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Mohammed Abdulhai Abuhassna,1 Hadeel Abdullah Aldajani,2 Khalil Wassam AlQahtani,3 Arwa Khader Alzahrani,4 Deena Abdullah AlAwwad,5 Oubada Suliman,6 Mona Talal Rajeh,7 Sajna Ashraf,8 Sadeq Ali Al-Maweri9 1Restorative Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia; 2Ministry of Health, Riyadh, Saudi Arabia; 3Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia; 4Faculty of Dentistry, Umm Alqura University, Makkah, Saudi Arabia; 5College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia; 6Prosthodontics Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia; 7Dental Public Health Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Oral Medicine and Diagnostic Sciences, Vision Colleges, Riyadh, Saudi Arabia; 9College of Dental Medicine, QU Health, Qatar University, Doha, QatarCorrespondence: Sadeq Ali Al-Maweri, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar, Tel +974 33838572, Email Sadali05@hotmail.com; salmaweri@qu.edu.qaBackground: Antibiotics are widely used in dental practice, especially for endodontic infections. The present survey aimed to investigate the knowledge and practices of dental interns in Saudi Arabia regarding antibiotic prescription for endodontic treatment.Methods: The present online questionnaire-based, cross-sectional study involved dental interns in private and public dental schools, Saudi Arabia. A pre-validated questionnaire was distributed to 900 dental interns via different social media platforms. The questionnaire consisted of 16 close-ended questions related to participants’ demographic data and knowledge and practices of antibiotic prescription in context of endodontic treatments. Data were managed and analyzed using IBM-SPSS version 25, and Chi-square test was used to compare between the groups.Results: A total of 555 dental interns completed the questionnaire, giving a response rate of 61.1%. Overall, the surveyed participants revealed inadequate knowledge and unnecessary use of antibiotics during endodontic procedures. While majority of the participants (75.3%) correctly identified the first choice of antibiotics during endodontic treatments, a considerable proportion of the participants did not recognize the clinical indications of antibiotics in endodontic patients. Additionally, around one-fifth (18.9%) of the participants were unaware of the potential side effects of the prescribed antibiotics.Conclusion: The present survey revealed unsatisfactory knowledge and practices of antibiotic prescription in context of endodontic therapy among Saudi dental interns. Therefore, dental schools in Saudi Arabia should address such a gap through updating the curriculum and integrating real-world clinical scenarios using problem-based learning. Additionally, periodic continuous education courses aiming at improving dental professionals’ knowledge about antibiotics and their clinical uses for endodontic therapy are highly encouraged.Keywords: antibiotic prescription, knowledge, practices, dental interns

Abstract Background Although self-limiting viral infections are predominant, children with acute infections are often prescribed antibiotics by family physicians. The aim of the study is to evaluate the impact of two interventions, namely C-reactive protein point-of-care testing and educational training, on antibiotic prescribing by family physicians. Methods This randomised controlled intervention study included acutely ill children consulted by 80 family physicians from urban and rural practices in Latvia. The family physicians were divided into two groups of 40. The family physicians in the intervention group received both interventions, i.e. C-reactive protein point-of-care testing and educational training, whereas the family physicians in the control group continued to dispense their standard care. The primary outcome measure was the antibiotic prescribing at the index consultation (delayed or immediate prescription) in both study groups. The secondary outcome was CRP testing per study group. Patient- and family physician- related predictors of antibiotic prescribing were analysed as associated independent variables. Practice location effect on the outcomes was specially addressed, similar to other scientific literature. Results In total, 2039 children with acute infections were enrolled in the study. The most common infections observed were upper and lower respiratory tract infections. Overall, 29.8% (n = 607) of the study population received antibiotic prescription. Our binary logistic regression analysis did not find a statistically significant association between antibiotic prescriptions and the implemented interventions. In the control group of family physicians, a rural location was associated with more frequent antibiotic prescribing and minimal use of CRP testing of venous blood samples. However, in the intervention group of family physicians, a rural location was associated with a higher level of C-reactive protein point-of-care testing. Furthermore, in rural areas, a significant reduction in antibiotic prescribing was observed in the intervention group compared with the control group (29.0% (n = 118) and 37.8% (n = 128), respectively, p = 0.01). Conclusion Our results show that the availabilty of C-reactive protein point-of-care testing and educational training for family physicians did not reduce antibiotic prescribing. Nevertheless, our data indicate that regional variations in antibiotic-prescribing habits exist and the implemented interventions had an effect on family physicians practices in rural areas.

To study the influence of demographic and organizational factors to antibiotic utilization in dental implant surgery in Sweden. Descriptive statistics regarding antibiotic prescription between 2009 and 2019 was retrieved from two national registers, the Swedish Prescribed Drug Register and the Dental Health register, both administered by the National Board of Health and Welfare. During the years 2009–2019 a significant decrease of the proportion of prescriptions of systemic antibiotics in conjunction with implant surgical procedures occurred in all patient groups where the most common procedure was the insertion of a single implant. The proportion of dental visits when implant surgical treatment was performed which resulted in a prescription of antibiotics decreased significantly from 1/3 to approximately 1/5. However, comparing Public and Private dental care providers, the reduction was significantly greater in Public dental care. Patients with low level of education in urban regions, treated in Private dental clinics were more likely to receive antibiotics in conjunction to implant surgery compared to other groups. Phenoxymethylpenicillin is the most widely used substance in conjunction with implant surgery. There is still room for improvement in reduction of antibiotic prescriptions in conjunction to implant surgical procedures in Sweden. [ABSTRACT FROM AUTHOR]

Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32–36 gestation weeks), and 58 very-to-extreme preterm infants (<32 gestation weeks). Infants' attachment was observed with the Ainsworth Strange Situation's experimental paradigm at 12 months of corrected age. Findings indicate that infant attachment strategy is associated with antibiotics uptake, but results vary across samples. The proportion of infants that used antibiotics is highest among ambivalent-attached infants in the full-term sample but highest among avoidant-attached infants in the very-to-extreme premature sample. Moreover, higher infant gestational age and lower maternal sensitivity determine higher antibiotic use. [ABSTRACT FROM AUTHOR]

Purpose: No consensus exists whether to administer prophylactic antibiotics in conjunction with manual placenta removal. This study aimed to investigate the postpartum risk of a new prescription of antibiotic treatment, a possible indirect variable for infection, after manual placenta removal. Methods: Obstetric data were merged with data from the Anti-Infection Tool (Swedish antibiotic registry). All vaginal deliveries (n = 13 877) at Helsingborg Hospital, Helsingborg, Sweden, from January 1st, 2014 until June 13th, 2019 were included. Diagnosis codes for infection can be lacking, while the Anti-Infection Tool is complete as it is unavoidable in the computerized prescription system. Logistic regression analyses were performed. The risk of a prescription of antibiotics 24 h to 7 days postpartum was analyzed in the entire study population, and in a subgroup of women not having received any antibiotics 48 h prior to delivery until 24 h after delivery, referred to as "antibiotic-naïve." Results: Manual placenta removal was associated with an increased risk of an antibiotic prescription, adjusted (a) OR = 2.9 (95%CI 1.9–4.3). In the antibiotic-naïve subgroup, manual placenta removal was associated with an increased risk of antibiotic prescription, in general, aOR = 2.2 (95%CI 1.2–4.0), endometritis-specific antibiotics, aOR = 2.7 (95%CI 1.5–4.9), and intravenous antibiotics, aOR = 4.0 (95%CI 2.0–7.9). Conclusion: Manual placenta removal is associated with an increased risk of antibiotic treatment postpartum. An antibiotic-naïve population might benefit from prophylactic antibiotics to reduce the risk of infection, and prospective studies are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Antibiotics are synthetic or natural substances used to treat bacterial infectious diseases. When used incorrectly, they can be a factor in the development of antimicrobial resistance, increased treatment time, costs, and mortality. The present study aimed to assess the pattern of inappropriate use of antibiotics and their predictors in pediatric patients admitted to the Central Hospital in Nampula, Mozambique. Methods A cross-sectional, retrospective study with a quantitative approach was conducted between January and July 2019. The population consisted of children ages 0–10 years hospitalized in the pediatric ward I. Binary logistic regression was used to determine risk factors for the inappropriate use of antibiotics with 95% confidence interval. Results The prevalence of antibiotic use among pediatric patients was 97.5%. Of the 464 antibiotics prescribed, 39.9% were for patients suffering from gastroenteritis, 21.8% and 9.1% for those affected with pneumonia and malaria, respectively. Most antibiotics were for parenteral use (95.9%, 445/464). Many (36.5%) of the prescriptions had errors, primarily in the duration of treatment (74.0%) or dosage (24.4%). Binary logistic regression analysis revealed that patients prescribed ≥ 3 antibiotics (OR = 2.83, 95% CI 1.245–6.462, p-value = 0.013) or hospitalized for a short time (OR = 1.88, 95% CI 1.133–2.3140, p-value = 0.015) were more likely to experience inappropriate use of antibiotics. Conclusion The study showed both a high prevalence of antibiotic use and a high error rate in prescriptions, especially among patients prescribed ≥ 3 antibiotics or hospitalized for a short time. These results are concerning, since inappropriate and excessive use of antibiotics is a major factor in the development of antibiotic-resistant microorganisms. Therefore, policies to reduce the inappropriate and excessive use of antibiotics are necessary.

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.

Introduction: Dentists rely on antibiotics for the treatment of a wide variety of dental conditions. General dental practitioners prescribe antibioticsinappropriately both therapeutically and prophylactically. There is a dire need for dentists to prescribe antibiotics responsibly. Material & Methods: A cross sectional descriptive study was conducted on 150 dental practitioners of Sharif Medical and Dental College, SMDC, Lahore using a validated questionnaire. The practices were classified as poor (0-2), bad (3-5) and good (6-8). Knowledge of the participants was classified as poor (0-7), bad (8-14) and good (15-22). SPSS version 23 was used for analysis. Chi square and Fisher exact test were used to find out statistical association between levels of practice and knowledge with antibiotic prescription trends for dental problems. Results: Majority of the respondents (86.7%) had good knowledge regarding antibiotic prescription while 13.3 % had bad knowledge and 93.3% of the dentists demonstrated good practice of antibiotic prescription while none had poor practices. Majority of the dental practitioners (87.3%) prescribed antibiotics as post-operative prophylaxis. The association between knowledge and antibiotic prescription for fever (p=0.032), localized swelling (p=0.003), diffused swelling (0.0025), Root canal treatment (p=0.027), tooth fracture (p= 0.041), delayed treatment (p=0.026) and acute pulpitis (p=0.057) were found to be significant. Conclusion: The most common dental problem for which dentists prescribed antibiotics was post-operative prophylaxis followed by diffused oral swelling. Most of the dentists had good knowledge and practices regarding antibiotic prescription.

Background: Dental students engage in prescribing antibiotics, which, worldwide, are overprescribed. Purpose: To evaluate knowledge, attitudes and practices of antibiotic prescription through a survey in students of the eighth and ninth semester of Dentistry. Methods: Analytical cross-sectional study that recorded information at a single moment without interfering in the sample, seeks to explain the association between level of knowledge in antibiotic prescription with sex and semester, the study was conducted on 109 students, with a non-probabilistic sample. In Google Forms, a survey was conducted taken from the article by Cortés & Montenegro sent to institutional emails on knowledge, attitudes and practices of antibiotics in four domains: characterization of medical practice, knowledge about the diagnostic process, attitudes of the respondents regarding claims, practices in antibiotic use. Data were analyzed in SPSS statistical package version 26.0. Pearson's Chi square and Student's t-test were performed with a 5 % significance level. Findings: 43.1 % of students had a poor level of knowledge about antibiotic prescription, 46.8 % had a regular level of knowledge, and 10.1 % had an acceptable level of knowledge. A level of significance p=0.77 was found between level of knowledge with sex and p>0.40 between level of knowledge with semester. Conclusions: Eighth semester Dentistry students showed a better level of knowledge in antibiotic prescription; while, in relation to sex, women had better results and the level of significance indicates that there is no relationship between the level of knowledge with semester and sex. [ABSTRACT FROM AUTHOR]

Antibiotic resistance (ABR) is defined as bacteria's resistance to therapy despite therapeutic levels of antibiotics. It is a global health concern. Data on the antibiotic prescription practice of physicians, in general, are limited in Saudi Arabia. Therefore, we aim to assess the knowledge, attitude, and practice of antibiotic prescription between surgical and non-surgical residents at King Abdulaziz Medical City (KAMC). A cross-sectional study was conducted at KAMC in Jeddah, Saudi Arabia, from September 2019, until March 2020. The questionnaire contained demographic information and 31 questions based on the studied variables: knowledge (17), attitude (4), and practice (10). The response rate was 83 %. Male to female response rates were 54 % and 46 %, respectively. The majority of respondents (72 %) were non-surgical residents. Positive practice skills showed that 55 % of all healthcare residents always used practice guidelines for antibiotic prescription in their daily work (P-value < 0.001). Most residents (50 %) sometimes used delayed prescriptions. Non-surgical residents discussed ABR with patients more than surgical residents (P-value = 0.028). Lack of patient interest was the common cause for not discussing ABR with patients (42 %). Non-surgical residents had significantly more training on antibiotic prescription (p-value = 0.001). The fear of infection spread due to not prescribing an antibiotic was significantly higher in non-surgical residents (P-value < 0.001). Non-surgical residents (76 %) took a past medical history of antibiotic consumption more than surgical residents (24 %) (P-value = 0.003). Antibiotic prescription for residents was not influenced by advertisements (91 %). The most common resistant organisms reported by residents were insignificant between the two groups. The results also showed that the residents' common choice of antibiotics was not statistically different between surgical and non-surgical residents in most antibiotic classes. We found that practice guidelines, formal training, and taking patients' past medical histories were significantly higher among non-surgical residents. In contrast, surgical residents were prescribing more antibiotics due to the fear of the spread of the infection. Proper training is essential for all healthcare residents to overcome differences among different specialties. [ABSTRACT FROM AUTHOR]

Objective: To develop a treatment algorithm for patients with penicillin allergy., Methods: Retrospective study, carried out in adult patients with penicillin allergy, who were in group 3 or 4 of the established classification, and attended the outpatient clinic of the Department of Pulmonology and Allergy of the Central Hospital of the Social Security Institute, between January 2021 and December 2022. Each patient underwent an amoxicillin provocation test, after obtaining informed consent., Results: 60 patients were registered, who were able to remove the penicillin allergy label and whose medical history was corrected, with financial benefits for the patient and the health service of Paraguay., Conclusions: Penicillin allergy labels can lead to irrational prescription of antibiotics, prolonged hospital stays, and increased need for consultation. Risk stratification, based on historical characteristics alone, is capable of safely identifying ideal patients for direct challenge testing. This study demonstrates the feasibility of the first penicillin delabeling program applicable in an outpatient setting, which can be performed even outside of hospital allergy services.

Rising antibiotic use is a serious threat to the success of therapy in dentistry for bacterial resistance and side effects to the patients. The dentist community in Albania prescribing too many antibiotics. This survey assesses the mode of antibiotic use among Albanian dentists, with appropriate dosage and regimen, and antibiotic stewardship and their knowledge of relevant guidelines. Material and Methods: This survey study was conducted among 180 Albanian dentists. The questionnaire was distributed through e-mail addresses found in the database of the Faculty of Dental Medicine, University of Medicine of Tirana. We assessed 180 dentists out of which 154 (85.56%) completed the entire questionnaire. Results: There were 24,870 prescriptions in adult patients from 154 dentists for a period of six months with an average of 1,243 prescriptions per week. The most used antibiotics were fixed combinations of amoxicillin–clavulanic acid (67.43%) and azithromycin (39.3%) for allergic patients to beta-lactams. The results for antibiotic stewardship were incorrect in 37.01% of total providers, and gastrointestinal disorders were reported as side effects. Conclusion: This survey conducted among Albanian dentists shows a different trend of using antibiotics than in other countries. To tackle the current antibiotic resistance, dentists must be an important part of the antimicrobial stewardship program of the Public Health Institution in Albania to change individual behavior.

Background: Lower respiratory tract infections (LRTIs) and community-acquired pneumonia (CAP) are among the most frequent reasons for referrals to the pediatric emergency department (PED). The aim of this study is to describe the management of antibiotic prescription in febrile children with LRTI or CAP admitted to a third-level PED and to investigate the different variables that can guide physicians in this decision-making. Methods: This is an observational, retrospective, monocentric study including patients < 14 years old who were presented to the PED for a febrile LRTI or CAP during the first six months of the year 2017. Demographic and clinical data, PED examinations, recommended therapy, and discharge modality were considered. Two multivariate logistic regression analyses were performed on patients with complete profiles to investigate the impact of demographic, laboratory, and clinical variables on antibiotic prescription and hospital admission. Results: This study included 584 patients with LRTI (n = 368) or CAP (n = 216). One hundred and sixty-eight individuals (28.7%) were admitted to the hospital. Lower age, higher heart rate, and lower SpO2 were associated with an increased risk of hospitalization. Antibiotics were prescribed to 495 (84.8%) patients. According to the multivariate logistic regression, the diagnosis and duration of fever were substantially linked with antibiotic prescription. Conclusions: The present study reports real-life data about our PED experience. A high rate of antibiotic prescription was noted. In the future, it is necessary to improve antibiotic stewardship programs to increase clinical adherence to guidelines.

To investigate systemic antibiotics utilization in emergency dental care and to determine the most common treatment measures performed during emergency visits in public versus private emergency care in Sweden. Two questionnaires were answered by dentists at one large public and one large private emergency dental clinic in Stockholm, Sweden. The first questionnaire pertained to the emergency care provided to patients (n = 1023) and the second concerned the dentists' (n = 13) own knowledge and attitudes towards antibiotic treatment and oral infections. The results of the questionnaires were tested using a Chi-square test. Sixteen percent of all patients seeking emergency dental treatment received antibiotics. The most common overall reason for visiting an emergency clinic was pain (52%, n = 519). The most common diagnoses made by the participating dentists in the public clinic were tooth/filling fracture (17%, n = 91) and gingivitis (14%, n = 76), while in the private clinic they were tooth fracture (29%, n = 146) and symptomatic apical periodontitis (15%, n = 72). Although the number of patients with infection was higher in the public care clinic, there was no significant difference in total number of antibiotic prescriptions between the two clinics. The rate of patients receiving antibiotic prescription as sole treatment was 41% (n = 34) in private care and 31% (n = 18) in public care. Thirty-one percent (n = 4) of dentists prescribed antibiotics for patients with diagnoses normally not requiring antibiotics, citing reasons such as time limitation, patient request, patient travel, patient safety, and follow-up not possible. Although antibiotic prescription frequency among the Swedish emergency care dentists participating in this study was low, areas for improvement could include providing education to improve dentists' knowledge on both antibiotic prescription in emergency dental care and treatment of acute oral infections. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is among the top ten global threats as declared by WHO in 2019. Irrational use of antibiotics has led to the evolution of resistant microbes. There is limited data in our setting regarding microbes and their antibiotic susceptibility patterns. This study determines predominant bacterial isolates, their susceptibility pattern and current practices among prescribers regarding change of empirical to definitive treatment following antibiotic susceptibility test (AST) results. Method: A retrospective observational study involving 171 culture and AST reports of inpatients admitted between Jan-Dec 2020 in a tertiary-care hospital in Dar-es-Salaam. Results: Of 171 specimens, 52.6% were culture-positive. The frequently isolated organisms included Klebsiella species (21.1%), Escherichia coli (18.9%) and Staphylococcus aureus (14.4%). Of these, Gram-negative isolates showed high rates of resistance against third-generation cephalosporins (71.7%) whereas Gram-positive isolates showed high rates of resistance against penicillins (100%). More than half (58.1%) of the patients with positive culture had changes in antibiotics from empirical to definitive treatment that did not match the AST results. Conclusion: Varied rates of resistance to fourth-generation cephalosporin by the majority of bacterial isolates are alarming. This calls for the establishment of antimicrobial stewardship programs to cater for optimal and rational use of antibiotics by consumers and prescribers. [ABSTRACT FROM AUTHOR]

Background: Although self-limiting viral infections are predominant, children with acute infections are often prescribed antibiotics by family physicians. The aim of the study is to evaluate the impact of two interventions, namely C-reactive protein point-of-care testing and educational training, on antibiotic prescribing by family physicians.Methods: This randomised controlled intervention study included acutely ill children consulted by 80 family physicians from urban and rural practices in Latvia. The family physicians were divided into two groups of 40. The family physicians in the intervention group received both interventions, i.e. C-reactive protein point-of-care testing and educational training, whereas the family physicians in the control group continued to dispense their standard care. The primary outcome measure was the antibiotic prescribing at the index consultation (delayed or immediate prescription) in both study groups. The secondary outcome was CRP testing per study group. Patient- and family physician- related predictors of antibiotic prescribing were analysed as associated independent variables. Practice location effect on the outcomes was specially addressed, similar to other scientific literature.Results: In total, 2039 children with acute infections were enrolled in the study. The most common infections observed were upper and lower respiratory tract infections. Overall, 29.8% (n = 607) of the study population received antibiotic prescription. Our binary logistic regression analysis did not find a statistically significant association between antibiotic prescriptions and the implemented interventions. In the control group of family physicians, a rural location was associated with more frequent antibiotic prescribing and minimal use of CRP testing of venous blood samples. However, in the intervention group of family physicians, a rural location was associated with a higher level of C-reactive protein point-of-care testing. Furthermore, in rural areas, a significant reduction in antibiotic prescribing was observed in the intervention group compared with the control group (29.0% (n = 118) and 37.8% (n = 128), respectively, p = 0.01).Conclusion: Our results show that the availabilty of C-reactive protein point-of-care testing and educational training for family physicians did not reduce antibiotic prescribing. Nevertheless, our data indicate that regional variations in antibiotic-prescribing habits exist and the implemented interventions had an effect on family physicians practices in rural areas. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare antibiotic prescription rates in Denmark among elderly living in long-term care facilities to elderly living at home, with regards to total antibiotic use and antibiotic use for urinary tract infection. This is an observational registry-based study. The study population included all elderly Danish residents aged ≥75 years in 2016. Linear regression models were used to examine the difference in antibiotic prescription rates between elderly living in long-term care facilities and elderly living at home. Results were adjusted for age, sex and comorbidity, the latter assessed via the Charlson Comorbidity Index. The study population consisted of 416,627 elderly. Regression models showed that elderly living in long-term care facilities were prescribed 1.7 [CI 1.7–1.7] prescriptions/individual/year more than elderly living at home. For urinary tract infections the difference between elderly living in long-term care facilities and elderly living at home was 1.2 [CI 1.2–1.3] prescriptions/individual/year. Elderly living in long-term care facilities have a higher antibiotic prescribing rate than elderly living at home, despite controlling for age, sex and comorbidity. This indicates that long-term care facilities continuously should be a focus for antibiotic stewardship interventions. [ABSTRACT FROM AUTHOR]

Introduction: Long-term repercussions of Coronavirus Disease- 2019 (COVID-19) on antimicrobial resistance have been raised as a grave concern due to the rampant use of antibiotics in the management of COVID-19. As per meta-analysis, the prevalence of antibiotic prescribing was 74.6% which was significantly higher than the estimated prevalence of bacterial co-infection. World Health Organisation (WHO) recommended that antibiotic therapy should not be used in patients with mild/moderate COVID-19 unless there is any bacterial suspicion. Also, the guidelines laid down by the Ministry of Health and Family Welfare, Government of India, does not recommend systematic empiric antibiotic therapy in patients hospitalised with COVID-19. Despite not being recommended, antimicrobials are still given in clinical practice. Aim: To analyse prescriptions for antimicrobials and to identify potential predictors for antibiotic prescription. Materials and Methods: A retrospective observational study was conducted at a tertiary care teaching institute. Data (demographic profile, co-morbidities, disease category, prescribed antimicrobials, laboratory investigations, and duration of hospital stay) were collected from case files of patients with laboratory-confirmed Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. These patients were admitted in the institute from January 2021 to May 2021. Logistic regression was used to analyse factors associated with the empirical use of antimicrobial agents. Results: A total of 184 case files were analysed. The mean age of patients was 55.84±15.72 years, with a male preponderance (70.10%). Among antimicrobials, antivirals were prescribed in 159 (86.41%) patients, and antibiotics in 152 patients (82.6%). Antivirals prescribed include Remdesivir [109(68.55%)] and Favipiravir [70(44.02%)]. Ceftriaxone was found to be the highest prescribed antibiotic, with a median duration of administration of six days. An association was found between disease severity and CRP level with antibiotic prescription. On multivariable analysis, the odds of receiving antibiotics were 6.7 times higher in patients with severe disease. Conclusion: More than 80% of COVID-19 patients received antibiotics. Duration of hospital stay was similar among patients whether they received antibiotics or not. Disease severity and raised CRP level were strong predictors for prescribing antibiotics for COVID-19. [ABSTRACT FROM AUTHOR]

Antibiotic resistance remains a crucial global public health problem with excessive and inappropriate antibiotic use representing an important driver of this issue. Strategies to improve antibiotic prescription and dispensing are required in primary health care settings. The main purpose of this review is to identify and synthesize available evidence on the economic impact of educational interventions to reduce prescription and dispensing of antibiotics among primary health care professionals. Information about the clinical impact resulting from the implementation of interventions was also gathered. PubMed, Scopus, Web of Science and EMBASE were the scientific databases used to search and identify relevant studies. Of the thirty-three selected articles, most consisted of a simple intervention, such as a guideline implementation, while the others involved multifaceted interventions, and differed regarding study populations, designs and settings. Main findings were grouped either into clinical or cost outcomes. Twenty of the thirty-three articles included studies reporting a reduction in outcome costs, namely in antibiotic cost and associated prescription costs, in part due to an overall improvement in the appropriateness of antibiotic use. The findings of this study show that the implementation of educational interventions is a cost-effective strategy to reduce antibiotic prescription and dispensing among primary healthcare providers. [ABSTRACT FROM AUTHOR]

This study investigated the association between the COVID-19 pandemic and antibiotic prescription ratios and the determinants of antibiotic prescription in the community. The study was based on a retrospective population cohort of adults in a community setting. Antibiotic prescription ratios from March 1, 2020 to February 28, 2021 (COVID-19 period) were compared to similar months in previous years. Differences in visit type, infectious disease–related visit, and antibiotic prescription ratios during these visits were compared. A logistic regression model was used to identify independent determinants of antibiotic prescription during the study period. The cohort included almost 3 million individuals with more than 33 million community medical encounters per year. In the COVID-19 period, the antibiotic prescription ratio decreased 45% (from 34.2 prescriptions/100 patients to 19.1/100) compared to the previous year. Visits due to an infectious disease etiology decreased by 10% and prescriptions per visit decreased by 39% (from 1 034 425 prescriptions/3 764 235 infectious disease visits to 587 379/3 426 451 respectively). This decrease was observed in both sexes and all age groups. Telemedicine visits were characterized by a 10% lower prescription ratio compared to in-person visits. Thus, a threefold increase in telemedicine visits resulted in a further decrease in prescription ratios. The COVID-19 period was independently associated with a decrease in antibiotic prescription, with an OR of 0.852 (95% CI 0.848–0.857). We describe a significant decrease in antibiotic prescription ratios during the COVID-19 periods that was likely related to a decrease in the incidence of certain infectious diseases, the transfer to telemedicine, and a change in prescription practices among community-based physicians. [Display omitted] [ABSTRACT FROM AUTHOR]

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

Abstract Rates of antibiotic-resistant bacteria have increased worldwide over recent years, but the Italian Institute of Health reported a disruption to this trend in 2021 compared with 2020. Children are often recipients of unnecessary antibiotic prescriptions, especially for respiratory tract infections (RTIs). During the initial phase of the COVID-19 pandemic, common RTIs substantially decreased, so it is conceivable that antibiotic prescriptions also reduced during this time. To test this hypothesis, we retrospectively collected data on all visits to a pediatric primary care clinic in Northern Italy from February 20, 2020 to June 2, 2020 and compared data with the same period in 2019. We evaluated the antibiotic prescription rate according to the diagnosis at discharge. While the total number of visits significantly decreased (1335 in 2020 vs. 4899 in 2019), there was only a slight reduction in the antibiotic prescription rate (1039 in 2019, 21.2%, vs. 272 in 2020, 20.4%). However, this corresponded to a 73.8% decrease in the total number of antibiotic prescriptions, with antibiotics for RTI accounting for 69% of the total reduction. It is possible that, at the larger scale, reduced antibiotic prescription in pediatrics during the COVID-19 pandemic resulted in a slight reduction in antimicrobial resistance.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Introduction: Long-term repercussions of Coronavirus Disease-2019 (COVID-19) on antimicrobial resistance have been raised as a grave concern due to the rampant use of antibiotics in the management of COVID-19. As per meta-analysis, the prevalence of antibiotic prescribing was 74.6% which was significantly higher than the estimated prevalence of bacterial co-infection. World Health Organisation (WHO) recommended that antibiotic therapy should not be used in patients with mild/moderate COVID-19 unless there is any bacterial suspicion. Also, the guidelines laid down by the Ministry of Health and Family Welfare, Government of India, does not recommend systematic empiric antibiotic therapy in patients hospitalised with COVID-19. Despite not being recommended, antimicrobials are still given in clinical practice. Aim: To analyse prescriptions for antimicrobials and to identify potential predictors for antibiotic prescription. Materials and Methods: A retrospective observational study was conducted at a tertiary care teaching Institute, Nagpur, Maharashtra, India. Data (demographic profile, co-morbidities, disease category, prescribed antimicrobials, laboratory investigations, and duration of hospital stay) were collected from case files of 184 patients with laboratory-confirmed Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. These patients were admitted in the institute from January 2021 to May 2021. Logistic regression was used to analyse factors associated with the empirical use of antimicrobial agents. Results: A total of 184 case files were analysed. The mean age of patients was 55.84±15.72 years, with a male preponderance (70.10%). Among antimicrobials, antivirals were prescribed in 159 (86.41%) patients, and antibiotics in 152 patients (82.6%). Antivirals prescribed include Remdesivir [109 (68.55%)] and Favipiravir [70 (44.02%)]. Ceftriaxone was found to be the highest prescribed antibiotic, with a median duration of administration of six days. An association was found between disease severity and CRP level with antibiotic prescription. On multivariable analysis, the odds of receiving antibiotics were 6.7 times higher in patients with severe disease. Conclusion: More than 80% of COVID-19 patients received antibiotics. Duration of hospital stay was similar among patients whether they received antibiotics or not. Disease severity and raised CRP level were strong predictors for prescribing antibiotics for COVID-19.

Objectives: To assess appropriate antibiotics use in neonatal sepsis and to highlight the need for developing an Antibiotic stewardship program at local levels. Methods: A clinical audit was conducted in the neonatal ward of the tertiary care hospital of Lahore for one year from May 2019 to May 2020. Reports of blood culture and drugs susceptibility were gathered from the microbiology department, and clinical records were evaluated about the choice of the antimicrobials, dosage, frequency, and clinical prognosis. The statistics were applied using SPSS software. Results: Eighty five neonates with the mean age of five days were treated in tertiary care hospital for septicemia. Every patient received more than one antibiotic empirically. The most prescribed drug combination (90.6%) was Cefotaxime and Amikacin. Optimum antibiotics dose was prescribed in only 70.2% of cases. Blood isolates showed gram-negative bacilli in 69 (81.2%) cases, gram positive cocci in 14 (16.5%) cases, two (2.3%) culture susceptibility reports showed growth of candida. Gram negative organisms were most susceptible to Imipenem (54%), Piperacillin-Tazobactam (48%) and Gentamicin (48%). Gram-positive organisms showed the most susceptibility to Vancomycin (100%), Amikacin (92%), and Co-amoxiclav (85%). Meropenem (39%), Linezolid (28%), and Vancomycin (27%) were the most commonly given alternate antibiotics. All the patients (n=10, 11.8%) whose culture sensitivity reporting showed susceptibility to empirical therapy survived. Conclusion: Due to poor availability of latest data about local antibacterial resistance pattern and lack of knowledge among pediatricians about latest antibiotic prescribing protocols, many inconsistencies were noted in the use of antibiotics in neonatal sepsis which resulted in a poor outcome hence, reflecting in international key health indicators (neonatal mortality rate) of country. Concerning the change in the resistance pattern of microorganisms to antimicrobials, it is high time to collect local data about antibacterial susceptibility and develop an antibiotic stewardship program to stop inappropriate use of antibiotics. [ABSTRACT FROM AUTHOR]

This study aims to examine the antibiotics prescription in endodontic infections amongst dentists. The questionnaire was carried out by asking 149 Iraqi dentists to fill out an online form, which was sent to them through several social media platforms. The paper-based questionnaire composed of seven questions was distributed to dentists. A statistically significant difference (P<0.05) was identified among dentists with different years of experience in terms of antibiotic prescription among patients with endodontic infection. Surprisingly, when asked to decide on the correct prescription suitable for patients without medical allergy, 51.68% selected the wrong prescription as the answer and 48.32% selected the correct one. While for the patients with medical allergies, there was a significant difference (P<0.05) among dentists who have many years of experience who selected the best answer in terms of the antibiotic prescription for allergic patients. The endodontic infection can be treated by cleaning the root canal system to remove the intracanal infection. However, over-prescribed antibiotics are still prevalent without any rational justification and antibiotic abuse is spreading globally leading to microbial antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: Antibiotics are synthetic or natural substances used to treat bacterial infectious diseases. When used incorrectly, they can be a factor in the development of antimicrobial resistance, increased treatment time, costs, and mortality. The present study aimed to assess the pattern of inappropriate use of antibiotics and their predictors in pediatric patients admitted to the Central Hospital in Nampula, Mozambique. Methods: A cross-sectional, retrospective study with a quantitative approach was conducted between January and July 2019. The population consisted of children ages 0–10 years hospitalized in the pediatric ward I. Binary logistic regression was used to determine risk factors for the inappropriate use of antibiotics with 95% confidence interval. Results: The prevalence of antibiotic use among pediatric patients was 97.5%. Of the 464 antibiotics prescribed, 39.9% were for patients suffering from gastroenteritis, 21.8% and 9.1% for those affected with pneumonia and malaria, respectively. Most antibiotics were for parenteral use (95.9%, 445/464). Many (36.5%) of the prescriptions had errors, primarily in the duration of treatment (74.0%) or dosage (24.4%). Binary logistic regression analysis revealed that patients prescribed ≥ 3 antibiotics (OR = 2.83, 95% CI 1.245–6.462, p-value = 0.013) or hospitalized for a short time (OR = 1.88, 95% CI 1.133–2.3140, p-value = 0.015) were more likely to experience inappropriate use of antibiotics. Conclusion: The study showed both a high prevalence of antibiotic use and a high error rate in prescriptions, especially among patients prescribed ≥ 3 antibiotics or hospitalized for a short time. These results are concerning, since inappropriate and excessive use of antibiotics is a major factor in the development of antibiotic-resistant microorganisms. Therefore, policies to reduce the inappropriate and excessive use of antibiotics are necessary. [ABSTRACT FROM AUTHOR]

Background: The rise of multi-drug-resistant pathogens and nosocomial infections among hospitalized patients is partially attributed to the increased use of antibiotic therapy. A prediction model for in-hospital antibiotic treatment could be valuable to target preventive strategies. Methods: This was a retrospective cohort study, including patients admitted in 2018 to medical departments and not treated with antibiotics during the first 48 h. Data available at hospital admission were used to develop a logistic model to predict the probability of antibiotic treatment during hospitalization. The performance of the model was evaluated in two independent validation cohorts. Results: In the derivation cohort, antibiotic treatment was initiated in 454 (8.1%) out of 5592 included patients. Male gender, lower functional capacity, prophylactic antibiotic treatment, medical history of atrial fibrillation, peripheral vascular disease, solid organ transplantation, chronic use of a central venous catheter, urinary catheter and nasogastric tube, albumin level, mental status and vital signs at presentation were identified as predictors for antibiotic use during hospitalization and were included in the prediction model. The area under the ROC curve (AUROC) was 0.72 (95% CI 0.70–0.75). In the highest probability group, the percentage of antibiotic treatment was 18.2% (238/1,307). In the validation cohorts, the AUROC was 0.73 (95% CI 0.68–0.77) and 0.75 (95% CI 0.72–0.78). In the highest probability group, the percentage of antibiotic treatment was 12.5% (66/526) and 20.7% (244/1179) of patients. Conclusions: Our prediction model performed well in the validation cohorts and was able to identify a subgroup of patients at high risk for antibiotic treatment. [ABSTRACT FROM AUTHOR]

Introduction: There has been a rise in the use of broad spectrum antibiotics in patients undergoing surgeries in perioperative period including clean surgeries. The use of such antimicrobials is also found to be longer than recommended and is responsible for emregence of multi drug resistant infections. These add to antibiotic related complications and cost as well. Aim: To study the type of antibiotic prescription in patients undergoing clean surgeries and assess compliance with antibiotic policy and frame recommendations for improvements if any. Method: Fifty five patients were prospectively evaluated for perioperative antibiotics prescriptions and followed up till discharge/1 month for any nosocomial infections or other complications. The kind and duration of antibiotics were noted and assessed for extent of compliance to antibiotic policy. Results and Discussions: Compliance to perioperative surgical prophylaxis in time was good (91%) as per the protocol and all patients received prophylaxis. Broad spectrum antibiotics were used in almost 50% cases and duration was prolonged compared to the prescribed protocol. Prescription of oral antibiotics was continued in 72.7% % cases(40/55). There was no increased incidence of health care associated infections(HAI) in these patients. Conclusion: Compliance to Surgical antibiotic prophylaxis practices in clean surgeries is good in the hospital Broad spectrum antibiotics were in use in more than half cases and oral antibiotics were prescribed at discharge in most patients which is not in accordance with the protocol. The incidences of HAIs in these cases were not increased. Regular audit and continued training of all stake holders is necessary to raise awareness and improve practices for antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Abstract Background In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

Rising antibiotic use is a serious threat to the success of therapy in dentistry for bacterial resistance and side effects to the patients. The dentist community in Albania prescribing too many antibiotics. This survey assesses the mode of antibiotic use among Albanian dentists, with appropriate dosage and regimen, and antibiotic stewardship and their knowledge of relevant guidelines. Material and Methods: This survey study was conducted among 180 Albanian dentists. The questionnaire was distributed through e-mail addresses found in the database of the Faculty of Dental Medicine, University of Medicine of Tirana. We assessed 180 dentists out of which 154 (85.56%) completed the entire questionnaire. Results: There were 24,870 prescriptions in adult patients from 154 dentists for a period of six months with an average of 1,243 prescriptions per week. The most used antibiotics were fixed combinations of amoxicillin–clavulanic acid (67.43%) and azithromycin (39.3%) for allergic patients to beta-lactams. The results for antibiotic stewardship were incorrect in 37.01% of total providers, and gastrointestinal disorders were reported as side effects. Conclusion: This survey conducted among Albanian dentists shows a different trend of using antibiotics than in other countries. To tackle the current antibiotic resistance, dentists must be an important part of the antimicrobial stewardship program of the Public Health Institution in Albania to change individual behavior. [ABSTRACT FROM AUTHOR]

It is common for dentists to prescribe antibiotics in order to treat dental infections, although there seems to be widespread abuse of antibiotics as a result of inappropriate usage and low adherence to the guidelines. Consequently, antimicrobial resistance among children, awareness needs to be raised. For this paper we reviewed the literature from 2000 to 2021, in databases PubMed, Scopus and Google Scholar. Therefore, this review aims to discuss the principles of antibiotic prescriptions and emphasizes the guidelines of use and misuse and to the prescribing patterns depending on the age and weight of our young patients. [ABSTRACT FROM AUTHOR]

Objective  This study's objective was to assess an antibiotic stewardship intervention, compare pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein [TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich [MUC]), and assess adherence to national guidelines. Methods  Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared, and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric infectious disease staff. Medical records were reviewed to describe antibiotic consumption, antibiotic dosages and length of use, and adherence to national guidelines. Pediatric antibiotic usage was compared between hospitals and patient groups. Results  After the ABS intervention, the use of second-generation cephalosporins decreased, while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic prescriptions over the 4 months study period in the non-university hospital showed a high administration rate of second-generation cephalosporins and extended-spectrum penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy [DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve group antibiotics were only given in the ICU. Adherence to national guidelines was highest in the NICU and pediatric ICU wards. Striking was the relatively high rate of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards of the non-university hospital (TS) and the university hospital (MUC), the prescription ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC), p  = 0.02. ABS intervention changed the choice of described antibiotics, but not the overall frequency. Conclusion  Adherence to national guidelines was highest in fields with standardized therapy recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones, were prescribed more frequently, probably due to higher severity of illness. These data indicate that the usage of antibiotics and adherence to national guidelines show a wide variety, but ABS interventions were effective in changing prescription behavior. [ABSTRACT FROM AUTHOR]

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p

Abstract 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.

Abstract Background Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 h and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n = 94, 29.8%), metronidazole (n = 79, 23.9%) and other antibiotics belonging to the penicillin class (n = 89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases. Conclusion Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.

Abstract Purpose Although various prophylactic and/or postoperative systemic antibiotic regimens have been suggested to minimize failure after dental implant placement and postoperative infection, the role of antibiotics in implant dentistry is still controversial. The purposes of this questionnaire study were to determine the current antibiotic prescribing habits of clinicians in conjunction with dental implant placement and to understand whether any consensus has been reached among implant surgery performing clinicians. Methods An electronic questionnaire was sent by electronic mail to all members of the Turkish Dental Society. The questions were related to whether antibiotics were routinely prescribed either pre- or/and postoperatively during routine dental implant placement. The respondents were also asked to specify their workplace and education. The results were analyzed using SPSS software. Descriptive and chi-square analyses were used to compare categorical data; Kruskal–Wallis test was used to compare the quantitative data by category. Results A total of 429 members responded to the questionnaire. The clinicians having more experience had a greater tendency to prescribe preoperative antibiotics (p < 0.001), but there was no statistically significant difference between the postoperative antibiotic prescription choice of the clinician according to the clinicians’ experience (p > 0.05). A total of 175 of the clinicians preferred to prescribe preoperative antibiotics when there was systemic comorbidity; 99 of the clinicians preferred to prescribe antibiotics before every implant surgery. The aminopenicillins were the most commonly prescribed antibiotics by the clinicians. A total of 38.58% of the respondents (n = 130) who were prescribing preoperative antibiotics, 2000 mg aminopenicillin was given 1 h before the surgical procedure. Dentists and solo private practitioners were prescribing more preoperative antibiotics (p < 0,05). Conclusions There was no consensus among clinicians regarding the use of antibiotics in association with routine dental implant placement. Aminopenicillins were the most commonly prescribed antibiotics for both pre- and postoperatively. Furthermore, most of the antibiotic regimens being used are not in accordance with the current published data.

Objectives: This study investigated causes of fever in the primary levels of care in Southeast Asia, and evaluated whether C-reactive protein (CRP) could distinguish bacterial from viral pathogens. Methods: Blood and nasopharyngeal swab specimens were taken from children and adults with fever (>37.5 °C) or history of fever (

Background: Globally, there has been an overall decline in the effectiveness of antibiotics resulting in an upsurge in bacterial resistance, increased cost of healthcare and consequent high morbidity and mortality rates. Objective: To determine antibiotic prescription practices among healthcare workers at the Kenyatta National Hospital, Mbagathi, Pumwani Maternity and Mama Lucy Kibaki Hospitals, Nairobi, Kenya. Methods: The study design was a mixture of quantitative and qualitative methods. Self-administered questionnaires were used to gather information from 230 prescribing healthcare workers. Interviews and Focus Group Discussions (FGDs) were conducted purposively with the prescribing healthcare workers and patients to obtain qualitative data. Results: There was a significant difference in the distribution of study participants with regards to the availability of antibiotics prescribing policy (p = 0.05). Only 53 (23%) prescribers prescribed antibiotics as per the policy guide while 51 (22.2%) did not and 126 (54.8%) were not sure. Oral antibiotics (OR = 0.5, 95%CI 0.3-0.9), always referring to the 2016 Kenya Essential Medicines List (KEML) to prescribe antibiotics (OR = 4.2, 95%CI 1.3-13.1), separating antibiograms for inpatient and outpatient departments (OR = 4.3, 95%CI 1.11-15.5), and confidence of healthcare workers to prescribe antibiotics without laboratory tests (OR = 0.3, 95%CI 0.2-0.8) were associated with the prescription of antibiotics. Conclusion: There is need to improve antibiotic prescription practices among healthcare workers in public tertiary hospitals in Nairobi County to promote rational antibiotic use and control bacterial resistance.

Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32–36 gestation weeks), and 58 very-to-extreme preterm infants (

Background: Antimicrobial resistance represents one of the most significant future health challenges in terms of both clinical and economic impacts on healthcare systems. The reason behind this issue is the misuse of antibiotics for the treatment of non-bacterial pathologies. The objective of this study is to investigate the factors underlying antibiotic prescription in pediatricians in the Lombardy region., Methods: The study was conducted by means of a 32-item questionnaire that investigated both pediatricians' knowledge of antimicrobial resistance and the factors determining the choice to prescribe antibiotic therapy., Results: A total of 253 pediatricians participated in the survey. Most participants (71.6%) reported as highly relevant the need for a national plan against AMR. However, approximately half of the respondents declared the phenomenon of AMR as uncommon in pediatric settings. Among the identified associated factors, diagnostic uncertainty was associated with a stronger fear of legal repercussions and the influence of parental pressure when prescribing antibiotics., Conclusions: The inability to diagnose the bacterial origin of an infection might be the primary driver of prescribing choices, rather than other non-clinical factors, such as parental demands or a fear of lawsuits.

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. [ABSTRACT FROM AUTHOR]

Disinfection of the root canal system followed by abscess drainage or tooth extraction is generally sufficient to manage most chronic and even acute endodontic infections. Antibiotics in this circumstance are not needed. However, Gram-positive and Gram-negative facultative anaerobes involve a combination of polymicrobial infections and strictly anaerobic bacteria, such as odontogenic infections and particularly endodontic infections, can gain from antibiotics as an accessory to endodontic therapy. The Medline, Pubmed, Embase, NCBI, and Cochrane databases were searched for studies using systemic antibiotics to treat endodontic lesions. PubMed database was used for articles selection, and the following keys were used in the mesh (("Antibiotics "[Mesh]) AND ("in endodontic management" [Mesh]) OR (Antibiotics in endodontic management) Mesh])). The focus was awarded to those studies which reported the diagnosis of endodontic disease therapy options and outcomes and data on the type of antibiotic prescribed. It is imperative to improve upon current antibiotic-prescribing manners in the therapy of endodontic infections and to introduce educational initiatives to inspire their comprehensible and appropriate use, as antibiotics tend to be over-prescribed for endodontic infection management. [ABSTRACT FROM AUTHOR]

This study aimed to characterize the patterns and trends in the use of major oral antibiotics prescribed for adult outpatients diagnosed with acute upper respiratory tract infections (AURTIs) in Japan between 2008 and 2018. We analyzed administrative claims data for adults in Japan, between April 2008 and September 2018. The trends in oral antibiotic prescription were illustrated using the prescribing rate, and tested using interrupted time series analysis. We also assessed the factors associated with antibiotic prescription for AURTIs. Data on 7.54 million antibiotic prescriptions in 1,937,379 adults with AURTIs were analyzed; people ≥65-years old were scarcely included. The antibiotic prescribing rate declined from 49.9% in 2008 to 39.0% in 2018, and the rate of decrease accelerated after the national action plan on antimicrobial resistance was launched in April 2016. Acute nasopharyngitis was the most common indication. Cephalosporins (35.2%), macrolides (32.2%), fluoroquinolones (24.6%), and penicillins (5.88%) were the most commonly prescribed antibiotic classes. Sex, age, type and specialty of the facility, and season affected the likelihood of being prescribed antibiotics. The majority of antibiotics prescribed were broad-spectrum, but use of penicillins showed a higher rate of increase after 2016. The percentage of antibiotic prescriptions for AURTIs decreased significantly after implementing the action plan, indicating that it was effective to some extent. However, since the use of broad-spectrum antibiotics was high, there is scope for improving the prescribing pattern, including the types of antimicrobial agents; this is considered to be a future issue. [ABSTRACT FROM AUTHOR]

Introduction: One of the crucial steps of the antimicrobial stewardship process is the measurement of antimicrobial usage. This study aims to assess the antimicrobial prescription patterns in Iraqi hospitals by conducting a survey and to determine quality indicators in order to establish an effective antimicrobial stewardship program in Iraq. Materials and Methods: A point prevalence survey (PPS) was undertaken in the five main teaching hospitals in Baghdad, Iraq. The survey included all patients admitted to hospitals on the day of the survey. The study pursued comprehensive data on patients who received antimicrobial therapy on the day of the survey. Results: Among the 808 included inpatients, 66.7% were treated with at least one antimicrobial agent. The neonatal intensive care unit had the highest antimicrobial prescription rate (97.2%), whereas the adult intensive care units had the lowest rate (41.7%). Half of the antibiotics prescribed were used for surgical and medical prophylactic indications. Third-generation cephalosporin, particularly ceftriaxone, was the most commonly used antibiotic (31.5%) for all types of indications, and vancomycin and meropenem were the most prescribed antibiotics in cases of sepsis (32% each). Approximately 98.8% of the prescribed antibiotics were employed for empiric uses. No applied institutional guidelines were applied in the treatment of any indicated infectious diseases. The majority of the antibiotics used were administered parenterally. Culture sensitivity tests were only conducted on 10 (1.2%) patients. Conclusion: The present study revealed several quality indicators that need improvement, including excessive prescription of prophylactic antibiotics in Iraqi hospitals and extremely high empiric use of antibiotics. The Global-PPS tool provides data that will help Iraq’s health authorities in designing an action plan to improve the appropriate prescription of antimicrobial agents.