scholarly journals Tackling Anti-microbial Resistance: An Ethical Framework for Rational Antibiotic Use

2020 ◽  
pp. 321-344
Author(s):  
Jasper Littmann ◽  
Annette Rid ◽  
Alena Buyx
Keyword(s):  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Ethical Framework ◽  
Policy Makers ◽  
Rational Use ◽  
Acceptable Risks ◽  
Ethical Conflicts ◽  
Patients At Risk ◽  
Rational Use Of Antibiotics ◽  
Rational Antibiotic Use

Abstract To reduce the effect of antimicrobial resistance and preserve antibiotic effectiveness, clinical practice guidelines and health policy documents call for the “rational use” of antibiotics that aims to avoid unnecessary or minimally effective antibiotic prescriptions. In this paper, we show that rational use programmes can lead to ethical conflicts because they place some patients at risk of harm – for example, a delayed switch to second-line antibiotics for community-acquired pneumonia is associated with increased fatality rates. Implementing the rational use of antibiotics can therefore lead to conflicts between promoting patients’ clinical interests and preserving antibiotic effectiveness for future use. The resulting ethical dilemma for clinicians, patients and policy makers has so far not been adequately addressed. We argue that existing guidance for acceptable risks in clinical research can help to define risk thresholds for the rational use of antibiotics. We develop an ethical framework that allows clinicians and policy-makers to evaluate policies for rational antibiotic use in six practical steps.

scholarly journals Rational Antibiotic Use by Ordinary People in Jakarta

2019 ◽  
Vol 3 (1) ◽  
pp. 73-82
Author(s):  
Sherly Tandi Arrang ◽  
Fonny Cokro ◽  
Erlia Anggrainy Sianipar
Keyword(s):  
Antibiotic Use ◽  
Ordinary People ◽  
Self Medication ◽  
Rational Use ◽  
Resistance Risk ◽  
Inappropriate Use ◽  
Runny Nose ◽  
Life Threatening ◽  
Rational Use Of Antibiotics ◽  
Rational Antibiotic Use

Self-medication is defined as self treatment and self-diagnose for conditions such as cough, flu, fever, pain, stomach ulcers, worms, diarrhea, rash, and some other minor illnesses. Based on the data from Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI (2013), there were 103.860 of 294.959 households (35,2%) in Indonesia which store medicines for selfmedication (including 35,7% “Obat Keras” or “Gevaarlijk” and 27,8% antibiotics). DKI Jakarta (56,4%) is the highest province with respect to stored medicines. Some studies have found that 40-62% of antibiotics are not used properly. The inappropriate use of antibiotics can lead to antibiotic resistance risk and can be life-threatening for people in every part of the world. To address this problem, this community service was conducted to provide information about selfmedication of influenza and cough illness and to improve people’s knowledge in the proper use of antibiotics. Lecturing was chosen as the method for explaining the rational use of antibiotics and participants were requested to fill out a questionnaire. This activity was attended by 34 participants (and 32 participants filled out the questionnaire). About 13 participants (40,6%) provided correct answers to questions on the proper use of antibiotics. Twenty six participants (81,25%) said they had previously used antibiotics, 14 of them (53,85%) admitted to purchasing antibiotics without a prescription. Antibiotics are taken to treat symptoms such as runny nose, cough, sore throat, fever, and other conditions. A total of 7 participants (26,92%) admitted taking antibiotics with dosage modification and 8 participants (30,77%) switched one type of antibiotics with another type of antibiotics. Based on the results, we concluded that people did not have sufficient knowledge about the rational use of antibiotics. We suggested that counseling about the proper use of antibiotics should be improved.

Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
O Karadag Caman ◽  
S Uner ◽  
B Arica Yegin ◽  
H Ozcebe
Keyword(s):  
Public Health ◽  
Healthcare Professionals ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Rational Use ◽  
Leading Role ◽  
Pharmacy Technicians ◽  
Rational Use Of Antibiotics ◽  
Undergraduate Programs ◽  
Rational Antibiotic Use

Abstract Background Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption. Methods This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393). Results Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education. Conclusions Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care. Key messages Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.

scholarly journals Evaluation of a multimodal intervention to promote rational antibiotic use in primary care

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Inga Petruschke ◽  
◽  
Florian Salm ◽  
Michelle Kaufmann ◽  
Antje Freytag ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Use ◽  
Likert Scale ◽  
Antibiotic Prescribing ◽  
Rational Use ◽  
Multimodal Intervention ◽  
Tract Infections ◽  
Rational Use Of Antibiotics ◽  
Rational Antibiotic Use ◽  
Gp Training

Abstract Background Increasing antimicrobial resistance is a serious societal challenge affecting outpatient, inpatient and veterinary care. The German One-Health project, RAI (Rational use of Antibiotics via Information and Communication) addresses all three sectors. In the outpatient sector, General Practitioners (GPs) are the main prescribers of antibiotics and were therefore, targeted for this study. A multimodal intervention focusing on Acute Respiratory Tract infections (ARI) was designed and implemented. The aim of this study was to evaluate acceptance, rating and the self-reported impact of the intervention among GPs. Methods The intervention offered six tools: a GP training on rational antibiotic use, an app for self-monitoring, a leaflet and a set of posters (both for use as information materials in waiting rooms) and both digital and printed information prescriptions (material for ‘prescribing’ information instead of an antibiotic to the patient). The tools could be used according to individual preferences. The intervention was conducted between August 2016 and July 2017. Following the intervention, a three pages anonymous questionnaire was sent to all 271 participants. Items covered socio-demographic and professional background, use and judgement of the intervention tools (6 point Likert scale), impact of the intervention tools (4 point Likert scale). Results The response rate was 39% (n = 107). On average, respondents used 3.1 of the six available tools, with printed information prescriptions used most frequently (79%). Digital information prescriptions were used more frequently by men than by women (OR 2.8; 95% CI 1.16–7.24; p = 0.02). Eighty-seven percent of respondents stated that information prescriptions supported doctor-patient communication. In a comparison of the overall impression of the different intervention tools the GP training on rational antibiotic use was rated best (1.67 on a 6 point scale with 1 = highest, 6 = lowest) and most often noted as having had a “strong” or “very strong” impact on personal antibiotic prescribing behavior. Conclusions The multimodal intervention addressing education and communication was well accepted among GPs and could help in fostering rational use of antibiotics in primary care.

scholarly journals Study on knowledge, attitude and practices with respect to antibiotic use among medical students

2019 ◽  
Vol 8 (7) ◽  
pp. 1628
Author(s):  
Bhavika D. ◽  
A. Naga Teja Pavani ◽  
G. Meghavani ◽  
Aditya Jillella ◽  
Sameer Uz Zaman
Keyword(s):  
Antibiotic Resistance ◽  
Medical Students ◽  
Antibiotic Use ◽  
Educational Strategies ◽  
Key Factors ◽  
Cross Sectional ◽  
Response Options ◽  
Rational Use ◽  
Global Problem ◽  
Rational Use Of Antibiotics

Background: Antibiotic resistance has emerged as a serious global problem. Irrational prescribing of antibiotics is one of the key factors responsible for the development of antibiotic resistance. As today’s medical students will be the future prescribers their awareness regarding antibiotic resistance and rational prescribing of antibiotics is very much important. The main objective of the study was to evaluate the knowledge, attitude and practices of the medical students towards antibiotic use.Methods: A cross-sectional questionnaire-based study was conducted involving the medical students from all the semesters. A predesigned questionnaire was used to evaluate the knowledge, attitude and practices of the respondents. The response options were ‘yes’ or ‘no’ for some questions, and a 5 point Likert scale used to assess some questions. The data was analyzed using MS office Excel.Results: A total of 457 fully completed questionnaires from the respondents were evaluated. Majority of the respondents (70%) were females, and 91% of the respondents were aware of antibiotic resistance as a global problem. On analysis of score of questions assessing knowledge, 91% of respondents had attained a score in the range of 5-7. Majority (83%) of the respondents used antibiotics only on doctor’s prescription and 74% of the respondents had completed the prescribed course.Conclusions: The present study gives an insight on the knowledge, attitude and practices of medical students on antibiotic use, and can be used as a tool to plan educational strategies to improve the knowledge of the students regarding rational use of antibiotics.

scholarly journals Rational Use of Antibiotics – A Point Prevalence Study Carried out at a Tertiary Hospital in South-South Nigeria

2020 ◽  
pp. 39-47
Author(s):  
Okechukwu Chioma
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Point Prevalence ◽  
Prescribing Patterns ◽  
Prevalence Study ◽  
Antibiotic Prescribing ◽  
Point Prevalence Study ◽  
Rational Use ◽  
Rational Use Of Antibiotics

Introduction: The burden of antibiotic resistance in the hospitals and communities is progressively worsening hence the critical need to put into practice all the key components of rational use of antibiotics in our daily patient interactions. This paper aims to highlight the problem of antibiotic resistance, the importance of rational use of antibiotics and to show an on the spot sketch of the antibiotic use pattern among in-patients in the children wards in a tertiary hospital. Methodology: A brief review of the existing literature on antibiotic resistance and the rational use of antibiotics was done. A one-day cross-sectional point prevalence study was conducted in the children wards in UPTH and all children receiving antibiotics on that day, identified. The prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of the survey by the total number of patients on admission. Data were presented in percentages using pie and bar charts. Results: There were a total of 40 children on admission in the paediatric wards with a Male: Female ratio of 1.2:1. 34 (85.0%) of the children on admission were receiving at least one antibiotic. The most common route of administration of the antibiotics was the intravenous route (94.1%). The five most commonly prescribed antibiotics in the children medical wards and the emergency ward were Ceftriaxone, Gentamycin, Cefuroxime, Metronidazole and Crystalline penicillin, while the five most common antibiotics prescribed in the special care baby unit were Gentamycin, Ceftazidime, Ceftriaxone, Metronidazole and Ofloxacin. Only 10 (29.4%) out of children receiving antibiotics had a microbiology culture result available, and 4 were receiving antibiotics in line with the culture sensitivity pattern. Two (5.9%) children had a multidrug-resistant infection. Conclusion: This study showed a high prevalence of antibiotic use among inpatients and low utilization of microbiology culture results in the choice of antibiotics in a tertiary hospital in South-south Nigeria. Antibiotic prescribing patterns among healthcare workers should be improved upon by training and retraining of personnel as well as strict adherence to antibiotic prescription guidelines.

scholarly journals Knowledge, attitude and practices of antibiotic usage among university students from Karachi, Pakistan

2019 ◽  
Vol 7 (2) ◽  
pp. 519
Author(s):  
Dnyanesh Limaye ◽  
Patrick Ziesenis ◽  
Vaidehi Limaye ◽  
Mansoor Ahmad ◽  
Farah Saeed ◽  
...  
Keyword(s):  
University Students ◽  
Public Awareness ◽  
Antibiotic Use ◽  
Symptomatic Improvement ◽  
Cross Sectional Study ◽  
Antibiotic Usage ◽  
Cross Sectional ◽  
Rational Use ◽  
Rational Use Of Antibiotics ◽  
Medical Advances

Background: Antimicrobial resistance has become a serious global problem. A potential post-antibiotic era is threatening present and future medical advances. In Pakistan, the usage of antibiotic is unnecessarily high and due to over exposure to these drugs, bacteria are developing resistance against these drugs. It is necessary to improve public awareness about the rational use of antibiotics in order to bring a change in consumer’s behaviour. Therefore, present study was undertaken to assess the existing knowledge, attitude and practices related to antibiotic usage among university students.Methods: A cross-sectional study was carried out among university students from Karachi, Pakistan during May-June 2018. 200 students were approached to participate in the study of which 159 agreed to participate (males: 70, females: 89). Pretested questionnaire was distributed to the study subjects and the collected data was analyzed using IBM SPSS version 23.Results: Substantial number of (33% and 50%) participants were unaware about the differences in antibiotic: anti-inflammatory drugs and antibiotic: antipyretics respectively. 29% of the participants thought it is right to stop antibiotics only based on symptomatic improvement. Thirty nine percent and eighty three percent participants believed that antibiotics should always be prescribed to treat flu like symptoms and pneumonia respectively.Conclusions: Participants demonstrated average knowledge about antibiotics. Similarly, their attitude and practice toward antibiotic use was associated with misconceptions. An educational intervention is necessary to make them aware about rational use of antibiotics.

scholarly journals Antimicrobial practices among small animal veterinarians in Greece: a survey

2020 ◽  
Author(s):  
George Valiakos ◽  
Eleni Pavlidou ◽  
Christos Zafeiridis ◽  
Constantina N Tsokana ◽  
Victor J Del Rio Vilas
Keyword(s):  
Animal Health ◽  
Small Animal ◽  
Antibiotic Use ◽  
Microbiological Analysis ◽  
Gastrointestinal Infections ◽  
Rational Use ◽  
Inappropriate Use ◽  
Organ Systems ◽  
Pet Owner ◽  
Rational Use Of Antibiotics

Abstract Background The inappropriate use of antibiotics is a major issue in clinical practice in Greece with serious implications for public health and animal health. The purpose of the present study was to provide a first insight into the use of antibiotics by small animal practitioners in Greece and assess their compliance with general rules for the rational use of antibiotics. This is the first survey of its kind in Greece.Methods A questionnaire was designed to collect basic information on the use of antibiotics by pet veterinarians. The questionnaire was sent to a total of 70 veterinarians mainly operating in the region of Attica, a region that comprises almost 50% of the Greek population and where veterinarians are engaged solely in small animal practice. The questionnaire consisted of 37 closed questions dealing with various aspects on the use of antibiotics.Results The majority of respondents’ report cases where the pet owner initiated antibiotic treatment without veterinary prescription. Almost every clinician reported owner-compliance challenges. Regarding microbiological analysis, 73% of respondents prefer to adopt the empirical treatment while waiting the laboratory results or use antibiogram only when the treatment is unsuccessful. Eighty-eight per cent declared to use antimicrobials postoperatively in clean surgical procedures. Different types of antimicrobials and treatment durations than the ones proposed by guidelines on rational use of antibiotics are preferred for various organ systems e.g. in urinary and gastrointestinal infections. Conclusions Our findings suggest the need for guidelines on antibiotic use in small animal practice in Greece, and the deployment of systematic surveillance on antimicrobials use and resistance to inform the initial choice of antibiotics upon local antimicrobial resistance profiles. Targeting the other end of the problem, pet owners, our findings indicate the need to educate them on the rational use of antibiotics and, critically, stop antibiotic availability without prescription.

scholarly journals Antimicrobial practices among small animal veterinarians in Greece: a survey

2020 ◽  
Author(s):  
George Valiakos ◽  
Eleni Pavlidou ◽  
Christos Zafeiridis ◽  
Zoi Athanasakopoulou ◽  
Constantina N Tsokana ◽  
...  
Keyword(s):  
Animal Health ◽  
Small Animal ◽  
Antibiotic Use ◽  
Microbiological Analysis ◽  
Gastrointestinal Infections ◽  
Rational Use ◽  
Inappropriate Use ◽  
Organ Systems ◽  
Pet Owner ◽  
Rational Use Of Antibiotics

Abstract Background The inappropriate use of antibiotics is a major issue in clinical practice in Greece with serious implications for public health and animal health. The purpose of the present study was to provide a first insight into the use of antibiotics by small animal practitioners in Greece and assess their compliance with general rules for the rational use of antibiotics. This is the first survey of its kind in Greece. Methods A questionnaire was designed to collect basic information on the use of antibiotics by pet veterinarians. The questionnaire was sent to a total of 70 veterinarians mainly operating in the region of Attica, a region that comprises almost 50% of the Greek population and where veterinarians are engaged solely in small animal practice. The questionnaire consisted of 37 closed questions dealing with various aspects on the use of antibiotics. Results The majority of respondents’ report cases where the pet owner initiated antibiotic treatment without veterinary prescription. Almost every clinician reported owner-compliance challenges. Regarding microbiological analysis, 73% of respondents prefer to adopt the empirical treatment while waiting the laboratory results or use antibiogram only when the treatment is unsuccessful. Eighty-eight per cent declared to use antimicrobials postoperatively in clean surgical procedures. Different types of antimicrobials and treatment durations than the ones proposed by guidelines on rational use of antibiotics are preferred for various organ systems e.g. in urinary and gastrointestinal infections. Conclusions Our findings suggest the need for guidelines on antibiotic use in small animal practice in Greece, and the deployment of systematic surveillance on antimicrobials use and resistance to inform the initial choice of antibiotics upon local antimicrobial resistance profiles. Targeting the other end of the problem, pet owners, our findings indicate the need to educate them on the rational use of antibiotics and, critically, stop antibiotic availability without prescription.

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