SEASONAL VARIATIONS IN ANTIBIOTIC CONSUMPTION IN PAEDIATRIC PRIMARY CARE SETTINGS IN SERBIA

2015 ◽  
Vol 101 (1) ◽  
pp. e1.53-e1 ◽  
Author(s):  
Bojana Božić ◽  
Milica Bajčetić
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Seasonal Variations ◽  
Age Groups ◽  
Paediatric Population ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Number Of Children ◽  
Primary Care Settings ◽  
Prescription Rates

Background/ObjectiveAntibiotics are the most irrational prescribed drugs among the paediatric population. The aim of this study was to evaluate the seasonal variations in antibiotic prescribing profile among children in primary care settings in Serbia.MethodsPrescriptions of systemic antibiotics to the paediatric population (<18 years) for the period between 2011 and 2013 were analyzed by using the National Health Insurance Fund's outpatient reimbursement database.ResultsThe average number of antibiotic prescriptions was 1.887.615, while the average number of children receiving antibiotics was 728.285. The average annual rate was 1.394 antibiotic prescriptions per 1000 children. Significant differences in prescription rates in winter months compared to summer months were observed (t=5.51 p<0.001; t=2.29 p=0.045; t=3.65 p=0.004 for 95% confidence interval) during the followed up period. The average annual prevalence of antibiotic prescriptions was 54%. The most commonly prescribed antibiotics in paediatric population were amoxicillin, amoxicillin/clavulanic acid, cephalexin, azithromycin and erythromycin (90% of all prescribed antibiotics). The highest percentage of prescribed antibiotics was observed in the group of 2- to- 23- months-old children. Broad spectrum penicillins were the most prescribed antibiotics in all age groups, especially for children from 2–11 years of age, 51.92% (44.90%–57.13%), while the rate for cephalosporins was highest for children from 2–23 months, 30.91% (26.38%–36.44%), macrolides from 12 to 18 years, 22.67% (19.79%–26.05%) and quinolones from 0–1 month of age, 6.64% (5.09%–9.52%).ConclusionsSignificant seasonal variations in prescription practice and frequently used broad-spectrum antibiotics indicate that antibiotic prescribing is inappropriate.

scholarly journals Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0259065
Author(s):  
Yue Chang ◽  
Yuanfan Yao ◽  
Zhezhe Cui ◽  
Guanghong Yang ◽  
Duan Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Prescription ◽  
Intervention Group ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Feedback Intervention ◽  
Primary Care Settings ◽  
Cluster Randomised ◽  
Prescription Rates

Background The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. Methods We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. Discussion This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. Trial registration ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.

scholarly journals The effect of primary care availability on antibiotic consumption in Hungary: a population based panel study using unfilled general practices

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028233 ◽  
Author(s):  
Aniko Biro ◽  
Peter Elek
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Narrow Spectrum ◽  
Days Of Therapy ◽  
Prescribing Behaviour ◽  
General Practices ◽  
Care Availability

ObjectiveWe analyse the effect of primary care availability on antibiotic consumption and on the quality of antibiotic prescribing behaviour.DesignRetrospective panel design, secondary analysis of settlement-level administrative panel data (n=2320 settlements, T=72 months).Participants and settingWe analyse antibiotic consumption of the population of villages in Hungary, over years 2010 to 2015. We exploit the geographical and time variation in unfilled (mainly single-handed) general practices as a source of exogenous variation in the availability of primary care. We control for socioeconomic characteristics and settlement fixed effects in a panel regression framework.Outcome measuresAntibiotic expenditures and days of therapy (DOT); consumption of narrow-spectrum and broad-spectrum antibiotics; consumption of Access, Watch and Reserve antibiotics according to the AWaRe categorisation; number of visits to the general practitioner (GP).ResultsIf the general practice of a village becomes unfilled, the number of GP visits decreases on average by 9.3% (95% CI 5.6% to 12.9%), antibiotics DOT decrease on average by 3.2% (95% CI 1.0% to 5.4%) and expenditures on antibiotics decrease on average by 2.5% (95% CI 0.3% to 4.7%). The negative effect on antibiotic consumption is stronger in settlements where secondary care is less available, and where antibiotics were previously overprescribed. The quality of prescribing behaviour measured by the relative changes in the narrow-spectrum vs broad-spectrum as well as the Access versus Watch and Reserve antibiotics deteriorates significantly as a consequence of worse primary care availability.ConclusionsLimited availability of primary care reduces the consumption of antibiotics and at the same time impairs the quality of prescriptions through a decrease of the number of doctor-patient encounters.

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.

The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis

2018 ◽  
Vol 69 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Violeta Balinskaite ◽  
Alan P Johnson ◽  
Alison Holmes ◽  
Paul Aylin
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Segmented Regression ◽  
Broad Spectrum Antibiotic ◽  
Stewardship Program ◽  
The Impact

Abstract Background The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

scholarly journals Community seroprevalence of COVID-19 in probable and possible cases at primary health care centres in Spain

2020 ◽  
Author(s):  
Patricia Montenegro ◽  
Carlos Brotons ◽  
Jordi Serrano ◽  
Diana Fernández ◽  
Carlos Garcia-Ramos ◽  
...  
Keyword(s):  
Primary Care ◽  
Total Population ◽  
Community Sample ◽  
Age Groups ◽  
Multivariate Logistic Regression Analysis ◽  
Immunoglobulin M ◽  
Primary Care Settings ◽  
The Mean ◽  
Community Area ◽  
Asymptomatic Individuals

Abstract Background There is a scarcity of information about patients with mild or moderate symptoms during the coronavirus disease 2019 (COVID-19). This is especially true for those who attended and were followed up at primary care settings. Objectives We aim to measure the seroprevalence of antibodies against SARS-CoV-2 infection in a community sample of possible cases and among probable cases followed in primary care. Methods We selected a random sample of 600 individuals stratified by age groups from a total population of 19 899 individuals from a community area in Barcelona. We also invited all the patients that had been followed by General Practitioners (GPs). For both populations, we used COVID-19 rapid lateral flow immunoassays, which qualitatively assess the presence of patient-generated Immunoglobulins G (IgG) and Immunoglobulin M (IgM). Results Three hundred and eleven asymptomatic individuals from the randomly selected sample participated in the study. The mean age was 43.7 years [standard deviation (SD) = 21.79] and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting in an overall prevalence of 5.47% (95% confidence interval = 3.44–8.58). Six hundred and thirty-four symptomatic patients were followed up by GPs. The mean age was 46.97 years (SD = 20.05) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive. Results of the multivariate logistic regression analysis showed that the odds ratio for a positive test was significantly increased in patients who had fever, ageusia and contact with a patient diagnosed with COVID-19. Conclusions The seroprevalence of antibodies against SARS-CoV-2 among possible cases was lower than expected. Approximately, 40% of the symptomatic patients followed up by GPs during the peak months of the pandemic were positive.

scholarly journals Time Trends and Factors Associated with Antibiotic Prescribing in Swiss Primary Care (2008 to 2020)

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 837
Author(s):  
Nahara Anani Martínez-González ◽  
Stefania Di Gangi ◽  
Giuseppe Pichierri ◽  
Stefan Neuner-Jehle ◽  
Oliver Senn ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Trends ◽  
Antibiotic Consumption ◽  
Cross Sectional Study ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Employment Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Swiss Primary Care

Antibiotic resistance (ABR) is a major threat to public health, and the majority of antibiotics are prescribed in the outpatient setting, especially in primary care. Monitoring antibiotic consumption is one key measure in containing ABR, but Swiss national surveillance data are limited. We conducted a retrospective cross-sectional study to characterise the patterns of antibiotic prescriptions, assess the time trends, and identify the factors associated with antibiotic prescribing in Swiss primary care. Using electronic medical records data, we analysed 206,599 antibiotic prescriptions from 112,378 patients. Based on 27,829 patient records, respiratory (52.1%), urinary (27.9%), and skin (4.8%) infections were the commonest clinical indications for antibiotic prescribing. The most frequently prescribed antibiotics were broad-spectrum penicillins (BSP) (36.5%), fluoroquinolones (16.4%), and macrolides/lincosamides (13.8%). Based on the WHO AWaRe classification, antibiotics were 57.9% Core-Access and 41.7% Watch, 69% of which were fluoroquinolones and macrolides. Between 2008 and 2020, fluoroquinolones and macrolides/lincosamides prescriptions significantly declined by 53% and 51%; BSP prescriptions significantly increased by 54%. Increasing patients’ age, volume, and employment level were significantly associated with antibiotic prescribing. Our results may inform future antibiotic stewardship interventions to improve antibiotic prescribing.

scholarly journals Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study

2017 ◽  
Vol 67 (657) ◽  
pp. e300-e305 ◽  
Author(s):  
Lavanya Diwakar ◽  
Carole Cummins ◽  
Ronan Ryan ◽  
Tom Marshall ◽  
Tracy Roberts
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Number Of Children ◽  
Prescription Rates ◽  
The Uk ◽  
Primary Care Practices

BackgroundAdrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.Aim To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.Design and setting Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.MethodChildren and young people aged between 0–17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).ResultsA total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.ConclusionThe number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.

scholarly journals Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

2020 ◽  
Author(s):  
Dan Wang ◽  
Chaojie Liu ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Primary Care Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Latent Profile Analyses ◽  
Broad Spectrum Antibiotics

Abstract Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

scholarly journals Antimicrobial Prescription Practices for Outpatients with Cystitis: A Multicenter, Medical Record-Based Study

2021 ◽  
Author(s):  
Misa Takahashi ◽  
Hideharu Hagiya ◽  
Tsukasa Higashionna ◽  
Yasuhiro Nakano ◽  
Kota Sato ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Age Groups ◽  
Antibiotic Use ◽  
International Classification Of Diseases ◽  
Prescription Practices ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Prescription Rates ◽  
Uncomplicated Cystitis ◽  
Antimicrobial Prescription

Abstract To promote antimicrobial stewardship (AMS) and appropriate antibiotic use, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment in Japan. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, targeting outpatients aged ≥20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). We divided eligible cases into two age groups (20–49 years and ≥50 years) and defined broad-spectrum antimicrobials as fluoroquinolones, third-generation cephalosporins, and faropenem. Primary and secondary outcomes were defined as the prescription rates of broad-spectrum antimicrobials for the disease and the association of antimicrobial types with recurrence. The data of 1,445 patients were collected and that of 902 patients were analyzed. The overall proportion of broad-spectrum antimicrobial prescriptions was 69.1%. The broad-spectrum agents were prescribed frequently in the older group, male patients, and internal medicine. Recurrence was observed in 37 (4.1%) cases, and age, sex, or antimicrobial types were not associated with the recurrence. Hence, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. Administration of broad-spectrum antimicrobials was not associated with the prevention of the recurrence of cystitis.

Sign in / Sign up

Export Citation Format

Share Document