scholarly journals 1384. Conceptual Economic Model Methodology for Infant Pneumococcal Conjugate Vaccine Program and its Impact on Antimicrobial Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S701-S702
Author(s):  
Raymond Farkouh ◽  
Arianna Nevo ◽  
Jennifer Uyei ◽  
Benjamin Althouse ◽  
Cassandra Hall-Murray ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resource Utilization ◽  
Economic Model ◽  
Pneumococcal Disease ◽  
Data Sources ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Effective Prevention ◽  
Material Support ◽  
Antimicrobial Prescribing

Abstract Background Antimicrobial resistance (AMR) is a global threat to effective prevention and treatment of an ever-increasing range of infections. Pneumococcal conjugate vaccines (PCV) used in infant national immunization programs have been shown to decrease AMR pneumococci. Cost-effectiveness models evaluating the value for money of PCV programs have not considered the economic impact of reducing antimicrobial prescribing or prolonged infections due to treatment failures. Standardized frameworks are needed for models to address outcomes and impact on health resource utilization related to AMR. Methods We developed a conceptual modeling methodology suitable for a health economic evaluation of an infant PCV program. We considered impact of PCVs on pneumococcal disease (PD) specifically related to clinical management of AMR-PD, including AMR epidemiology, antibiotic prescribing patterns, and healthcare resource utilization. Model inputs were evaluated regarding optimal and available data sources considering the complex nature of AMR at the national, regional, and global level. Results The proposed framework considers impact of PCVs on antimicrobial prescribing due to invasive pneumococcal disease (IPD), community acquired pneumonia (CAP), and acute otitis media (AOM) across 3 pathways (Figure 1). The population and pathogen-level pathway describe epidemiology and vaccine impact. The care level pathway describes clinical disease management. The health outcomes pathway characterizes resistant or successfully treated PD costs and quality of life. Conceptual Economic Model Methodology Conclusion We present a generalizable methodology to quantify impact of PCVs on cases and outcomes of PD related to AMR. Modelling vaccine-preventable burden of AMR-PD requires data extrapolations and assumptions due to the myriad of interconnected pathways (i.e. microbiology, epidemiology, environment, health systems). Further work is needed to validate assumptions and linkages across incomplete data sources. Disclosures Raymond Farkouh, PhD, Pfizer (Employee) Arianna Nevo, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Jennifer Uyei, PhD, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Cassandra Hall-Murray, PharmD, Pfizer, Inc. (Employee) Joseph Lewnard, PhD, Pfizer, Inc. (Consultant, Grant/Research Support, Advisor or Review Panel member) Matthew Wasserman, MSc., Pfizer Inc. (Employee)

Antimicrobial use at the end of life: a scoping review

2020 ◽  
pp. bmjspcare-2020-002558
Author(s):  
Jack Fairweather ◽  
Lesley Cooper ◽  
Jacqueline Sneddon ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
End Of Life ◽  
Scoping Review ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Ovid Medline ◽  
Tract Infections

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.DesignScoping reviewData sourcesAn information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.Study selectionStudies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this populationData extractionTwo reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.ResultsEighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.ConclusionsUse of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.

scholarly journals Antibiotic Prescribing Patterns for Childhood infections in Ambulatory Settings

2021 ◽  
Author(s):  
Samah Al-Shatnawi ◽  
Sanabel Alhusban ◽  
Shoroq Altawalbeh ◽  
Rawand Khasawneh
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Action Plan ◽  
Prescribing Patterns ◽  
World Health ◽  
Low Income Countries ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Tract Infections ◽  
The Impact

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

scholarly journals Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa

2021 ◽  
Vol 21 (4) ◽  
pp. 1651-61
Author(s):  
Nahyan Almansoori ◽  
Nivisha Parag
Keyword(s):  
Emergency Department ◽  
Antimicrobial Resistance ◽  
Care Pathway ◽  
Prescribing Patterns ◽  
Health Concern ◽  
Antibiotic Prescribing ◽  
National Guidelines ◽  
Common Indication ◽  
Male Predominance ◽  
Surgical Conditions

Background: Antibiotic resistance is a major public health concern. The Emergency department (ED) is the community gate for healthcare where antibiotics are often prescribed. However, there is a paucity of data regarding antibiotic prescriptionpractices in Africa. Objectives: To describe the use of antibiotics in an ED and level of prescribing adherence to national guidelines. Methods: Retrospective observational study of antibiotic practice in ED. All patients who presented to ED during the study period and were prescribed an anti-microbial agent were included. Data on demographics, working diagnosis, anti-microbialprescribed, dose, route and prescriber level were used to provide descriptive statistics of these parameters. Results: We identified 195 (13.4%) patients who received anti-microbial therapy among 1454 charts reviewed. The mean age was 34.8 with male predominance. The most common indication identified was abscess in 37 (30.8%) patients and in general surgical conditions had the highest rate of antimicrobials prescribed at 54.3%. In addition, co-amoxiclav was the most commonly prescribed anti-microbial (72.15%). We found that combination therapy was not common practice in ED, with majority of the patients having received single anti-microbial therapy (87.18%). The appropriateness of antimicrobial prescriptions was (46.2%) and not statistically significant (P = 0.654). Conclusion: The most commonly prescribed anti-microbial was co amoxiclav and the most common indication was abscess. It was found that antibiotic prescription appropriateness was acceptable when compared to studies conducted in developedcountries. However, further research within other hospital departments will add to the study to determine the adherence as an institution rather than the Emergency department alone, as antimicrobial resistance is a major global healthcare problemand impacts patient care throughout the care pathway. Keywords: Antimicrobial resistance; antibiotic stewardship; emergency department.

scholarly journals Comparative study of antimicrobial prescribing pattern between Nepal and Pakistan

10.3823/845 ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 15
Author(s):  
Muhammad Umer Nadeem ◽  
Ram Bahadur Dhami ◽  
Krishna Prasad Dahal ◽  
Devi Ram Pokharel ◽  
Anil Kumar Singh ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Sectional Study ◽  
Prescribing Pattern ◽  
Cross Sectional ◽  
Antimicrobial Prescribing ◽  
Private And Public ◽  
Antimicrobial Prescription

Objective The purpose of this cross-sectional study conducted in different private and public sector hospitals of the major cities of Nepal and Pakistan was to compare and evaluate the antibiotic prescribing patterns. Methodology  The data was collected based on prescriptions received from different hospitals of Lahore, Pakistan and Kathmandu, Nepal without much interaction with the patients. Results Out of a total of 272 patients, 111 (40.8%) patients from Nepal and 161 (59.19%) patients from Pakistan were prescribed with 447 antibiotics. In both countries, out of total antibiotics prescribed, 42.30% were 3rd generation cephalosporins. Also, in Pakistan and Nepal, out of all the indications, 49.2% of the antibiotics were given in medical prophylaxis. Conclusion  In Pakistan, the antimicrobial prescription rate is comparatively higher than Nepal, and in both countries, there is a need of proper implementation of antibiotic prescribing guidelines for the prescription of antibiotics and the administration of antibiotics in medical prophylaxis.

Emerging Antimicrobial Resistance Among Methicillin Resistant Staphylococcus Aureus (MRSA) in a Tertiary Care Centre in North India

JMS SKIMS ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 48-49
Author(s):  
Javaid Ahmad Bhat ◽  
Shariq Rashid Masoodi
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Tertiary Care ◽  
Resistance Mechanisms ◽  
North India ◽  
Global Public Health ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Effective Prevention ◽  
Mupirocin Resistance

Apropos to the article by Dr Bali, titled “Mupirocin resistance in clinical isolates of methicillin-sensitive and resistant Staphylococcus aureus in a tertiary care centre of North India” (1), the authors have raised important issue of emerging antimicrobial resistance (AMR). Antimicrobial resistance is an increasingly serious threat to global public health that requires action across all government sectors and society. As per WHO, AMR lurks the effective prevention and management of an ever-increasing spectrum of infections caused by bacteria, parasites, fungi and viruses. Novel resistance mechanisms are emerging and spreading globally, threatening the man’s ability to treat common infectious diseases.

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