Nonadherence to National Guidelines for Antibiotic Treatment of Uncomplicated Gonorrhea in China

Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries to adapt WHO guidance into national guidelines for implementation in primary healthcare facilities. Early implementation was led by the Ministry of Health and Family Welfare (MOHFW) in 10 subdistricts of Bangladesh with support from USAID’s MaMoni Health System Strengthening project. This mixed methods implementation research case study explores programme feasibility and acceptability through analysis of service delivery data from 4590 sick young infants over a 15-month period, qualitative interviews with providers and MOHFW managers and documentation by project staff. Multistakeholder collaboration was key to ensuring facility readiness and feasibility of programme delivery. For the 514 (11%) infants classified as PSBI, provider adherence to prereferral treatment and follow-up varied across infection subcategories. Many clinical severe infection cases for whom referral was not feasible received the recommended two doses of injectable gentamicin and follow-up, suggesting delivery of simplified antibiotic treatment is feasible. However, prereferral antibiotic treatment was low for infants whose families accepted hospital referral, which highlights the need for additional focus on managing these cases in training and supervision. Systems for tracking sick infants that accept hospital referral are needed, and follow-up of all PSBI cases requires strengthening to ensure sick infants receive the recommended treatment, to monitor outcomes and assess the effectiveness of the programme. Only 11.2% (95% CI 10.3 to 12.1) of the expected PSBI cases sought care from the selected service delivery points in the programme period. However, increasing trends in utilisation suggest improved awareness and acceptability of services among families of young infants as the programme matured. Future programme activities should include interviews with caregivers to explore the complexities around referral feasibility and acceptability of simplified antibiotic treatment.

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Antibiotic treatment for respiratory tract infections in Polish primary care facilities: is it time to change national guidelines or doctor prescribing behaviour?

Journal of Evaluation in Clinical Practice ◽

10.1111/j.1365-2753.2007.00865.x ◽

2008 ◽

Vol 14 (3) ◽

pp. 470-472 ◽

Cited By ~ 2

Author(s):

Slawomir Chlabicz ◽

Barbara Pytel-Krolczuk

Keyword(s):

Primary Care ◽

Respiratory Tract ◽

Antibiotic Treatment ◽

Respiratory Tract Infections ◽

National Guidelines ◽

Care Facilities ◽

Prescribing Behaviour ◽

Tract Infections

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Comprehensive Description of Pathogens and Antibiotic Treatment Guidance in Children With Community-Acquired Pneumonia Using Combined Mass Spectrometry Methods

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.695134 ◽

2021 ◽

Vol 11 ◽

Author(s):

Liying Sun ◽

Chi Zhang ◽

Shuhua An ◽

Xiangpeng Chen ◽

Yamei Li ◽

...

Keyword(s):

Mass Spectrometry ◽

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Community Acquired Pneumonia ◽

Molecular Testing ◽

Respiratory Pathogens ◽

National Guidelines ◽

Culture Methods ◽

Identification Rate ◽

Infection Pattern

The objective of this study was to evaluate the value of molecular methods in the management of community-acquired pneumonia (CAP) in children. Previously developed mass spectrometry (MS)-based methods combined with quantitative real-time PCR (combined-MS methods) were used to describe the aetiology and evaluate antibiotic therapy in the enrolled children. Sputum collected from 302 children hospitalized with CAP were analyzed using the combined-MS methods, which can detect 19 viruses and 12 bacteria related to CAP. Based on the results, appropriate antibiotics were determined using national guidelines and compared with the initial empirical therapies. Respiratory pathogens were identified in 84.4% of the patients (255/302). Co-infection was the predominant infection pattern (51.7%, 156/302) and was primarily a bacterial-viral mixed infection (36.8%, 111/302). Compared with that using culture-based methods, the identification rate for bacteria using the combined-MS methods (61.8%, 126/204) increased by 28.5% (p <0.001). Based on the results of the combined-MS methods, the initial antibiotic treatment of 235 patients was not optimal, which mostly required switching to β-lactam/β-lactamase inhibitor combinations or reducing unnecessary macrolide treatments. Moreover, using the combined-MS methods to guide antibiotic therapy showed potential to decrease the length of stay in children with severe CAP. For children with CAP, quantitative molecular testing on sputum can serve as an important complement to traditional culture methods. Early aetiology elucidated using molecular testing can help guide the antibiotic therapy.

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The impact of national recommendations on antibiotic treatment of community acquired pneumonia. Do pediatricians follow the national guidelines?

10.1183/1393003.congress-2017.pa550 ◽

2017 ◽

Author(s):

Grażyna Kraj ◽

Katarzyna Krenke ◽

Joanna Peradzyńska ◽

Julita Chądzyńska ◽

Krystian Wołoszyn ◽

...

Keyword(s):

Antibiotic Treatment ◽

Community Acquired Pneumonia ◽

National Guidelines ◽

The Impact

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Infection control audit of Clostridium difficile-associated diarrhoea at the University Hospital of Wales

British Journal of Infection Control ◽

10.1177/175717740200300606 ◽

2002 ◽

Vol 3 (6) ◽

pp. 16-18

Author(s):

L Jenkins ◽

D Hilt ◽

J Brazier ◽

I Hosein

Keyword(s):

Clostridium Difficile ◽

Antibiotic Treatment ◽

Antibiotic Use ◽

University Hospital ◽

Beta Lactam ◽

National Guidelines ◽

Single Room ◽

Hospitalised Patients ◽

The University ◽

Clostridium Difficile Associated Diarrhoea

Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised patients, and has been implicated in a number of outbreaks with significant morbidity and mortality. It is widely regarded as a hospital-acquired problem, associated with antibiotic use. An audit aimed at reviewing compliance against local Clostridium difficile- associated diarrhoea (CDAD) policy at the University Hospital of Wales, Cardiff was undertaken from May to July 1999. Despite the difficulty in adhering to national guidelines on single-room isolation, the prevalence of CDAD at our hospital has decreased in recent years. Community acquired CDAD accounted for 15% of our cases, which supports increasing levels of community CDAD (Kalstrom et al 1998). Recent antibiotic treatment was recorded for 82% of the audit cases, with beta-lactam being the most frequently prescribed. Antibiotic treatment for infection other than CDAD was stopped for only 11% of the cases. Where treatment was given for CDAD, clinical staff followed approved guidance.

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Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients

Respiratory Research ◽

10.1186/s12931-020-01606-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kristian Bagge ◽

Pradeesh Sivapalan ◽

Josefin Eklöf ◽

Frederik Böetius Hertz ◽

Christian Østergaard Andersen ◽

...

Keyword(s):

Clavulanic Acid ◽

Antibiotic Treatment ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

National Guidelines ◽

Cox Proportional Hazards Models ◽

First Choice ◽

Exposure Variable ◽

Amoxicillin Clavulanic Acid ◽

Exacerbation Of Copd

Abstract Background For antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome. Methods The Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints. Results For the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC. Conclusion In AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone.

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