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

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.

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Polypharmacy and Pharmacological Treatment of Diabetes in Older Individuals: A Population-Based Study in Quebec, Canada

Pharmacy ◽

10.3390/pharmacy7040161 ◽

2019 ◽

Vol 7 (4) ◽

pp. 161

Author(s):

Marie-Eve Gagnon ◽

Caroline Sirois ◽

Marc Simard ◽

Céline Plante

Keyword(s):

Disease Surveillance ◽

Population Level ◽

Population Based ◽

Lipid Lowering ◽

Hypoglycemic Agents ◽

Older Individuals ◽

Factors Associated ◽

Cardiovascular Comorbidities ◽

Disease Surveillance System ◽

Lipid Lowering Agents

Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study among individuals aged 66–75 years with diabetes in 2014–2015. We described the number of medications and the classes of medications used and calculated the proportion of individuals using at least one medication from each of these classes: hypoglycemics, antihypertensives and lipid-lowering agents. We identified the factors associated with the use of this combination of treatments by performing robust Poisson regressions. The 146,710 individuals used an average of 12 (SD 7) different medications, mostly cardiovascular (91.3% of users), hormones, including hypoglycemic agents (84.5%), and central nervous system medications (79.8%). The majority of individuals (59%) were exposed to the combination of treatments and the factor most strongly associated was the presence of cardiovascular comorbidities (RR: 1.29; 99% CI: 1.28–1.31). Older individuals with diabetes are exposed to a large number of medications. While the use of the combination of treatments is significant and could translate into cardiovascular benefits at the population level, the potential risk associated with polypharmacy needs to be documented.

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Antibiotic use in children and youths with asthma: a population-based case-control study

ERJ Open Research ◽

10.1183/23120541.00944-2020 ◽

2021 ◽

Vol 7 (1) ◽

pp. 00944-2020

Author(s):

Ivy Fong ◽

Jingqin Zhu ◽

Yaron Finkelstein ◽

Teresa To

Keyword(s):

Case Control Study ◽

Antibiotic Prescription ◽

Conditional Logistic Regression ◽

Antibiotic Use ◽

Population Based ◽

Case Control ◽

Use Patterns ◽

Nested Case Control ◽

Stratified Analysis ◽

Control Study

RationaleAntibiotics are among the most common medications dispensed to children and youths. The objective of this study was to characterise and compare antibiotic use patterns between children and youths with and without asthma.MethodsWe conducted a population-based nested case–control study using health administrative data from Ontario, Canada, in 2018. All Ontario residents aged 5–24 years with asthma were included as cases. Cases were matched to controls with a 1:1 ratio based on age (within 0.5 year), sex and location of residence. Multivariable conditional logistic regression was used to obtain an odds ratio and 95% confidence interval for having filled at least one antibiotic prescription, adjusted for socioeconomic status, rurality, and presence of common infections, allergic conditions and complex chronic conditions.ResultsThe study population included 1 174 424 Ontario children and youths aged 5–24 years. 31% of individuals with asthma and 23% of individuals without asthma filled at least one antibiotic prescription. The odds of having filled at least one antibiotic prescription were 34% higher among individuals with asthma compared to those without asthma (OR 1.34, 95% CI 1.32–1.35). In the stratified analysis, the odds ratios were highest in the youngest group of children studied, aged 5–9 years (OR 1.45, 95% CI 1.41–1.48), and in females (OR 1.36, 95% CI 1.34–1.38).ConclusionAsthma is significantly associated with increased antibiotic use in children and youths. This association is the strongest in younger children and in females.

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The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance

International Journal for Population Data Science ◽

10.23889/ijpds.v3i3.433 ◽

2018 ◽

Vol 3 (3) ◽

Cited By ~ 2

Author(s):

Lisa Lix ◽

James Ayles ◽

Sharon Bartholomew ◽

Charmaine Cooke ◽

Joellyn Ellison ◽

...

Keyword(s):

Chronic Disease ◽

Surveillance System ◽

Disease Surveillance ◽

Health Agency ◽

Population Based ◽

Population Characteristics ◽

Administrative Databases ◽

Distributed Model ◽

Case Definitions ◽

Disease Surveillance System

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

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Clostridioides difficile infection and antibiotic prescription rates in the community: Explaining the gender gap

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1268 ◽

2020 ◽

pp. 1-3

Author(s):

Mariam Younas ◽

Julie Royer ◽

Sharon B. Weissman ◽

Hana R. Winders ◽

Sangita Dash ◽

...

Keyword(s):

South Carolina ◽

Gender Gap ◽

Antibiotic Prescription ◽

Population Based ◽

Incidence Rates ◽

Cross Sectional ◽

Crude Incidence ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Prescription Rates

Abstract In this cross-sectional population-based study, women had significantly higher crude incidence rates of both community-associated Clostridioides difficile infection (CA-CDI) and ambulatory antibiotic prescriptions compared to men in South Carolina in 2015. After adjustments for antibiotic prescription rates, there was no difference in the incidence rates of CA-CDI between the genders.

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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.

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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.

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Antibiotic use and irrational antibiotic prescriptions in 66 primary healthcare institutions in Beijing City, China, 2015–2018

BMC Health Services Research ◽

10.1186/s12913-021-06856-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yumiti Taxifulati ◽

Haishaerjiang Wushouer ◽

Mengyuan Fu ◽

Yue Zhou ◽

Kexin Du ◽

...

Keyword(s):

Tract Infection ◽

Primary Healthcare ◽

Antibiotic Prescription ◽

Antibiotic Use ◽

Developed Countries ◽

Prescription Data ◽

Prescription Rate ◽

Beijing City ◽

Acute Tonsillitis ◽

Community Healthcare

Abstract Objectives To identify the patterns of antibiotic use and irrational antibiotic prescriptions in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, China. Materials and methods All primary healthcare institutions (7 community healthcare centres and 59 community healthcare stations in total) in Dongcheng District were included in the study. Prescription data from January 2015 to December 2018 was derived from the Beijing Prescription Reviewing System of Primary healthcare institutions and analysed retrospectively. The antibiotic prescription rate was calculated and cases of irrational antibiotic prescriptions were identified. Results We extracted 11,166,905 prescriptions from the database. Only 189,962 prescriptions were included in the study, among which 9167 (4.8%) contained antibiotics. The antibiotic prescription rate fell from 5.2% in 2015 to 4.1% in 2018 while irrational antibiotic prescription rate increased from 10.4 to 11.8%. Acute Bronchitis was the most prevalent diagnosis (17.6%) for antibiotic prescriptions, followed by Unspecified Acute Respiratory Tract Infection (14.4%), Acute Tonsillitis (9.9%), and Urinary Tract Infection (6.4%). Around 10% of the prescriptions for the top 7 diagnoses identified were rated as irrational. Cephalosporins, fluoroquinolones, and macrolides were the most prescribed antibiotics, which accounted for 89.3% of all antibiotic prescriptions. Of all the antibiotic prescriptions, 7531 were reviewed, among which 939 (12.5%) were rated as irrational because of antibiotic use. Among all the irrational prescriptions, prescriptions with inappropriate antibiotic use and dosage accounted for the majority (54.4%). Conclusion Although a relatively low level of antibiotic utilization was found in PHIs in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained. Considering the imbalanced allocation of medical resources between primary healthcare setting and secondary and tertiary hospitals, there need to be more efforts invested in regions with different levels of economic development.

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Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.35.10.02 ◽

2015 ◽

Vol 35 (10) ◽

pp. 184-193 ◽

Cited By ~ 7

Author(s):

C. Blais ◽

L. Rochette

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Disease Surveillance ◽

Population Based ◽

Administrative Databases ◽

Case Definitions ◽

Disease Surveillance System ◽

Incidence And Mortality ◽

Causes Of Mortality ◽

Incident Cases

Introduction Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis. Methods Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD). Results In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Agestandardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period. Conclusion The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.

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An ongoing national programme to reduce antibiotic prescription and use

Microbiology Australia ◽

10.1071/ma07201 ◽

2007 ◽

Vol 28 (4) ◽

pp. 201 ◽

Cited By ~ 1

Author(s):

Lynn M Weekes ◽

Judith M Mackson ◽

Margaret A Artist ◽

Sonia Wutzke

Keyword(s):

Antimicrobial Resistance ◽

General Practitioners ◽

Antibiotic Prescription ◽

Community Pharmacists ◽

Consumer Attitudes ◽

Antibiotic Use ◽

National Programme ◽

Prescription Rates ◽

National Programs ◽

Over Time

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.

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Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.301 ◽

2018 ◽

Vol 45 (3) ◽

pp. 295-303 ◽

Cited By ~ 20

Author(s):

Lina H. Al-Sakran ◽

Ruth Ann Marrie ◽

David F. Blackburn ◽

Katherine B. Knox ◽

Charity D. Evans

Keyword(s):

Multiple Sclerosis ◽

Administrative Data ◽

Predictive Value ◽

Disease Surveillance ◽

Population Based ◽

Case Definition ◽

Case Definitions ◽

Health Administrative Data ◽

Disease Surveillance System ◽

Definition Of

AbstractObjective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n=400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age- and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased.

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