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Abstract Background Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis. [ABSTRACT FROM AUTHOR]

Sami Alobaidi,1 Naji Dwid,2 Khaldoun Shikh Souk,3 Mohamed Cheikh,4 Ahmed Mandurah,3 Khaled Al-Khatib,3 Ans Ahmed,3 Hani Almoallim5 1Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia; 2Doctor Soliman Fakeeh Hospital, Nephrology Fellow for Saudi Commission for Health Specialties, Jeddah, Saudi Arabia; 3Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 4Doctor Soliman Fakeeh Hospital, Rheumatology Fellow for Saudi Commission for Health Specialties, Jeddah, Saudi Arabia; 5Medical College, Umm Alqura University (UQU), Makkah, 21441, Saudi ArabiaCorrespondence: Sami AlobaidiDepartment of Medicine, University of Jeddah, Jeddah, Saudi ArabiaEmail salobaidi@uj.edu.saContext: Hyperuricemia is prevalent in patients with chronic kidney disease (CKD). Although it is associated with CKD incidence and progression, treating asymptomatic hyperuricemia with uric acid-lowering agents is still debatable.Aim of Work: determine the rate of non-classical prescription of allopurinol in CKD patients.Settings and Design: This was a retrospective study of adult patients prescribed allopurinol with CKD (stages 2– 5) in Doctor Soliman Fakeeh Hospital (DSFH) Jeddah, Saudi Arabia, from 1/1/2016 to 1/1/2017.Subjects and Methods: Eligible patients were identified from the hospital’s pharmacy system and cross-referenced with the electronic health records. Demographic data, laboratory results and indication as recorded by the prescribing physician were extracted. Prescriptions with no indication were categorized based on the uric acid levels. Hyperuricemia was documented as mild (6– 10 mg/dL in females and 7– 13 mg/dL in males) and severe (> 13mg/dL in men and > 10mg/dL in women).Statistical Analysis Used: Descriptive statistics (frequencies, percentages).Results: From the 594 identified patients, 464 (78.1%) were males. A third of prescriptions (209/594) had no indication, 43.5% of which (91/209) had no documented uric acid levels, and 16.3% (34/209) had normal levels. Including patients with undocumented indication, 64.2% (381/594) were prescribed allopurinol for hyperuricemia, 86.4% of which (329/381) had mild hyperuricemia, and only 13.6% (52/381) had severe hyperuricemia. Other indications included malignancy-related disorders (6.2%, 37/594), gouty arthritis (5.2%, 31/594), and stones of unknown aetiology (3.4%, 20/594).Conclusion: The percentage of allopurinol prescription to patients with CKD without a clear indication in our centre was markedly high. This might increase the risk for side effects with no evidence-based benefits.Keywords: allopurinol, gout, hyperuricemia, hyperuricosuria, over prescription, chronic kidney disease

Objective: Misuse of prescription opioids is a significant public health issue in Australia. There has been a rapid rise in prescription opioid use, with an associated increase in overdose and death. The over‐prescribing of oral opioids, especially oxycodone, in the ED has been identified as a contributor to this problem overseas. It is unclear if similar practice occurs in the Australian ED. The primary aim of our study was to identify the incidence of oral oxycodone administration to patients within the ED. The secondary outcome was to identify the incidence of oxycodone prescribed to patients on discharge from the ED into the community. Methods: Our study was designed as an observational, retrospective data analysis of the incidence of oxycodone prescribed within the three EDs of a large Australian public health service. All immediate‐release (IR) and slow‐release (SR) oral oxycodone prescribed over a 4‐year period (2015–2018) was included. Results: There were 890 557 presentations to the three EDs during the period, which resulted in 288 242 episodes of oxycodone administration within department, equivalent to 324 administrations per 1000 presentations. There were 39 381 prescriptions for oxycodone provided on discharge, resulting in an incidence of 44 prescriptions per 1000 discharged. The most frequently prescribed opioid medication in the ED was oxycodone IR 5 mg, 78.6% of discharge prescriptions generated provided a maximum quantity (20 for IR formulation or 28 for SR) of tablets allowable under the pharmaceutical benefits scheme. Conclusions: There is a higher incidence of oxycodone prescribing in the Australian ED than previously recognised. An overuse of oxycodone may be contributing to adverse patient outcomes and a public health crisis. Hospitals should consider appropriate steps to reduce the incidence of opioid prescribing and the supply of these medications into the community. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to assess the Practice of dental practitioners with reference to the prescription of antibiotics in patients with periodontitis. METHODOLOGY: A self-administered, structured questionnaire was distributed to Three hundred and Fifty subjects including dental students of final year BDS, house officer, and lecturers. The questionnaire inquired about the prescription of antibiotics in different types of periodontal diseases and the type of severity. Frequencies and percentages were calculated and the data was analyzed using SPSS software version 20. RESULTS: For periodontal abscess and gingivitis respectively, 95.2% and 99.1% of the participants, reported they will not prescribe antibiotics. While,44.8% of the participants reported they give antibiotics to patients with Necrotizing Ulcerative Periodontitis, 50.9% preferred the use of antibiotics in patients with Aggressive Periodontitis while 57% said they will give antibiotics in chronic periodontitis. Amoxicillin (53%) was the preferred drug for periodontal cases followed by Augmentin (34.2%). CONCLUSION:There is a wide prescription of antibiotics by dental practitioners, without any scientific evidence to justify the use of anitbiotics in periodontal diseases cases. [ABSTRACT FROM AUTHOR]

The Australian National Chronic Obstructive Pulmonary Disease ( COPD) guidelines recommend that inhaled corticosteroids ( ICS) be reserved for patients with a post-bronchodilator forced expiratory volume in 1 s ( FEV1) less than 50% predicted and those who experience ≥2 exacerbations in 12 months. In total, 707 COPD patients were identified from the lung function test database at our tertiary hospital; 52.4% of patients with a post-bronchodilator FEV1 ≥50% were prescribed an ICS. Significant discordance exists between guideline recommendations and inhaler prescription. [ABSTRACT FROM AUTHOR]

Background: Proton pump inhibitors (PPIs) are the drugs used to treat and prevent acid peptic conditions. Their efficacy and safety profile has led to injudicious prescription of these drugs exposing patients to various potential risks and increased healthcare expenditure. Methodology: A retrospective observational study was done from 10th January to 24th January, 2015 in Medicine Indoor in a tertiary care hospital to determine the trend of prescribing PPIs on discharge of Medical inpatients. Result: We found 117 patients were discharged in the study period; 83 were male and 34 were female. Among them 102 (87.17%) were prescribed PPIs on their discharge. Mean age was 44.79 years. Among the study population only 29 patients (28.5%) truly needed PPIs during their discharge. The mean duration of prescribed PPIs was 28 days. Conclusion: Amore rational prescription of PPI during discharge will have better impact on patient safety and health care expenditure. [ABSTRACT FROM AUTHOR]

This study draws on a general theoretical framework comprising of a decision maker (a doctor), perceived moral intensity of the issue (breastfeeding substitute prescription), and the situational environment (hospital policy, pharma company promotions, and mother’s beliefs regarding breastfeeding) to explain the physician’s role and influence on mothers’ infant feeding choices when prescribing infant formula in Kuwait, Middle East. Moral intensity is an issue-contingent model that suggests ethical decisions vary in terms of how much a moral imperative is present in a situation. The moral intensity of the issue is assessed using six components. Path Least Squares results indicate the following moral intensity components have significant impact on prescription behavior: magnitude of consequences, probability of effect, and temporal immediacy. Company promotion and hospital policy also significantly influence doctor’s prescription of infant formula. Doctors appear to disengage from the consequences of over prescribing infant formula.

Study was conducted to assess the over prescription of antibiotics by Karachi dentists working in public and private sector. The sample size of the study was 500. A questionnaire was developed and distributed among the Registered Dental Practitioners. This study was spread over 6 months. Data entry and analysis was done on SPSS software version 20. Descriptive statistics were generated. The present study provides evidence of over prescription of antibiotics by dentists of Karachi, Pakistan. Therefore, appropriate guidelines should be provided by regulatory bodies. Local measures should be prioritized by removing the cause. It is necessary to take educational initiatives to encourage rational and correct use of antibiotics. [ABSTRACT FROM AUTHOR]