The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

Abstract Background During the early phase of the COVID-19 pandemic, antibiotic usage among COVID-19 patients was noted to be high in many countries. The objective of this study was to determine the prevalence of antibiotic usage and factors affecting antibiotic usage among COVID-19 patients during the early phase of the COVID-19 pandemic in Malaysia. Methods This was a cross-sectional study that involved reviewing medical records of COVID-19 Malaysian patients aged 12 and above who were diagnosed with COVID-19 and received treatment in 18 COVID-19 hospitals from February to April 2020. A minimum sample of 375 patients was required. A binary logistic regression analysis was performed to determine factors associated with antibiotic usage. Variables with p < 0.05 were considered statistically significant. Results A total of 4043 cases were included for analysis. The majority of the patients (87.6%) were non-smokers, male (65.0%), and had at least one comorbidity (37.0%). The median age was 35 years (IQR: 38). The prevalence of antibiotic usage was 17.1%, with 5.5% of them being prescribed with two or more types of antibiotics. The most frequent antibiotics prescribed were amoxicillin/clavulanic acid (37.8%), ceftriaxone (12.3%), piperacillin/tazobactam (13.3%), azithromycin (8.3%), and meropenem (7.0%). Male patients (adjusted OR 1.53), who had a comorbidity (adjusted OR 1.36), associated with more severe stage of COVID-19 (adjusted OR 6.50–37.06), out-of-normal range inflammatory blood parameters for neutrophils, lymphocytes, and C-reactive protein (adjusted OR 2.04–3.93), corticosteroid use (adjusted OR 3.05), and ICU/HDU admission (adjusted OR 2.73) had higher odds of antibiotic use. Conclusions The prevalence of antibiotic usage in the early phase of the COVID-19 pandemic was low, with amoxicillin/clavulanic acid as the most common antibiotic of choice. The study showed that clinicians rationalized antibiotic usage based on clinical assessment, supported by relevant laboratory parameters.

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Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10143092 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3092

Author(s):

Juan Manuel Aragoneses ◽

Javier Aragoneses ◽

Cinthia Rodríguez ◽

Juan Algar ◽

Ana Suárez

Keyword(s):

Dominican Republic ◽

Clavulanic Acid ◽

Bacterial Resistance ◽

Antibiotic Use ◽

World Health Organisation ◽

World Health ◽

Binary Logistic Regression Analysis ◽

Self Medication ◽

Cross Sectional ◽

Amoxicillin Clavulanic Acid

The World Health Organisation has warned of the increase in antibiotic resistance, estimating that by 2050 it could become the leading cause of death worldwide. Several studies and literature reviews show a correlation between antibiotic use and bacterial resistance, with unnecessary broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and azithromycin, being one of the main causative factors. An interview-based survey of 2160 participants was conducted to assess the prevalence in the practice of self-medication with antibiotics among dental patients in the Dominican Republic. A series of open-ended questions regarding self-medication and class of antibiotics were put to the patients. Over a third of the study population (39.7%) admitted to the practice of antibiotic self-medication. Most of the respondents (58.4%) who indulged in self-medication were females, and it was prevalent in the older adults between 32–42 years old (36%). There was a negative correlation between age and self-medication practice (p < 0.001) observed with point biserial correlation test. Binary logistic regression analysis found an odds ratio of 0.97 (p < 0.001). The most consumed antibiotics were amoxicillin/clavulanic acid (52%), amoxicillin (31.1%), and azithromycin (10.1%). It is imperative to educate patients about the harmful effects of self-medication and to stress the need for governments to implement stricter laws on non-prescription drug availability.

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Antibiogram Development in the Setting of a High Frequency of Multi-Drug Resistant Organisms at University Teaching Hospital, Lusaka, Zambia

Antibiotics ◽

10.3390/antibiotics10070782 ◽

2021 ◽

Vol 10 (7) ◽

pp. 782

Author(s):

Brenna M. Roth ◽

Alexandra Laps ◽

Kaunda Yamba ◽

Emily L. Heil ◽

J. Kristie Johnson ◽

...

Keyword(s):

Clavulanic Acid ◽

Teaching Hospital ◽

Clinical Decision Making ◽

Clinical Decision ◽

Antibiotic Use ◽

Cross Sectional Study ◽

University Teaching ◽

World Health ◽

Cross Sectional ◽

Amoxicillin Clavulanic Acid

Antimicrobial resistance is a global challenge requiring reliable surveillance data collection and use. Prior studies on resistance in Zambia depended on laboratory methods with limited standardization. Since 2015, the University Teaching Hospital (UTH) microbiology laboratory has used the Vitek 2 Compact (bioMerieux, Inc., Marcy-l’Étoile, France) for standardized identification and susceptibility testing. We conducted a cross-sectional study of 2019 bacterial isolates collected from July 2015 to April 2017 to identify bacterial causes of infections, their susceptibility to commonly used antibiotics at UTH, and develop hospital antibiograms with a multidisciplinary team using World Health Organization guidance. We found high levels of antibiotic resistance among Gram negative bacteria. Escherichia coli and Klebsiella pneumoniae were highly resistant to all antibiotics except amikacin and carbapenems. E. coli had susceptibilities of 42.4% to amoxicillin/clavulanic acid, 41.4% to ceftriaxone, 40.2% to ciprofloxacin, and 10.4% to trimethoprim/sulfamethoxazole (TMP/SMX). K. pneumoniae had susceptibilities of 20.7% to amoxicillin/clavulanic acid, 15.6% to ceftriaxone, 48.5% to ciprofloxacin, and 12.3% to TMP/SMX. The high resistance to 3rd generation cephalosporins indicates high rates of beta-lactamase production. This is information that clinicians need to inform clinical decision making and choice of empiric antibiotics and that UTH requires to inform antimicrobial stewardship such as improvements in antibiotic use.

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Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

Primary Health Care Research & Development ◽

10.1017/s1463423621000116 ◽

2021 ◽

Vol 22 ◽

Author(s):

Rian Lelie- van der Zande ◽

Marcel Bouvy ◽

Martina Teichert

Keyword(s):

Urinary Tract ◽

Clavulanic Acid ◽

Cross Sectional Study ◽

Adult Women ◽

Sectional Study ◽

Cross Sectional ◽

First Choice ◽

Febrile Uti ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

Abstract Aim: To study whether changes in drug preferences in the Dutch guideline for the treatment of Urinary Tract Infection (UTI) for General Practitioners (GPs) in 2013, resulted in corresponding changes in antibiotic dispensing. Background: For the treatment of uncomplicated UTI, nitrofurantoin remained the first choice, while fosfomycin became the second choice and changed ranks with trimethoprim. For a subsequent febrile UTI, ciprofloxacin became the first choice and changed ranks with amoxicillin/clavulanic acid, co-trimoxazole remained the third choice. Methods: In this observational cross-sectional study, routinely collected dispensing data from the Dutch Foundation of Pharmaceutical Statistics from 2012 to 2017 were used. The number of women 18 years and older, treated with one of the guideline antibiotics for uncomplicated UTI and subsequent febrile UTI were analysed annually. Proportions were calculated. Data were stratified for age categories. Failure of uncomplicated UTI treatment was defined as the dispensing of an antibiotic for febrile UTI within 14 days after the dispensing of an antibiotic for uncomplicated UTI. Findings: Data were available from 81% of all pharmacies in 2012 to 89% in 2017. Percentages of women dispensed nitrofurantoin were relatively stable with 87.4% in 2012 and 84.4% in 2017. Percentages of women dispensed fosfomycin increased from 5.4% in 2012 to 21.8% in 2017, whereas percentages of women dispensed trimethoprim decreased from 17.8% to 8.0%. Within age categories, the percentage of women dispensed fosfomycin increased from 12.4% in women 18–30 years old to 36.7% in women above 80 years old. Percentages of women dispensed antibiotics for febrile UTI remained stable at 5% annually. Percentages of women receiving ciprofloxacin increased from 1.9% in 2012 to 3.3% in 2017, while those receiving amoxicillin/clavulanic acid decreased from 2.9% to 1.8%. New guideline recommendations resulted in corresponding changes in dispensed antibiotics for uncomplicated UTI and subsequent febrile UTI. Drug choices differed for age categories.

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Knowledge, attitude and practices of antibiotic usage among university students from Karachi, Pakistan

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20185502 ◽

2019 ◽

Vol 7 (2) ◽

pp. 519

Author(s):

Dnyanesh Limaye ◽

Patrick Ziesenis ◽

Vaidehi Limaye ◽

Mansoor Ahmad ◽

Farah Saeed ◽

...

Keyword(s):

University Students ◽

Public Awareness ◽

Antibiotic Use ◽

Symptomatic Improvement ◽

Cross Sectional Study ◽

Antibiotic Usage ◽

Cross Sectional ◽

Rational Use ◽

Rational Use Of Antibiotics ◽

Medical Advances

Background: Antimicrobial resistance has become a serious global problem. A potential post-antibiotic era is threatening present and future medical advances. In Pakistan, the usage of antibiotic is unnecessarily high and due to over exposure to these drugs, bacteria are developing resistance against these drugs. It is necessary to improve public awareness about the rational use of antibiotics in order to bring a change in consumer’s behaviour. Therefore, present study was undertaken to assess the existing knowledge, attitude and practices related to antibiotic usage among university students.Methods: A cross-sectional study was carried out among university students from Karachi, Pakistan during May-June 2018. 200 students were approached to participate in the study of which 159 agreed to participate (males: 70, females: 89). Pretested questionnaire was distributed to the study subjects and the collected data was analyzed using IBM SPSS version 23.Results: Substantial number of (33% and 50%) participants were unaware about the differences in antibiotic: anti-inflammatory drugs and antibiotic: antipyretics respectively. 29% of the participants thought it is right to stop antibiotics only based on symptomatic improvement. Thirty nine percent and eighty three percent participants believed that antibiotics should always be prescribed to treat flu like symptoms and pneumonia respectively.Conclusions: Participants demonstrated average knowledge about antibiotics. Similarly, their attitude and practice toward antibiotic use was associated with misconceptions. An educational intervention is necessary to make them aware about rational use of antibiotics.

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Patterns of Antimicrobial therapy in acute tonsillitis: A cross-sectional Hospital-based study from UAE

Anais da Academia Brasileira de Ciências ◽

10.1590/0001-3765201420120036 ◽

2014 ◽

Vol 86 (1) ◽

pp. 451-457 ◽

Cited By ~ 2

Author(s):

LISHA J. JOHN ◽

MEENU CHERIAN ◽

JAYADEVAN SREEDHARAN ◽

TAMBI CHERIAN

Keyword(s):

Clavulanic Acid ◽

Antimicrobial Agents ◽

Median Number ◽

Cross Sectional Study ◽

Current Sensitivity ◽

Acute Tonsillitis ◽

Cross Sectional ◽

Sensitivity Pattern ◽

Amoxicillin Clavulanic Acid ◽

Culture And Sensitivity

Background: Diseases of the ear, nose and throat (ENT) are associated with significant impairment of the daily life and a major cause for absenteeism from work. Aim: The study determined antimicrobial prescription pattern in patients with acute tonsillitis. Materials and Methods: A cross-sectional study was carried out among all the patients attending the ENT department with acute tonsillitis. Data were retrieved from the medical records using a proforma. Statistical analysis was carried out using SPSS.19. Results: Total of 238 patients included (Males 138; females 100). About 96% of total drugs were prescribed by generic name. Median number of drugs prescribed was four (range 1-7). Eighty eight percent of prescriptions contained antimicrobials, (78.5%) analgesics and (57.9%) antipyretics. Amoxicillin / Clavulanic acid (24.8%) and Ceftriaxone (12.2%) were the most commonly prescribed antimicrobials. Parenteral route was preferred in 41.6%. About 23.7% of the patients on Amoxicillin / Clavulanic acid had received the drug as intravenous injection. Culture and sensitivity tests were carried out in 106 (44.5%) of the cases. Antimicrobials were changed / added after the culture and sensitivity test in 25 patients. Conclusion: Study findings highlighted rational practices in drug prescribing. Therapeutic guidelines based on current sensitivity pattern optimize the use of antimicrobial agents.

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Knowledge, attitude and practices of antibiotic usage among students from Mumbai University

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20182270 ◽

2018 ◽

Vol 6 (6) ◽

pp. 1908 ◽

Cited By ~ 3

Author(s):

Dnyanesh Limaye ◽

Sanika Naware ◽

Priyanka Bare ◽

Shreya Dalvi ◽

Ketaki Dhurve ◽

...

Keyword(s):

Public Awareness ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Antibiotic Usage ◽

Sectional Study ◽

Infectious Disease Control ◽

Cross Sectional ◽

Attitude And Practice ◽

Inflammatory Drugs ◽

High Level

Background: Discovery of antibiotics have helped to manage the devastating diseases. Presently, the antibiotic era is threatened by the emergence of high level of antibiotic resistance of important pathogens. Misuse of antibiotics poses a serious risk to infectious disease control. It is necessary to improve public awareness to bring a change in the behavior of consumers. Therefore, present study was undertaken to assess the existing knowledge, attitude and practices related to antibiotic usage among university students.Methods: A cross-sectional study was carried out among students from Mumbai University, India during May-June 2017. 300 students were approached to participate in the study of which 250 agreed to participate (males: 117; females: 133). Pretested questionnaire was distributed and collected data was analyzed using IBM SPSS version 23.Results: Substantial number (33% and 40%) participants were unaware about the differences in antibiotic-anti-inflammatory drugs and antibiotic-antipyretics respectively. 28% of the participants thought it is right to stop antibiotics only based on symptoms improvement. Sixty eight percent and seventy nine percent participants believed that antibiotics should always be prescribed to treat flu like symptoms and pneumonia respectively.Conclusions: Participants demonstrated poor knowledge about antibiotics. Similarly, their attitude and practice toward antibiotic use was associated with misconceptions. An educational intervention can be introduced to make them aware about rational antibiotic practices.

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ANTIBIOTICS IN THE HANDS OF COMMUNITY PHARMACISTS: A PROSPECTIVE AVENUE FOR COMMUNITY BASED ANTIMICROBIAL STEWARDSHIP INITIATIVE

African Journal of Health, Safety and Environment ◽

10.52417/ajhse.v2i2.160 ◽

2021 ◽

Vol 2 (2) ◽

pp. 63-70

Author(s):

N. A. Isabel ◽

O. I. Joshua ◽

A. E. Efe

Keyword(s):

Antimicrobial Stewardship ◽

Community Pharmacists ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Benin City ◽

Amoxicillin Clavulanic Acid ◽

Fever Treatment ◽

Study Participants

Antimicrobial stewardship (AMS) is high on the agenda of global health organizations with an increasing interest in community-based AMS initiatives, as this is where the majority of antibiotic use occurs. This study sought to evaluate the practice of community pharmacists toward antibiotic use and the likely need for AMS. This was a descriptive cross-sectional study conducted among registered community pharmacists in Benin City, Nigeria. A structured questionnaire was used for data collection. All study participants were duly informed on study objectives and informed consent was sought. The data obtained from the study were analyzed using IBM SPSS version 22. Of the 101 pharmacists who participated in the study, 92 (91.1%) dispensed antibiotics without prescription. The most prescribed antibiotic is Ciprofloxacin 59(58.42%), followed by Amoxicillin 42 (41.58%) and Amoxicillin-Clavulanic acid 41 (40.59%). Ninety-six (95%) of the pharmacists use antibiotics agents as an adjunct in Typhoid fever treatment, and 78(77.2%) of them use it as an adjunct in Malaria treatment. Cost 32 (31.68%) is the most common reason for dispensing antibiotics without laboratory investigation and physician’s consultation. Most (93.1%) pharmacists agree that they need training on antimicrobial stewardship practice. The antibiotic prescription pattern among community pharmacists was high, the possibility of antibiotic misuse in the hands of community pharmacists without appropriate guidelines cannot be overlooked. This emphasizes the need for the inclusion of community pharmacies in antimicrobial stewardship programs.

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Nutrient pattern of unsaturated fatty acids and vitamin E increase resting metabolic rate of overweight and obese women

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000664 ◽

2020 ◽

pp. 1-9

Author(s):

Habib Yarizadeh ◽

Leila Setayesh ◽

Caroline Roberts ◽

Mir Saeed Yekaninejad ◽

Khadijeh Mirzaei

Keyword(s):

Vitamin E ◽

Metabolic Rate ◽

Unsaturated Fatty Acids ◽

Resting Metabolic Rate ◽

Blood Parameters ◽

Cross Sectional Study ◽

Obese Women ◽

Cross Sectional ◽

Dietary Nutrients ◽

Nutrient Patterns

Abstract. Objectives: Obesity plays an important role in the development of chronic diseases including cardiovascular disease and diabetes. A low resting metabolic rate (RMR) for a given body size and composition is a risk factor for obesity, however, there is limited evidence available regarding the association of nutrient patterns and RMR. The aim of this study was to determine the association of nutrient patterns and RMR in overweight and obese women. Study design: This cross-sectional study was conducted on 360 women who were overweight or obese. Method: Dietary intake was assessed using a semi-quantitative standard food frequency questionnaire (FFQ). Nutrient patterns were also extracted by principal components analysis (PCA). All participants were evaluated for their body composition, RMR, and blood parameters. Result: Three nutrient patterns explaining 64% of the variance in dietary nutrients consumption were identified as B-complex-mineral, antioxidant, and unsaturated fatty acid and vitamin E (USFA-vit E) respectively. Participants were categorized into two groups based on the nutrient patterns. High scores of USFA-vit E pattern was significantly associated with the increase of RMR (β = 0.13, 95% CI = 0.79 to 68.16, p = 0.04). No significant associations were found among B-complex-mineral pattern (β = −0.00, 95% CI = −49.67 to 46.03, p = 0.94) and antioxidant pattern (β = 0.03, 95% CI −41.42 to 22.59, p = 0.56) with RMR. Conclusion: Our results suggested that the “USFA-vit E” pattern (such as PUFA, oleic, linoleic, vit.E, α-tocopherol and EPA) was associated with increased RMR.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽

10.3390/antibiotics10070866 ◽

2021 ◽

Vol 10 (7) ◽

pp. 866

Author(s):

Iltaf Hussain ◽

Nisa Yousaf ◽

Sana Haider ◽

Pervisha Jalil ◽

Muhammad Usman Saleem ◽

...

Keyword(s):

Antimicrobial Resistance ◽

University Students ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Dosing Regimen ◽

Student Knowledge ◽

Chi Square ◽

Cross Sectional ◽

Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

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