scholarly journals Impact of a pilot multimodal intervention to decrease antibiotic use for respiratory infections in a geriatric clinic

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Lakshmi R. Chauhan ◽  
Misha Huang ◽  
Mona Abdo ◽  
Skotti Church ◽  
Danielle Fixen ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Low Cost ◽  
Action Plan ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Quality Improvement Initiative ◽  
Antibiotic Prescribing ◽  
Clostridioides Difficile ◽  
Before And After ◽  
Amoxicillin Clavulanate

Abstract Background: More than 80% of antibiotics are prescribed in the outpatient setting, of which 30% are inappropriate. The National Action Plan for Combating Antimicrobial Resistance called for a 50% decrease in outpatient antibiotic use by 2020. Inappropriate antibiotics are associated with adverse reactions and Clostridioides difficile infection, especially among older adults. Study design: Before and after study. Methods: We performed a quality improvement initiative at the University of Colorado Seniors Clinic. Providers received education on antibiotic guidelines, electronic antibiotic order sets were introduced with standardized stop dates. Antibiotic use data were collected for 6 months before and 6 months after the intervention, from December to May to avoid seasonal variation. Descriptive statistics and linear mixed-effects regression models were used for this comparison. Results: Total antibiotic prescriptions for acute respiratory conditions decreased from 137 prescriptions before the intervention (December 1, 2017, to May 31, 2018) to 112 prescriptions after the intervention (December 1, 2018, to May 31, 2019), driven primarily by decreases in antibiotic prescriptions for pneumonia, sinusitis, and bronchitis. Prescriptions for broad-spectrum antibiotics declined following the intervention including decreases in levofloxacin from 12 (9%) to 3 (3%) and amoxicillin-clavulanate from 15 (12%) to 7 (7%). We detected significant reductions in prescribed antibiotic durations (days) after the intervention for sinusitis (estimate, −2.0; 95% CI, −3.1 to −1.0; P = .0003), pharyngitis (estimate, −2.5; 95% CI, −4.6 to −0.5; P = .018), and otitis (−3.2; 95% CI, −5.2 to −1.3; P = .008). Conclusions: Low-cost interventions were initially successful in changing patterns of antibiotic use and decreasing overall antibiotic prescribing among older patients in the outpatient setting. Long-term follow-up studies are needed to determine the sustainability and clinical impact of these interventions.

scholarly journals 968. Effect of Outpatient Antibiotic Ordering Restrictions on Antibiotic Prescribing Patterns at a State-wide VA Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S32-S32
Author(s):  
Rohini Dave ◽  
Jacqueline Bork
Keyword(s):  
Healthcare System ◽  
Respiratory Infections ◽  
Outpatient Setting ◽  
Unintended Consequences ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Inappropriate Use ◽  
Amoxicillin Clavulanate ◽  
Rural Clinics ◽  
The Impact

Abstract Background Approximately 30% of antibiotics prescribed in the outpatient setting are inappropriate, mostly due to unnecessary prescriptions (Rx) for upper respiratory infections. Ordering restrictions is one approach to curtail inappropriate use. However, this approach may cause unintended consequences, such as increases in Rx of higher level antibiotics. This study evaluated the downstream effect of an azithromycin (AZM) ordering restriction. Methods This was a pre–post evaluation of the impact of an AZM removal (October 2017) on prescribing patterns of common outpatient antibiotics at the VA Maryland Healthcare System. AZM restriction was placed >10 years ago for concerns of emerging AZM resistance and overuse. During the study period, fluoroquinolone (FQ) use was scrutinized due to increasing toxicity risk. The proportion of several outpatient antibiotic Rx were compared between October 2017 and September 2018 (FY17) and October 2018 and September 30, 2018 (FY18) using χ 2 and logistic regression. FQ and AZM Rx were also stratified by location of prescribing clinic (urban vs. rural) and duration (≤14 days vs. >14 days). Results There were 15,972 and 14,451 prescriptions in FY17 and FY18, respectively. AZM Rx increased from 1,247 (7%) Rx in FY17 to 1,734 (11%) in FY18 (P < 0.0001) with an OR of 1.8 (95% CI 1.65–1.94). There was a greater effect on shorter than longer duration (OR 1.9 vs. 1.3, P < 0.0001), but no significant effect difference for urban and rural clinics (OR 1.8 vs. 1.9, P = 0.6). Conversely, FQ Rx decreased from 2,414 (15%) in FY17 to 1,731 (11%) in FY18 (P < 0.0001) with an OR of 0.7 (95% CI 0.66–0.76). There was a greater effect on shorter than longer duration (0.6 vs. 1.2, P < 0.0001) and also a greater effect on urban than rural clinics (OR 0.6 vs. 0.97, P < 0.0001). Doxycycline, amoxicillin–clavulanate and trimethoprim–sulfamethoxazole did not change significantly. Conclusion Removal of AZM restriction led to a significant decrease in FQ Rx, with greater effect in shorter duration and urban clinics, and an increase in AZM Rx, with greater effect in shorter duration, but no difference in clinic setting. Disparity of rural prescribers needs further exploration, as do other interventions outside of restrictive ordering, which needs periodic evaluation of risk and benefit if implemented. Disclosures All Authors: No reported Disclosures.

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

scholarly journals Rurality of Residence and Inappropriate Antibiotic Use for ARI Among Young Tennessee Children

2020 ◽  
Author(s):  
Keerti L Dantuluri ◽  
Jean Bruce ◽  
Kathryn M Edwards ◽  
Ritu Banerjee ◽  
Hannah Griffith ◽  
...  
Keyword(s):  
Incidence Rate Ratio ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
The United States ◽  
Census Bureau ◽  
Outpatient Setting ◽  
United States Census ◽  
United States Census Bureau ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Abstract Background Antibiotic use is common for acute respiratory infections (ARI) in children, but much of this use is inappropriate. Few studies have examined whether rurality of residence is associated with inappropriate antibiotic use. We examined whether rates of ARI-related inappropriate antibiotic use among children vary by rurality of residence. Methods We conducted a retrospective cohort study of children aged 2 months – 5 years enrolled in Tennessee Medicaid between 2007 and 2017 and diagnosed with ARI in the outpatient setting. Study outcomes included ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. Multivariable Poisson regression was used to measure associations between rurality of residence, defined by the United States Census Bureau, and the rate of study outcomes, while accounting for other factors including demographics and underling comorbidities. Results 805,332 children met selection criteria and contributed 1,840,048 person-years (p-y) of observation. Children residing in completely rural, mostly rural, and mostly urban counties contributed 70,369 (4%) p-y, 479,121 (26%) p-y, and 1,290,558 p-y (70%), respectively. Compared with children in mostly urban counties (238 per 1000 p-y), children in mostly rural (450 per 1000 p-y) and completely rural counties (468 per 1000 p-y) had higher rates of inappropriate antibiotic use (adjusted incidence rate ratio [aIRR]: 1.34 (95% confidence interval [CI]: 1.33 – 1.35) and aIRR: 1.33 (CI: 1.32 – 1.35), respectively). Conclusion Inappropriate antibiotic use is common among young children with ARI, with higher rates in rural compared to urban counties. These differences should inform targeted outpatient antibiotic stewardship efforts.

scholarly journals 1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S398
Author(s):  
Natalie Tucker ◽  
Ezzeldin Saleh ◽  
Marcela Rodriguez
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Custom Made ◽  
Days Of Therapy ◽  
Before And After ◽  
The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

scholarly journals Impact of the COVID-19 pandemic on community antibiotic prescribing in Scotland

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
William Malcolm ◽  
Ronald A Seaton ◽  
Gail Haddock ◽  
Linsey Baxter ◽  
Sarah Thirlwell ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Age Groups ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescription Data ◽  
National Data ◽  
Time Data ◽  
Electronic Messaging ◽  
The Impact ◽  
Selection Of

Abstract Background Following concerns about increased antibiotic use during the COVID-19 pandemic, trends in community antibiotic prescriptions in Scotland were evaluated. Methods The primary care prescription electronic messaging system used in GP practices with NHS contracts provided near real-time data analysis of national data. The main outcome measures were the weekly number of prescriptions for antibiotics generated by prescribers in GP practices in 2020 compared with 2019. Results At end of Week 12 2020 (22 March), after a sharp increase, the number of prescriptions commonly used for respiratory infections was 44% higher than the corresponding week in 2019. The number of prescriptions for respiratory antibiotics reduced through April and May 2020, with 34% fewer prescriptions issued by end of Week 22 (31 May) than in the corresponding week in 2019. Reductions were pronounced in all age groups but particularly apparent for prescriptions for children aged 0–4 years. These data were compared with weekly prescriptions for a selection of non-respiratory antibiotics and no difference was seen between 2020 and 2019. Conclusions Trends in antibiotic prescription data show that after an initial surge, and following ‘lockdown’ in Scotland, the total number of prescriptions for antibiotics commonly used for respiratory infections fell. We believe this is the first published national evaluation of the impact of COVID-19 on community use of antibiotics. Further analysis of national data is planned to provide a greater understanding of the reasons behind these trends.

scholarly journals Antibiotic Prescription Patterns for Acute Diarrhea in a Hospital in Shanghai in 2016: A Cross-sectional Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S326-S326
Author(s):  
Yanhong Hu ◽  
Shanjuan Wang ◽  
Sunying Hua ◽  
Merlin Willcox ◽  
Michael Moore ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Respiratory Infections ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Negative Resistance ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Oral Rehydration ◽  
Stewardship Program

Abstract Background Unnecessary antibiotic use increases the risk for antibiotic resistance. The rates of antibiotic use for upper respiratory infections are high in hospitals in China. Although most guidelines advise against the use of antibiotics for acute diarrhea, little is known about antibiotic use practices for acute diarrhea in China. Methods A retrospective prescription review from a Shanghai hospital outpatient electronic health records system was conducted from 1 January 2016 to 30 December 2016. Records were included for adult patients. The microbial resistance seasonal data in 2016 were extracted. Chi-squared and multivariable logistic regression and adjusted odd ratio (aOR) were used to assess the relationships between demographic characteristics and antibiotic prescribing. Results In total, there were 16,565 prescriptions, 16,060 prescriptions were included in the final analysis after excluding the follow up visits. There were 12,131 (76%) prescriptions with antibiotics prescribed. 5505 (45%) of the antibiotics prescribed were injectable. Of the antibiotics prescribed, levofloxacin was the most frequent (85%), followed by various cephalosporins (14%). Of the cephalosporin prescriptions, third-generation products were the most common (97%). Treatment with oral rehydration salts (ORS) was prescribed 34 (0.2%) times, probiotics were prescribed 3414 (21%) times and smectite was prescribed 2209 (14%) times. Multivariable regression analysis showed that those more likely to receive antibiotics were age 31–50 aOR 1.3 (1.1–1.4), P &lt; 0.001, evaluated in the late evening (11pm to 7am) aOR 2.6 (2.2–2.9) P &lt; 0.001, in the early evening (6pm-11pm) aOR 2.0 (1.8–2.2) P &lt; 0.001, in the summer (June-August) aOR 1.7 (1.5–1.9) P &lt; 0.001. At the same time, the Gram-positive and Gram-negative resistance rates to levofloxacin exceeded 40%, including 50% of E. coliisolates. Conclusion High rates of antibiotic use were observed for acute diarrhea in this hospital. Given the inappropriateness of antibiotics for acute diarrhea and the nonsensical high rates of of intravenous levofloxacin use and the concurrent high rates of the levofloxacin resistance, a more effective antibiotic stewardship program is needed to improve patient outcomes, reduce costs, reinforce policy and address the underlying causes of antibiotic abuse. Disclosures All authors: No reported disclosures.

Patient Knowledge and Experiences With Antibiotic Use and Delayed Antibiotic Prescribing in the Outpatient Setting

2019 ◽  
pp. 089719001988942 ◽  
Author(s):  
Mary Beth A. Seipel ◽  
Emily S. Prohaska ◽  
Janelle F. Ruisinger ◽  
Brittany L. Melton
Keyword(s):  
Antibiotic Stewardship ◽  
General Public ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Patient Knowledge ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional

Background: Most antibiotic prescriptions originate in the outpatient setting and an estimated 30% are unnecessary. Pharmacists are well positioned to positively impact antibiotic prescribing habits; the role of the community pharmacist in outpatient antibiotic stewardship programs is not well defined. Objectives: The objectives of this study were to (1) assess the knowledge of the general public regarding appropriate antibiotic use, and (2) assess the experiences of the general public regarding delayed antibiotic prescriptions. Methods: A cross-sectional survey was administered at community pharmacies in Kansas from September 2018 to January 2019. Eligible individuals were older than 18 years and self-reported their ability to speak and read English. The 22-item survey collected demographics, knowledge regarding appropriate antibiotic use, and participant understanding and experiences of delayed antibiotic prescribing. Descriptive statistics assessed demographics and chi-square compared responses between demographics. Results: Of 347 surveys completed, respondents were mainly Caucasian (91.6%), female (58.2%), and aged 60 years or older (59.1%). Those with high school education or below were more likely to believe antibiotics kill viruses (43.1% vs 20.9%, respectively; p < 0.01) and that antibiotics work on most coughs and colds (31.4% vs 16.2%, respectively; p = 0.01). Delayed antibiotic prescriptions were more frequently offered to those who had received an antibiotic prescription in the last year compared to those who had not (36.1% vs 15%, p < 0.001). Conclusion: Gaps in patient knowledge about appropriate antibiotic use and delayed prescribing present an opportunity for community pharmacists to educate patients and become involved in outpatient antibiotic stewardship.

scholarly journals The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection

2019 ◽  
Vol 70 (8) ◽  
pp. 1620-1627 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Nick Daneman ◽  
Kevin L Schwartz ◽  
Bradley Langford ◽  
Allison McGeer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Regression Models ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Before And After

Abstract Background Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. Methods We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering &gt;90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. Results A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18–1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28–1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07–1.31). Conclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.

scholarly journals 214. Antibiotic Use for Common Infections in British Columbia: A Review of Outpatient Prescribing from 2000 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S109-S109
Author(s):  
Ariana Saatchi ◽  
David M Patrick ◽  
Andrew Morris ◽  
Michael Silverman ◽  
Marcus Povitz ◽  
...  
Keyword(s):  
British Columbia ◽  
Anatomical Therapeutic Chemical ◽  
Community Setting ◽  
Antibiotic Use ◽  
Modern Medicine ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
New Targets ◽  
Common Infections

Abstract Background Antimicrobial resistance continues to jeopardize the future of modern medicine; as 92% of all antibiotics are used in the community, it is imperative to parse outpatient prescribing. In British Columbia (BC), efforts to curb the use of these essential medications have included: stewardship campaigns, practitioner guidelines, and vaccine scheduling amendments. This study reviews the trends in antibiotic use over the past two decades to identify new targets for Provincial stewardship and intervention. Methods Antibiotic prescription information was extracted from PharmaNet, a centralized data system that links all pharmacies with prescriptions dispensed in the community setting. The Medical Service Plan records reimbursement claims submitted by physicians for services provided, including diagnostic codes. Antibiotic prescriptions were extracted from PharmaNet and then matched to the billing system using anonymized patient identifiers. Prescription rates were calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification. Results Our study included 3,564,258 individuals over an 18-year period, with a total of 26,108,576 antibiotic prescriptions issued, for common infections. Overall antibiotic utilization decreased 18% (from 228 to 187 prescriptions per 1000 population) over the course of the study period. This trend was reflected in both Beta-Lactam (-37%) and Macrolide (-50%) antibiotics; two of the most common classes prescribed in the outpatient setting. A significant outlier was the J01X class of Other Antibacterials, which increased by a staggering 218%, by 2018. Further analyses are currently underway to stratify these changes in magnitude by demographic variables to identify specific, new targets for stewardship. Rates of outpatient antibiotic prescriptions, for common infections, per 1000 population, by major ATC class, over time. Conclusion Outpatient antibiotic prescribing has decreased steadily since 2000. These promising results can be ascribed to the various Provincial initiatives to quell the misuse of these medications. However, many of the indications tied to these prescriptions do not warrant the use of antibiotics, and further analyses are necessary to evaluate prescribing quality to fully delineate the state of antibiotic use in BC. Next steps also include comparing BC rates with Ontario, another large province of Canada. Disclosures All Authors: No reported disclosures

scholarly journals Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

2021 ◽  
Author(s):  
ESF Orubu ◽  
A Najwa ◽  
C Ching ◽  
S Bu Jawdeh ◽  
J Anderson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Low Cost ◽  
Antibiotic Use ◽  
Current Status ◽  
War Wounds ◽  
Low Income Country ◽  
Antimicrobial Sensitivity ◽  
Important Solution ◽  
Amoxicillin Clavulanate

AbstractAntimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multi-faceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last five years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices and stewardship in Yemen, supported by a non-systematic scoping literature review and a key informant interview. Participants (96%, n=57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), Antimicrobial Sensitivity Tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of low-cost AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

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