvement represents the clinical scenario at high risk of over-prescription for therapeutic purposes. Possible predictors of over-prescribing included demographics and professional characteristics, and it was found to be higher in EIs without indication than in the cases in which the prescription is indicated for therapeutic purposes. The odds of over-prescription for prophylactic purposes were higher in the cases of acute apical periodontitis and lower in the cases of symptomatic irreversible pulpitis compared with acute and chronic alveolar abscess, in which the prescription is indicated. Conclusions: The main findings of the present study provide an up-to-date insight about the pattern of antibiotic prescriptions for EIs and evidence useful to identify opportunities to reduce over-prescription among DPs through tailored interventions. The development of practical antibiotic prescribing guidelines with a clear description of indications and regimens ease of use is strongly needed.

Antimicrobial resistance (AMR) is a threat to public health, impacting both human and animal health as well as the economy. This study sought to describe antibiotic prescription practices and use in the Kintampo North Municipal Veterinary Clinic in Ghana using routinely collected data. Of the 513 animals presented for care between 2013 and 2019, the most common animals were dogs (71.9%), goats (13.1%), and sheep (11.1%). Antibiotics were prescribed for 273/513 (53.2%) of the animals. Tetracycline was the most commonly prescribed class of antibiotics, (99.6%). Of the 273 animals that received antibiotics, the route of administration was not documented in 68.9%, and antibiotic doses were missing in the treatment records in 37.7%. Details of the antibiotic regimen and the medical conditions diagnosed were often not recorded (52.8%). This study recommends appropriate documentation to enable continuous audit of antibiotic prescription practice and to improve quality of use. There is also the need for a national survey on antibiotic prescribtion and use in animal health to support policy implementation and decision making in One-Health in Ghana.

Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia. Pneumonia accounted for approximately 16% of the 5.6 million under-five deaths word wide in 2016. In Uganda, it kills approximately 2,400 children per year. Early diagnosis and appropriate case management with rational use of antibiotics remain the most effective intervention to reduce pneumonia-related mortality. This study aimed at determining antibiotic prescription rationality and associated in-patient treatment outcomes in children aged 2–59 months with severe community-acquired pneumonia at Bwizibwera Health Centre IV from 1st May 2018 to 30th April 2019. Methods We conducted a retrospective cohort study design; data were collected from in-patient records of all children aged 2–59 months with severe community-acquired pneumonia who met the eligibility criteria for a period of one year. Data abstraction template was used for data collection. Health care records of children aged 2–59 months who had other co-morbidities and were on medication that could influence or impact on in-patient treatment outcomes from 1st May 2018 to 30th April 2019 were excluded. Data was entered and analyzed using Epi-info v 7.2 and STATA v 13.0 respectively, Descriptive statistics were reported and Chi-square test was used to compare the proportions. Results Of the total records of children retrieved and screened (N = 847), 229 prescription records of children fulfilled inclusion criteria, 57 (24.9%) had rational prescriptions with good outcomes and 172 (75.1%) had irrational prescriptions with 10 (4.4%) having unfavorable outcomes. The majority (73.7%) of those who received rational prescription were on treatment with a combination of benzyl penicillin plus gentamycin while (26.3%) were on ampicillin plus gentamycin. The majority (32.4%) of patients with good treatment outcomes were aged 6 – 11 months. This age category also doubled as the group that experienced the highest percentage (40.0%) of unfavorable outcomes. There were no statistically significant associations between patient characteristics and treatment outcomes. Conclusion In conclusion, the majority of children had irrational antibiotic prescriptions and 40 percent of children aged 6–11 Months had unfavorable treatment outcomes with 20 percent death. This study also found out that majority of antibiotic prescription among children under five was irrational and it’s against Uganda clinical guideline for treatment of severe pneumonia among children under five.

The objective of this study was to assess the impact of an education intervention for primary health care physicians, based on the knowledge of clinical practice guidelines and availability of rapid antigen detection test for group A streptococci (GAS), on the improvement of antibiotic prescription for patients with acute respiratory tract infections. Before and after the intervention, physicians collected data from ten consecutive patients who attended during a 3-week period. This process was performed twice a year for 6 consecutive years (2012–2017). A total of 18,001 patients were visited by 391 primary care physicians during the study period, 55.6% before intervention and 44.4% after intervention. After intervention, the antibiotic prescription decreased significantly, from 33.0 to 23.4% (p p

Mohammed A Alobaid,1 Saad Alobaid,2 Mohammed Alshahrani3 1Restorative Dental Science Department & Department of Dental Education, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 2Dental Department, Medical Services/King Khalid University Medical Hospital, Abha, Saudi Arabia; 3Dental Clinic in Primary Health Care Center, Ministry of Health, Abha, Saudi ArabiaCorrespondence: Mohammed A Alobaid Tel +966561343636Email moalobaid@outlook.com; manaseer@kku.edu.saAim: To assess the views of the dental interns (DIs) and general dental practitioners (GDPs) in the Asir region of Saudi Arabia on antibiotic prescription for endodontic therapy.Methods: The link to a cross-sectional online survey with 16 quantitative and qualitative questions was e-mailed to 60 DIs at the College of Dentistry of King Khalid University (group 1 [G1]) and 60 GDPs at the governmental primary healthcare centers in the Asir region of Saudi Arabia (group 2 [G2]). The data obtained from the survey were then subjected to a comparative statistical analysis. The inter-group statistical comparison of the distribution of categorical variables was tested using the chi square test or the Fisher’s exact probability test if more than 20% of the cells had an expected frequency of less than 5. The p-values > 0.05 were considered statistically significant. The data were statistically analyzed using Statistical Package for Social Sciences (SPSS version 22.0, IBM Corporation, USA) for MS Windows.Results: The response rate was 83.3% for G1 and 63.33% for G2. Of the participants in G2, 39.5% had 1– 5 years’ clinical experience (the participants in G1 had no clinical experience). The number of endodontic emergency patients seen per day was significantly higher in G1 (88% and 63.2% of the participants in G1 and G2, respectively, were seeing 0– 3 endodontic emergency patients per day). There was an insignificant difference between G1 and G2 in awareness of the existence of antibiotic prescription guidelines in endodontic therapy (57.9% and 56.0%, respectively; p > 0.05). There was also an insignificant difference between the groups in the rate of antibiotic prescription for endodontic problems, with 84% of the G1 participants and 86.8% of the G2 participants prescribing antibiotics only for limited patients. In the analysis of the clinical-vignette items (Q11– 16), it was found that the rate of antibiotic prescription did not significantly differ between G1 and G2 (p > 0.05). No significant difference was found in the rate of antibiotic prescription for symptomatic reversible pulpitis, symptomatic irreversible pulpitis, and chronic apical periodontitis cases (p > 0.05). In contrast, the rate of antibiotic prescription for the symptomatic apical periodontitis, acute apical abscess, and systemic complications cases differed significantly (8% for G1 and 18.4% for G2, 54% for G1 and 76.3% for G2, and 98% for G1 and 73.7% for G2, respectively).Conclusion: No significant difference in the rate of antibiotic prescription was found between the DIs and GDPs in this study. However, both groups showed an inappropriate rate of antibiotic prescription for some endodontic conditions. Further and more extensive studies involving a wider geographical region and different colleges of dentistry in Saudi Arabia are recommended.Keywords: antibiotic in endodontics, antibiotic prescription, antibiotic over-use, antibiotics

The objectives of the present study were to provide a snapshot analysis of antibiotic appropriateness in two hospitals in Southern Italy in three specific areas, surgical, medical and intensive care, and to evaluate the risk factors associated with inappropriateness in antimicrobial prescriptions. We conducted a multicentre observational study in two hospitals in the Campania region. We collected data of all patients admitted on the day of evaluation to antibiotic therapy or prophylaxis through a case report form. The primary outcome was to assess the inappropriateness of antibiotic prescribing, related to the spectrum, dose, route of administration and duration of treatment—in particular, to assess whether there was a difference in the adequacy of the prescriptive practice in the medical, surgical and intensive sectors. Prescriptive inappropriateness was more frequently observed in surgical units (79.8% of the 104 antimicrobial prescriptions) than in medical units (53.8% of the 65 prescriptions, p = 0.0003) or in intensive care units (64.1% of the 39 prescriptions, p = 0.052). The reasons for the inappropriate antimicrobial prescriptions were similar in the three areas evaluated: antimicrobial unnecessary and antimicrobial not recommended were the most frequent reasons for inappropriateness. Not participating in an antimicrobial stewardship program (ASP) was identified as a factor associated with inappropriate antimicrobial prescriptions in medical and surgical units, but not in Intensive Care Units (ICUs). ASPs may enhance the appropriateness of antimicrobial prescriptions especially in medical and surgical units. In ICUs, specific programs able to limit empirical therapies and encourage the collection of microbiological samples may be useful to set up targeted therapies and to design antimicrobial protocols.