An ongoing national programme to reduce antibiotic prescription and use

High levels of antibiotic use have been associated with higher levels of antimicrobial resistance. The National Prescribing Service (NPS) has been running national programs to reduce prescription and use of antibiotics in Australia since 1999. These programs have used a range of strategies to influence general practitioners, community pharmacists and consumers. Over time, there have been modest changes in consumer attitudes towards antibiotics and antibiotic prescription rates continue to decline.

Download Full-text

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

10.21203/rs.3.rs-59028/v2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Regina Poss-Doering ◽

Dorothea Weber ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Resistance ◽

General Practitioners ◽

Antibiotic Prescription ◽

Treatment Options ◽

Inappropriate Prescribing ◽

Female Gender ◽

Reference Groups ◽

Prescription Rates ◽

To Receive

Abstract Background Antimicrobial resistance is fueled by inappropriate prescribing and use of antibiotics. Global and national strategies support rational and adequate use of antibiotics to retain treatment options and fight resistances. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) was intended to promote the rational and appropriate use of antibiotics for acute non-complicated infections by addressing physicians, care teams and patients through multiple interacting interventions. This paper presents patterns of antibiotics prescribing for patients with acute non-complicated infections in participating primary care networks prior to the start of the ARena project, explores variation across subgroups of patients and draws comparisons to reference groups which represent standard care. Methods In mixed logistic regression models, we explored factors associated with the primary outcome defined as the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to primary care networks, reference groups, and subgroups. Results Across all observed cases, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. Being the largest group of physicians observed, General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were moderate (8.1% in reference groups and 9.9% in primary care networks). Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions compared to males (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion Prior to the ARena project, observed antibiotic prescription rates for acute non-complicated infections were moderate, but there was still room for improvement. The use of recommended substances was low which indicates a need for creating stronger awareness of guideline-conform use of antibiotics.

Download Full-text

Baseline assessment of antibiotics prescribing for acute, non-complicated infections in primary care in Germany in the cluster randomized trial ARena

10.21203/rs.3.rs-59028/v1 ◽

2020 ◽

Author(s):

Regina Poss-Doering ◽

Dorothea Weber ◽

Martina Kamradt ◽

Edith Andres ◽

Petra Kaufmann-Kolle ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Antibiotic Prescription ◽

Treatment Options ◽

Inappropriate Prescribing ◽

Cluster Randomized Trial ◽

Female Gender ◽

Reference Groups ◽

Prescription Rates ◽

To Receive

Abstract BackgroundAntimicrobial resistance is fueled by inappropriate prescribing and use of antibiotics. Global and national strategies support rational and adequate use of antibiotics to retain treatment options and fight resistances. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) was intended to promote the rational and appropriate use of antibiotics for acute non-complicated infections by addressing physicians, care teams and patients through multiple interacting interventions. This paper presents patterns of antibiotics prescribing for patients with acute non-complicated infections in participating primary care networks prior to the start of the ARena project, explores variation across subgroups of patients and draws comparisons to reference groups which represent standard care. MethodsIn mixed logistic regression models, we explored factors associated with the proportion of patients with acute non-complicated infections consulting primary care practices who received an antibiotic prescription. Secondary outcomes concerned the prescription of different types of antibiotics. Descriptive methods were used to summarize the data referring to primary care networks, reference groups, and subgroups. ResultsAcross all observed cases, antibiotic prescription rates were 31.7% in reference groups and 32.0% in primary care networks. Being the largest group of physicians observed, General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR=0.465 CI=[0.302; 0.719], p<0.001, pediatricians vs. General practitioners: OR=0.369 CI=[0.135; 1.011], p=0.053). Quinolone prescription rates were moderate (8.1% in reference groups and 9.9% in primary care networks). Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a recommended substance. Younger patients were less likely to receive antibiotics (OR=0.771 CI=[0.636; 0.933], p=0.008). Female gender was associated with higher rates of antibiotic prescriptions compared to males (OR=1.293 CI=[1.201, 1.392], p<0.001).Conclusion Prior to the ARena project, observed antibiotic prescription rates for acute non-complicated infections were moderate, but there was still room for improvement. The use of recommended substances was low which indicates a need for creating stronger awareness of guideline-conform use of antibiotics.

Download Full-text

Antibiotic use for typhoid in India: Estimation from private sector prescription data during 2013-15

10.1101/2021.12.10.21267591 ◽

2021 ◽

Author(s):

Shaffi Fazaludeen Koya ◽

Habib Hasan Farooqui ◽

Aashna Mehta ◽

Sakthivel Selvaraj ◽

Sandro Galea

Keyword(s):

Private Sector ◽

Disease Surveillance ◽

Primary Care Physicians ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Population Based ◽

Prescription Data ◽

Adult Age ◽

Disease Surveillance System ◽

Prescription Rates

Background India's typhoid burden estimates are based on a limited number of population-based studies and data from a grossly incomplete disease surveillance system. In this study, we estimated the total and sex-and age-specific antibiotic prescription rates for typhoid. Methods We used systematic antibiotic prescription by private sector primary care physicians in India. We categorized antibiotics using the WHO classification system and calculated the prescription for various classes of antibiotics. Results We analyzed 671 million prescriptions for the three-year period (2013-2015), of which an average of 8.98 million antibiotic prescriptions per year was for typhoid, accounting for 714 prescriptions per 100,000 population. Combination antibiotics are the preferred choice of prescribers in the adult age group, while cephalosporins are the preferred choice in children and young age. The prescription rate decreased from 792/100,000 in 2013 to 635 in 2015. Conclusion We report a higher rate of antibiotic prescription for typhoid using prescription data, indicating a higher disease burden than previously estimated. Quinolones are still widely used in monotherapy, and children less than 10 years account for more than a million cases annually, which calls for a routine vaccination program.

Download Full-text

Perceptions, Current Practices and Interventions of Community Pharmacists Regarding Antimicrobial Stewardship: A Qualitative Study in France

10.21203/rs.3.rs-1033731/v1 ◽

2021 ◽

Author(s):

Claire Durand ◽

Aude Chappuis ◽

Eric Douriez ◽

Frédérique Poulain ◽

Raheelah Ahmad ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Antimicrobial Resistance ◽

Community Health ◽

Antimicrobial Stewardship ◽

Thematic Analysis ◽

Community Pharmacists ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Community Health Care

Abstract Background: Community health care accounts for the vast majority of antibiotic use in Europe. Given the threat of antimicrobial resistance (AMR), there is an urgent need to develop new antimicrobial stewardship (AMS) interventions in primary care that could involve different health care providers including community pharmacists. This study aimed to explore the perceptions, currents practices and interventions of community pharmacists regarding antimicrobial stewardship.Methods: Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of community pharmacists combined with a snowballing technique. Interviews were audio recorded, transcribed and analyzed using thematic analysis. The Consolidated Framework for Implementation Research was used while developing the interview guide and carrying out thematic analysis.Results: Sixteen community pharmacists participated. All the respondents had good awareness about antimicrobial resistance and believed community pharmacists had an important role in tackling AMR. Some barriers to community pharmacists’ participation in AMS were identified such as difficult interactions with prescribers, lack of time and lack of access to patient medical records and diagnosis. Increased patient education, audits and feedback of antibiotic prescribing, increased point-of-care testing and delayed prescribing were interventions suggested by the pharmacists to improve antibiotic use in primary care. Strategies cited by participants to facilitate the implementation of such interventions are increased pharmacist-general practitioner collaboration, specialized training, clinical decision support tools as well as financial incentives. Conclusions: This study suggests that community pharmacists could play a greater role in infection management and AMS interventions. Further interprofessional collaboration is needed to optimize antibiotic prescribing and utilization in community health care.

Download Full-text

Community antibiotic prescribing for children in France from 2015 to 2017: a cross-sectional national study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa162 ◽

2020 ◽

Author(s):

Nhung T H Trinh ◽

Robert Cohen ◽

Magali Lemaitre ◽

Pierre Chahwakilian ◽

Gregory Coulthard ◽

...

Keyword(s):

Broad Spectrum ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

National Study ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic ◽

Duration Of Treatment ◽

Cross Sectional ◽

Prescription Rates ◽

Tract Infections

Abstract Objectives To assess recent community antibiotic prescribing for French children and identify areas of potential improvement. Methods We analysed 221 768 paediatric (<15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA’s EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing. Results GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9–26.3) versus 21.6 (95% CI 21.0–22.2) per 100 visits, respectively; P < 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3–50.3) versus 35.6% (95% CI 34.1–37.1), P < 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years. Conclusions Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.

Download Full-text

Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antibiotics ◽

10.3390/antibiotics10020196 ◽

2021 ◽

Vol 10 (2) ◽

pp. 196

Author(s):

Alma C. van de Pol ◽

Josi A. Boeijen ◽

Roderick P. Venekamp ◽

Tamara Platteel ◽

Roger A. M. J. Damoiseaux ◽

...

Keyword(s):

Infectious Disease ◽

Primary Care ◽

Health Care ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Skin Infections ◽

Prescription Rates ◽

Ear Infections ◽

Disease Entities

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

Download Full-text

Community Antibiotic Use at the Population Level During the SARS-CoV-2 Pandemic in British Columbia, Canada

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab185 ◽

2021 ◽

Author(s):

Abdullah A Mamun ◽

Ariana Saatchi ◽

Max Xie ◽

Hannah Lishman ◽

Edith Blondel-Hill ◽

...

Keyword(s):

Enzyme Inhibitors ◽

Moving Average ◽

Population Level ◽

Antibiotic Use ◽

Control Measures ◽

Office Visits ◽

Interrupted Time Series Analysis ◽

Level Change ◽

Prescription Rates ◽

Over Time

Abstract Objectives To examine the aggregate rates of antibiotic use at population level and compare these rates over time against historical averages to identify the effect of SARS-CoV-2 and the resulting control measures, upon community prescribing. Methods We collected antibiotic prescriptions and physician office visits from January 1, 2016 to July 21, 2020. We calculated monthly prescription rates stratified by sex, age group, profession, diagnosis type and antibiotic class. We looked at monthly prescription rate as a moving average over time. Using interrupted time series analysis method we estimated the changes in prescription rates after March 2020. Results The moving average of overall monthly prescription rates during January to June of 2020 were below the minimum of the historical years’ moving averages (2016-2019). We observed >30% reduction in overall monthly prescription rates in April, May and July of 2020 compared to the same months of 2019. We observed overall monthly prescription rates experienced a significant level change of -12.79 (p < 0.001) after COVID-19 after March 2020, with the greatest level change of -18.02 among 1-4 years (p<0.001). We estimated an average -5.94 (p<0.001) change in RTI-associated monthly prescription rates after March 2020. Overall prescription rates comparing January – July 2019 and their 2020 counterparts showed a decrease in monthly prescribing ranging from -1 to -5 for: amoxicillin, amoxicillin and enzyme inhibitors, azithromycin, clarithromycin and sulfamethoxazole. Conclusion In BC, Canada, overall and RTI-specific monthly antibiotic prescription rates declined significantly during April to July 2020 compared to the same months in pre-pandemic years.

Download Full-text

Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/243801 ◽

2014 ◽

Vol 2014 ◽

pp. 1-17 ◽

Cited By ~ 7

Author(s):

Harald J. Hamre ◽

Anja Glockmann ◽

Reinhard Schwarz ◽

David S. Riley ◽

Erik W. Baars ◽

...

Keyword(s):

Observational Studies ◽

Antibiotic Prescription ◽

Secondary Analysis ◽

Public Health Problem ◽

Antibiotic Use ◽

Major Public Health Problem ◽

Unadjusted Odds Ratio ◽

Prescription Rates ◽

Ear Infections

Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P<0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

Download Full-text

Seasonal Variation in an Outpatient Antibiotic Prescription Rates in Alkharj

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i930476 ◽

2020 ◽

pp. 1-7

Author(s):

Nehad J. Ahmed

Keyword(s):

Medical Records ◽

Public Hospital ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Outpatient Setting ◽

Sectional Study ◽

Cross Sectional ◽

Prescription Rates ◽

Outpatient Prescriptions

Aim: The aim of this study was to describe the seasonal variations in dispensing antibiotic prescriptions in the outpatient setting of a public hospital in Alkharj. Methodology: A retrospective cross-sectional study was conducted. The outpatient prescriptions in 2017 and 2018 were collected from medical records in a public hospital in Alkharj. The data include the number of prescribed antibiotics in general, the number of prescribed antibiotics in different months and seasons in the outpatient setting. Results: In the outpatient setting in 2017 and 2018, antibiotics were prescribed excessively in most of the months. About 27.84 %of the prescriptions in 2017 were in spring season and about 26.64% of the prescriptions in 2018 were in autumn. Total number of antibiotics prescriptions in 2017 and 2018 were 5348 in spring followed by 5097 in autumn. Conclusion: The results of the present study showed the widespread use of antibiotics by practitioners that was associated with season of prescribing. In general, there are excess use of antibiotics in all months. It is important to understand how the prescribing of antibiotic varies throughout the year to design an appropriate intervention to decrease incorrect antibiotic use.

Download Full-text

Emergence of Quinolone Resistance and Cephalosporin MIC Creep inNeisseria gonorrhoeaeIsolates from a Cohort of Young Men in Kisumu, Kenya, 2002 to 2009

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00155-11 ◽

2011 ◽

Vol 55 (8) ◽

pp. 3882-3888 ◽

Cited By ~ 24

Author(s):

Supriya D. Mehta ◽

Ian Maclean ◽

Jeckoniah O. Ndinya-Achola ◽

Stephen Moses ◽

Irene Martin ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Male Circumcision ◽

Selective Pressure ◽

Pcr Amplification ◽

Tetracycline Resistance ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Drug Choice ◽

Agar Dilution ◽

Over Time

ABSTRACTWe evaluated antimicrobial resistance inNeisseria gonorrhoeaeisolated from men enrolled in a randomized trial of male circumcision to prevent HIV. Urethral specimens from men with discharge were cultured forN. gonorrhoeae. MICs were determined by agar dilution. Clinical and Laboratory Standards Institute (CLSI) criteria defined resistance: penicillin, tetracycline, and azithromycin MICs of ≥2.0 μg/ml; a ciprofloxacin MIC of ≥1.0 μg/ml; and a spectinomycin MIC of ≥128.0 μg/ml. Susceptibility to ceftriaxone and cefixime was shown by an MIC of ≤0.25 μg/ml. Additionally, PCR amplification identified mutations inparCandgyrAgenes in selected isolates. From 2002 to 2009, 168N. gonorrhoeaeisolates were obtained from 142 men. Plasmid-mediated penicillin resistance was found in 65%, plasmid-mediated tetracycline resistance in 97%, and 11% were ciprofloxacin resistant (quinolone-resistantN. gonorrhoeae[QRNG]). QRNG appeared in November 2007, increasing from 9.5% in 2007 to 50% in 2009. Resistance was not detected for spectinomycin, cefixime, ceftriaxone, or azithromycin, but MICs of cefixime (P= 0.018), ceftriaxone (P< 0.001), and azithromycin (P= 0.097) increased over time. In a random sample of 51 men, gentamicin MICs were as follows: 4 μg/ml (n= 1), 8 μg/ml (n= 49), and 16 μg/ml (n= 1). QRNG increased rapidly and alternative regimens are required forN. gonorrhoeaetreatment in this area. Amid emerging multidrug-resistantN. gonorrhoeae, antimicrobial resistance surveillance is essential for effective drug choice. High levels of plasmid-mediated resistance and increasing MICs for cephalosporins suggest that selective pressure from antibiotic use is a strong driver of resistance emergence.

Download Full-text