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Background: Existing evidence underscores inappropriate antimicrobial prescribing and use in the community setting. Increased and inappropriate antimicrobial use are major factors contributing to the emergence and transmission of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programmes are critical for mitigating AMR, enhancing patient outcomes, and reducing healthcare costs. Despite the existing Australian National Action Plan on AMR, optimisation of antimicrobial use in the community setting remains inadequately investigated. This study explored health professionals' perspectives on community AMS practices and systems, identifying challenges and areas for improvement. Methods: This qualitative study utilised semi-structured interviews to explore the perspectives of 17 different health professionals from diverse community practice settings in South-East Queensland, Australia. Interviews were audio-recorded, anonymised, and transcribed verbatim. Data were thematically analysed, with NVivo 12 utilised for organisation and analysis. Data were then mapped and examined using the Elements of Medicines Stewardship (EMS), which aligns with United States Centers for Disease Control and Prevention– Core Elements of Antibiotic Stewardship. This was reported following the consolidated criteria for reporting qualitative research checklist. Results: Four main themes described the health professionals' insights on community AMS practices and systems. Thematic analysis from these findings reveals a state of ambiguity and fragmentation in the community AMS practices and systems. In comparison to the hospital-based AMS system, the Australian community AMS system appears to be in its nascent stages of development. Applying the EMS is essential for developing and implementing community AMS strategies to enhance practices and systems. Conclusion: The study identified key health system factors that impact the implementation of community AMS programmes and highlighted the need for developing community-specific governance and frameworks that integrate multidisciplinary strategies to support effective implementation and enhance patient outcomes. This research will inform community AMS intervention strategies, influencing policy and practice to advance sustainable healthcare and address antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background This scoping review examined the concept and scope of appropriateness of antimicrobial prescribing in the community setting and how it has been measured. Methods Utilizing the Joanna Briggs Institute's methodology, we appraised peer-reviewed articles and unpublished studies, focusing on the US, UK, Canada, and Australia, with no limit to date. Results Four basic components of antimicrobial prescribing to be evaluated during assessment of antimicrobial appropriateness in the community setting were identified: diagnosis for infection or indication for antimicrobial therapy, choice of antimicrobial therapy, dosing, and duration of therapy. The benchmark for definition of appropriateness is crucial in assessing antimicrobial prescribing appropriateness. The use of recommended guidelines as a benchmark is the standard for appropriate antimicrobial therapy, and when necessary, susceptibility testing should be explored. Conclusions Studies evaluating the appropriateness of antimicrobial prescribing should assess these components of antimicrobial prescribing, and this should be clearly stated in the aim and objectives of the study. [ABSTRACT FROM AUTHOR]

Background: We evaluated galcanezumab for migraine prevention in patients who met International Classification of Headache Disorders, 3rd edition criteria for menstrually related migraine (MRM). Methods: Patients were identified post hoc from three double‐blind, randomized, phase 3 clinical trials in patients with episodic migraine. Patients completed a 1‐month prospective baseline period and up to 6 months (EVOLVE‐1 and ‐2, studies pooled) of double‐blind treatment with galcanezumab (120 mg/month) or placebo. Menses and headache information were recorded by electronic daily diary. Patients with a migraine attack starting during the 5‐day perimenstrual interval (first day of bleeding ± 2 days) for ≥2 of their first three diary‐recorded menstrual cycles were categorized as having MRM. The primary efficacy measure was mean change in monthly migraine headache days from baseline, averaged over Months 4 through 6. Response rates, change in monthly perimenstrual migraine headache days, monthly non‐perimenstrual migraine headache days, and quality of life were also assessed. Results: Post hoc MRM analysis criteria were met by 462/1133 women (41%). Mean (standard deviation) baseline monthly migraine headache days were 9.7 (±3.1; n = 146) for galcanezumab‐treated patients and 9.6 (±2.8; n = 316) for placebo‐treated patients. The mean change (standard error [SE]) in migraine headache days over Months 4 through 6 was −5.1 days (±0.39) for galcanezumab versus −3.2 (±0.35) for placebo (p < 0.001). The mean change (SE) in perimenstrual migraine headache days over Months 4 through 6 was −0.75 days (±0.08) for galcanezumab versus −0.49 (±0.07) for placebo (p = 0.004). For migraine headache days outside the perimenstrual period, the mean change in migraine headache days was −4.6 (±0.38) for galcanezumab and −2.8 (±0.33) for placebo (p < 0.001). Improvements in response rates and the Migraine‐Specific Quality of Life Questionnaire were also observed over Months 4 through 6. Conclusion: Galcanezumab was effective for migraine prevention in women with MRM. [ABSTRACT FROM AUTHOR]

Aim: COVID-19 has brought unprecedented challenges to the healthcare system. The rapid spread of the virus, laboratory burn-out, exhausted staff, diagnostic uncertainty and lack of guidelines cumulatively disrupted hospital antimicrobial stewardship (AMS) programs. This scoping review evaluated how the COVID-19 pandemic has impacted the implementation of AMS, particularly within the context of clinical audits., Methods: An initial trend analysis was performed using a database search from 2000 to 2022. This review was developed following PRISMA-Scr guidelines. Databases such as Medline, Embase, Cochrane Library and CINAHL were searched using Medical Subject Headings and free text for 'Children', 'antimicrobial stewardship' and 'COVID-19'. Primary studies that reported data on antimicrobial use among hospitalised children during COVID-19 from December 2019 to December 2022 were considered., Results: Paediatric AMS-related research output changed annually by -4.94% in 2022 compared to 14.44% in 2019. Of 677 articles, 15 were included, with 3 added through snowballing technique. All the studies were observational and from countries of all income levels. A quantitative measure of antibiotic use was the commonly assessed sub-category of AMS, while three studies performed the audit for a reason for antibiotic use, microbiological cultures, and surgical prophylaxis. Most studies reported antimicrobial use as prevalence, while two reported the days of therapy, and two used the AWaRe classification and the antibiotic spectrum index (ASI)., Conclusions: Paediatric AMS activities were disrupted during the COVID-19 pandemic. A basic quantitative measure of antibiotic use was the only measure of assessment, with other AMS components unreported. A robust paediatric-focused AMS resilient to future pandemics and evidence-informed stewardship approach is needed., (© 2025 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)