scholarly journals Electronic antibiotic stewardship--reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting

2008 ◽  
Vol 62 (3) ◽  
pp. 608-616 ◽  
Author(s):  
K. L. Buising ◽  
K. A. Thursky ◽  
M. B. Robertson ◽  
J. F. Black ◽  
A. C. Street ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Hospital Setting ◽  
Broad Spectrum Antibiotics

A RANDOMIZED TRIAL TO MEASURE THE OPTIMAL ROLE OF THE PHARMACIST IN PROMOTING EVIDENCE-BASED ANTIBIOTIC USE IN ACUTE CARE HOSPITALS

2001 ◽  
Vol 17 (2) ◽  
pp. 171-180 ◽  
Author(s):  
George Dranitsaris ◽  
Diana Spizzirri ◽  
Monique Pitre ◽  
Allison McGeer
Keyword(s):  
Acute Care ◽  
Broad Spectrum ◽  
Randomized Clinical Trials ◽  
Intervention Group ◽  
Hospital Setting ◽  
Control Group ◽  
Evidence Based ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics ◽  
The Impact

Background: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant in the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-based medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with randomization incorporated into the design as well as patient-related therapeutic outcomes.Methods: A total of 323 patients who were prescribed cefotaxime were randomized into an intervention or nonintervention group where only the former was challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotaxime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response.Results: Overall, 94% of orders in the intervention group met cefotaxime dosage criteria compared with 86% in the control group (p = .018). However, there was no impact with respect to promoting cefotaxime use for an appropriate indication (81% vs. 80%; p = .67). There was a trend for improved clinical outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31).Conclusions: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improve the dosing of such agents. However, several barriers to optimizing the impact of the pharmacist were implied by the data. Removing these barriers could increase the pharmacists' utility as an agent for improved patient care.

scholarly journals 51 Overuse of ceftriaxone in children with otitis media: experience at a Canadian tertiary care hospital

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e21-e21
Author(s):  
Mila Arnautovich ◽  
Ann-Christine Godard ◽  
Jean-Francois Turcotte
Keyword(s):  
Otitis Media ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Tertiary Care ◽  
Penicillin Allergy ◽  
White Blood Count ◽  
Oral Drugs ◽  
Broad Spectrum Antibiotics ◽  
Amoxicillin Clavulanate ◽  
History Of

Abstract Background Acute otitis media (AOM) is extremely common. In fact, most children experience at least one ear infection before starting school. It is also recognized as the most frequent reason to administer antibiotics in children. However, many advocate for limited use of antibiotics in healthy children over 6 months of age using a watchful waiting approach. This applies even more for broad-spectrum antibiotics in the context of antibiotic stewardship. The Canadian Paediatric Society (CPS) recommends using parenteral ceftriaxone only when oral drugs are not tolerated or amoxicillin-clavulanate fails. Objectives This primary aim of this study was to describe the use of ceftriaxone in the treatment of children with AOM. Secondary aims were to assess length of therapy and complications as well as determine if the use of ceftriaxone met the criteria of refractory AOM suggested by the CPS. Design/Methods We performed a retrospective observational cohort study of children aged between the ages of 6 months and 5 years with a diagnosis of AOM at a single tertiary care center. All children were seen between March 2017 and February 2019 in a pediatric outpatient medical day unit and received at least one dose of ceftriaxone. Chart review was performed and multiples variables were included in the analysis. Patients with insufficient chart data or with a congenital ear anomaly were excluded. Results A total of 276 patients were included. Patients were aged 17.5 ± 9 months and a majority were boys (N=160). Most patients were fully immunized (N=252). A history of penicillin allergy was reported for 59 patients. Previous AOM was common (N=205) while tympanostomy tubes were rare (N=12). With regards to the diagnosis of AOM, a majority (N=153) had bilateral AOM. Diagnosis of AOM was based on inflammation (N=204), bulging tympanic membrane (N=158) or middle ear effusion (N=118). Fourteen patients had a tympanic perforation. Almost all patients were febrile (N=266). One patient had a positive blood culture (streptococcus pneumoniae) and one had a mastoiditis. Among those who underwent bloodwork (N=212), white blood count was 15.2 ± 6.7 x 109. With regards to antibiotics, most patients (N=218) were initially given oral antibiotics, with amoxicillin given as a first line therapy for 99 patients. A minority of patients received amoxicillin-clavulanate prior to receiving ceftriaxone (N=105). Reasons for the use of ceftriaxone included intolerance to oral drugs (N=18), failure of (or recent exposure to) amoxicillin-clavulanate (N=89) and a history of penicillin allergy (N=50). Most patients were treated with a course of three days with only 51 patients receiving one or two doses. Conclusion In our cohort, the use of ceftriaxone was not limited to nonresponsive AOM. In fact, a minority of patients received ceftriaxone in the setting of intolerance to oral drugs or failure of amoxicillin-clavulanate. This goes against current CPS recommendations and suggests an overuse of broad-spectrum antibiotics. Obviously, this needs to be addressed in the context of antibiotic stewardship.

scholarly journals Veterinarians’ Perception, Knowledge and Practices of Antibiotic Stewardship in Enugu State Southeast, Nigeria

2017 ◽  
Vol 9 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Madubuike Umunna ANYANWU ◽  
Oluwatosin Ajoke KOLADE
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Southeastern Nigeria ◽  
Significance Level ◽  
Broad Spectrum Antibiotics ◽  
Enugu State ◽  
Antibiotic Stewardship Abs

A cross-sectional survey utilizing structured questionnaires was used to study the veterinarians’ perception, knowledge and practices of antibiotic stewardship (ABS) in Enugu State, Southeastern Nigeria. Data obtained were analyzed using chi-square on SPSS (Version 15.0) at a significance level of P < 0.05 to determine possible associations between variables and perceptions/knowledge about ABS. Out of 280 respondents, 41 (17.1%) had heard about ABS. Minority of the respondents perceived/knew that using antibiotics only when necessary (6.4%, 18), administering antibiotics at the appropriate dose (6.4%, 18) and administering antibiotics for appropriate duration in every case (4.3%, 12) were among the principles of ABS. The study also showed that age, gender, qualification, years of practice and locations did not exert any influence (P > 0.05) on the awareness of respondents about ABS. More than one-third of the respondents wrongly perceived that increasing the use of broad-spectrum antibiotics (35.4%, 99) is one of the goals of ABS, whereas the minority of the respondents rightly perceived/knew that minimizing toxicity and other adverse effects (16.8%, 47) and reducing antibiotic resistance (ABR) (43.2%, 121) are also goals of ABS. Only 21.4% (60) had overall knowledge of ABS. Prescribing antibiotics without seeing/examining the patient, prescribing antibiotics for any case suspected to be infectious, prescribing broad-spectrum antibiotics despite availability of narrow-spectrum antibiotics, prescribing different classes/types of antibiotics concurrently to ensure therapeutic efficacy, prescribing overdose of antibiotics to ensure efficacy and non-consultation of the  veterinary formulary/other resources when in doubt during prescription, are some of inappropriate/untoward ABS practices/behaviors/attitudes amongst the respondents. No significant association (P > 0.05) was found between practices of ABS and age, gender, qualification, years of practice and location. In conclusion, the veterinarians’ awareness/perception and practices of ABS is abysmally poor in the study area, thus education of Nigerian veterinarians about ABS and the teaching of the principles and practices of ABS during veterinary schools are recommended. 

scholarly journals Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257993
Author(s):  
Sara Rossin ◽  
Elisa Barbieri ◽  
Anna Cantarutti ◽  
Francesco Martinolli ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Community Acquired Pneumonia ◽  
Broad Spectrum Antibiotics ◽  
Outpatient Group ◽  
Before And After ◽  
Tract Infections ◽  
The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

scholarly journals Leveraging implementation science to advance antibiotic stewardship practice and research

2021 ◽  
pp. 1-8
Author(s):  
Daniel J. Livorsi ◽  
Mari-Lynn Drainoni ◽  
Heather Schacht Reisinger ◽  
Neha Nanda ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Public Health ◽  
Antibiotic Resistance ◽  
Implementation Science ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Medicine ◽  
Health Crisis ◽  
The Public ◽  
Public Health Crisis ◽  
Broad Spectrum Antibiotics

Antibiotics are among the most commonly prescribed medications, and there is evidence to guide the optimal use of these agents for most situations encountered in clinical medicine, including for both treatment and prophylaxis. Nevertheless, clinicians routinely prescribe antibiotics in ways that diverge from this evidence, such as prescribing them when not indicated, for durations longer than necessary, or selecting broad-spectrum antibiotics when a narrower-spectrum agent would suffice.1,2 This overuse of antibiotics contributes to the public health crisis of antibiotic resistance while exposing patients to potential antibiotic-related harms.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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