ASSESSMENT OF ANTIBIOTIC USAGE PATTERN IN PATIENTS OF PEDIATRIC DEPARTMENT-A PROSPECTIVE STUDY

Objective: The study aimed to assess the antibiotic usage pattern in patients of the pediatric department in ESI Hospital, Indiranagar, Bangalore. Methods: A prospective six-month observational study was conducted in the pediatric department. The history of the patients was collected from the case sheets and the patient demographic details were also collected. The details of antibiotics prescribed and the other therapy applied to the patients were collected in terms of dosage, duration, and route of administration. The antibiotic consumption was assessed based on qualitative and quantitative indicators which assess the appropriateness of antibiotic use, and the dosage of antibiotics prescribed, respectively. Regarding the qualitative evaluation of antibiotic consumption, the World Health Organization (WHO) guideline was considered to appraise compliance with indication and dosing. Results: Distribution of drug prescription indicators showed that the average number of drugs per encounter was 3.7, which is more than the standards suggested by WHO and should be reduced as much as possible to mitigate polypharmacy and its consequences. 93.45% of encounters existed leastwise with one or more antibiotics, which was higher than the WHO standards. Almost 56.08% of drugs were prescribed considering their generic name, which was very much lower than the ideal percentage recommended by WHO. Conclusion: The percentage of encounters with one or more antibiotics was very higher than the WHO standard percentage, which indicates the irrationality of antibiotic prescribing. To minimize the irrationality of prescriptions and their inappropriateness, effective interventions and compliance with antibiotic prescribing guidelines are required.

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Informing the development of a standardised approach to measure antibiotic use in secondary care: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-026792 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026792

Author(s):

Selina Patel ◽

Arnoupe Jhass ◽

Susan Hopkins ◽

Laura Shallcross

Keyword(s):

Secondary Care ◽

Scale Up ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Primary Data ◽

Antibiotic Prescribing ◽

Cochrane Central Register ◽

Antibiotic Consumption Surveillance

IntroductionEcological and individual-level evidence indicates that there is an association between level of antibiotic exposure and the emergence and spread of antibiotic resistance. The Global Point Prevalence Survey in 2015 estimated that 34.4% of hospital inpatients globally received at least one antimicrobial. Antimicrobial stewardship to optimise antibiotic use in secondary care can reduce the high risk of patients acquiring and transmitting drug-resistant infections in this setting. However, differences in the availability of data on antibiotic use in this context make it difficult to develop a consensus of how to comparably monitor antibiotic prescribing patterns across secondary care. This review will aim to document and critically evaluate methods and measures to monitor antibiotic use in secondary care.Methods and analysisWe will search Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and websites of key organisations for published reports where an attempt to measure antibiotic usage among adult inpatients in high-income hospital settings has been made. Two independent reviewers will screen the studies for eligibility, extract data and assess the study quality using the Newcastle-Ottawa scale. A description of the methods and measures used in antibiotic consumption surveillance will be presented. An adaptation of the Affordability, Practicability, Effectiveness, Acceptability, Side-effects Equity framework will be used to consider the practicality of implementing different approaches to measuring antibiotic usage in secondary care settings. A descriptive comparison of definitions and estimates of (in)appropriate antibiotic usage will also be carried out.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. The results will be published in relevant peer-reviewed journals and presented at relevant conferences or meetings where possible. This review will inform future approaches to scale up antibiotic consumption surveillance strategies to attempt to maximise impact through standardisation.PROSPERO registration numberCRD42018103375

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Use of the World Health Organization Access, Watch, and Reserve Classification to Follow Trends in Prescription of Antibiotic Use in Two Pediatric Intensive Care Units in Rio de Janeiro, Brazil

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1701648 ◽

2020 ◽

Vol 15 (03) ◽

pp. 155-160

Author(s):

André Ricardo Araujo da Silva ◽

Cristina Vieira de Souza Oliveira ◽

Cristiane Henriques Teixeira ◽

Izabel Alves Leal

Keyword(s):

Time Series ◽

Intensive Care ◽

Time Series Analysis ◽

World Health Organization ◽

Pediatric Intensive Care ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

World Health ◽

The World ◽

Health Organization

Abstract Objective The recommended percentage of antibiotic use in pediatric intensive care units (PICUs) using the World Health Organization (WHO) Access, Watch, and Reserve (AWaRE) classification is not known. Methods We have conducted an interrupted time series analysis in two PICUs in Rio de Janeiro, Brazil, over a period of 18 months. The type of antibiotics used was evaluated using the WHO AWaRE classification, and the amount of antibiotic was measured using days of therapy/1,000 patient-days (DOT/1000PD) after implementation of an antimicrobial stewardship program (ASP). The first and last semesters were compared using medians and the Mann–Whitney's test. The trends of antibiotic consumption were performed using time series analysis in three consecutive 6-month periods. Results A total of 2,205 patients were admitted, accounting for 12,490 patient-days. In PICU 1, overall antibiotic consumption (in DOT/1000PD) was 1,322 in the first 6 months of analysis and 1,264.5 in the last 6 months (p = 0.81). In PICU 2, the consumption for the same period was 1,638.5 and 1,344.5, respectively (p = 0.031). In PICU 1, the antibiotics classified in the AWaRE groups were used 33.2, 57.9, and 8.4% of the time, respectively. The remaining 0.5% of antibiotics used were not classified in any of these groups. In PICU 2, the AWaRE groups corresponded to 30.2, 60.5, and 9.3% of all antibiotics used, respectively. There was no use of unclassified antibiotics in this unit. The use of all three groups of WHO AWaRE antibiotics was similar in the first and the last semesters, with the exception of Reserve group in PICU 2 (183.5 × 92, p = 0.031). Conclusion A significant reduction of overall antibiotic use and also in the Reserve group was achieved in one of the PICU units studied. The antibiotics classified in the Watch group were the most used in both units, representing ∼60% of all the antibiotics consumed.

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172. Inpatient Antibiotic Prescribing Patterns Using the WHO Access Watch and Reserve (AWaRe) Classification in Okinawa, Japan: A Point Prevalence Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.374 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S195-S196

Author(s):

Payal K Patel ◽

Naoyuki Satoh ◽

Masashi Narita ◽

Yoshiaki Cho ◽

Yusuke Oshiro ◽

...

Keyword(s):

World Health Organization ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Point Prevalence ◽

Prescribing Patterns ◽

World Health ◽

Antibiotic Prescribing ◽

Full Time ◽

Prevalence Survey ◽

Health Organization

Abstract Background Few studies have been done on inpatient antibiotic use in Japan and antibiotic stewardship programs with dedicated full-time equivalents are rare. We sought to better understand inpatient antibiotic use in Okinawa, Japan. We applied the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) Classification to compare our findings to international literature. Access antibiotics are common front-line antibiotics, Watch antibiotics are high-priority antibiotics with toxicity or resistance concerns, and Reserve antibiotics are last-line treatments for multi-drug resistant infections. Methods A point prevalence study was conducted in five hospitals in Okinawa, Japan on Oct 1, 2020. Physicians conducted chart reviews of all patients receiving intravenous antibiotics. Type of antibiotic, reason for use, duration, and microbiologic data was collected. The primary aim was to evaluate the proportion of patients who received antibiotics on the assessment date; secondary aims were to categorize antibiotics according to indication, class and AWaRe classification. Descriptive statistics were used to derive the distribution of AWaRe Classifications and drug class. Results 1,728 unique patients were included and 504 (29%) received ≥1 antibiotic on the assessment date. A total of 559 antibiotics were used for 504 patients and 22.0% (n=123) were for prophylaxis. Of those receiving antibiotics for treatment (N=436), 385 (88.3%) patients had a documented infection source. The most common indications for antibiotic use were pneumonia (24.2% n=93), urinary tract infection (19.7% n=76), and intraabdominal (17.9% n=69). Overall, 43.1% (n=241) of the antibiotics were categorized Access and 54.4% (n=304) Watch [Figure 1]. Cephalosporins were the most common antibiotic class (56% n=313), followed by β-lactam inhibitors (18% n=106) and narrow penicillins (8.2% n=46) [Figure 2]. Conclusion 29% of inpatients in these 5 Okinawan hospitals were prescribed an antibiotic on the survey date. A majority of antibiotics used fall under the WHO AWaRe Watch classification which are antibiotics that may be more likely to cause resistance. Understanding appropriateness of antibiotics used in this population could inform antibiotic stewardship strategies and reduce antibiotic resistance. Figure 1. Antibiotic Distribution According to World Health Organization (WHO) Access, Watch and Reserve (AWaRe) Classification Figure 2. Antibiotic Distribution by Class in Okinawan Hospitals Disclosures All Authors: No reported disclosures

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Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

PLoS ONE ◽

10.1371/journal.pone.0245902 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245902

Author(s):

Kristina Skender ◽

Vivek Singh ◽

Cecilia Stalsby-Lundborg ◽

Megha Sharma

Keyword(s):

Design Patterns ◽

Central India ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Prescribing Patterns ◽

Essential Medicines ◽

World Health ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Defined Daily Doses

Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

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High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries

PLoS ONE ◽

10.1371/journal.pone.0241899 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0241899

Author(s):

Barbara Bortone ◽

Charlotte Jackson ◽

Yingfen Hsia ◽

Julia Bielicki ◽

Nicola Magrini ◽

...

Keyword(s):

The United States ◽

Antibiotic Consumption ◽

Essential Medicines ◽

World Health ◽

Fixed Dose ◽

Middle Income ◽

Us Fda ◽

Analysis System ◽

Health Organization ◽

Data Analysis System

Antibiotic fixed dose combinations (FDCs) can have clinical advantages such as improving effectiveness and adherence to therapy. However, high use of potentially inappropriate FDCs has been reported, with implications for antimicrobial resistance (AMR) and toxicity. We used a pharmaceutical database, IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS®), to estimate sales of antibiotic FDCs from 75 countries in 2015. Antibiotic consumption was estimated using standard units (SU), defined by IQVIA as a single tablet, capsule, ampoule, vial or 5ml oral suspension. For each FDC antibiotic, the approval status was assessed by either registration with the United States Food and Drug Administration (US FDA) or inclusion on the World Health Organization (WHO) Essential Medicines List (EML). A total of 119 antibiotic FDCs were identified, contributing 16.7 x 109 SU, equalling 22% of total antibiotic consumption in 2015. The most sold antibiotic FDCs were amoxicillin-clavulanic acid followed by trimethoprim/sulfamethoxazole and ampicillin/cloxacillin. The category with the highest consumption volume was aminopenicillin/β-lactamase inhibitor +/- other agents. The majority of antibiotic FDCs (92%; 110/119) were not approved by the US FDA. Of these, the most sold were ampicillin/cloxacillin, cefixime/ofloxacin and metronidazole/spiramycin. More than 80% (98/119) of FDC antibiotics were not compatible with the 2017 WHO EML. The countries with the highest numbers of FDC antibiotics were India (80/119), China (25/119) and Vietnam (19/119). There is high consumption of FDC antibiotics globally, particularly in middle-income countries. The majority of FDC antibiotic were not approved by either US FDA or WHO EML. International initiatives such as clear guidance from the WHO EML on which FDCs are not appropriate may help to regulate the manufacturing and sales of these antibiotics.

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Outpatient Antibiotic Prescribing in Massachusetts, 2011–2015

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz169 ◽

2019 ◽

Vol 6 (5) ◽

Cited By ~ 8

Author(s):

R Monina Klevens ◽

Evan Caten ◽

Scott W Olesen ◽

Alfred DeMaria ◽

Scott Troppy ◽

...

Keyword(s):

Anatomical Therapeutic Chemical ◽

Local Population ◽

Antibiotic Use ◽

Population Based ◽

The State ◽

World Health ◽

Antibiotic Prescribing ◽

Census Tracts ◽

Outpatient Prescription ◽

Ongoing Surveillance

Abstract Background The objectives of this study were to develop methods to measure population-based outpatient antibiotic prescribing in Massachusetts and to describe the findings as a first step toward institution of ongoing surveillance. Methods We analyzed outpatient prescription claims from the Massachusetts All-Payers Claims Database from 2011 to 2015. We grouped claims for antibiotics according to the World Health Organization’s Anatomical Therapeutic Chemical Classification System using the National Library of Medicine’s RXNorm database. We grouped prescribers into 17 specialties. Antibiotic use rates were calculated, and simple frequencies were used to describe patterns. Results The overall annual rate of outpatient antibiotic use for individuals aged 0–64 years was 696 prescriptions per 1000 people. During 2015, 68% of people in Massachusetts had no antibiotic prescription, and 17% had only 1 prescription. There was dramatic variability in antibiotic use rates by census tract within the state (rates of penicillin use ranged from 31 to 265 prescriptions per 1000 people, macrolides from 28 to 333, cephalosporins from 8 to 89, quinolones from 13 to 118). Antibiotic use rates were generally lower in urban census tracts. From 2011 to 2015, there was a 17% decline in antibiotic prescribing, with the greatest decline for macrolides (28%). Conclusions There was variability in antibiotic prescribing within Massachusetts by age, sex, and antibiotic class. Variation in antibiotic use across census tracts within the state was similar to the variation in use across US states. Continued measurement and detailed local population rates of antibiotic use in Massachusetts will provide feedback for local prescribers.

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1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.983 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S398

Author(s):

Natalie Tucker ◽

Ezzeldin Saleh ◽

Marcela Rodriguez

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Custom Made ◽

Days Of Therapy ◽

Before And After ◽

The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

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Broad Spectrum project: factors determining the quality of antibiotic use in primary care: an observational study protocol from Italy

BMJ Open ◽

10.1136/bmjopen-2020-038843 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038843

Author(s):

Peter Konstantin Kurotschka ◽

Alice Serafini ◽

Marco Massari ◽

Roberto Da Cas ◽

Adolfo Figueiras ◽

...

Keyword(s):

Drug Prescription ◽

National Health System ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Prescription Data ◽

Italian Region ◽

Related Factors ◽

Knowledge And Attitudes ◽

The Impact

IntroductionThe overuse of antibiotics is causing worldwide spread of antimicrobial resistance (AMR). Compared with other countries, Italy has both high antibiotic consumption rates and high rates of AMR. Due to the fact that around 90% of antibiotics are prescribed by general practitioners (GPs), this study aims to measure the impact of knowledge, attitudes and sociodemographic and workplace-related factors on the quality of antibiotic prescriptions filled by GPs in the Italian Region of Sardinia.Methods and analysisKnowledge, attitude, sociodemographic and workplace-related factors deemed to influence physicians prescribing behaviour will be evaluated in a cross-sectional study conducted among all GPs of the Italian Region of Sardinia (n=1200). A knowledge and attitudes questionnaire (Knowledge and Attitudes on Antibiotics and Resistance - Italian version: ITA-KAAR) accompanied by a sociodemographic form will be linked to drug prescription data reimbursed by the National Health System. European Surveillance of Antibiotic Consumption quality indicators for outpatient antibiotic use will be calculated from drug prescription records. Every GP will be deemed to have demonstrated an adequate quality of prescriptions of antibiotics if half of the indicator score plus one is better than the median of the region. A multivariate Poisson regression model with robust variance estimation will be used to evaluate the impact of the determinants of antibiotic prescriptions on the actual prescribing quality of each physician.Ethics and disseminationThe project has been approved by the ethics committee of the Regional Health Trust of Sardinia (176/2019/CE, 24 September 2019). The results will be useful to inform evidence-based interventions to tackle irrational antibiotic use in the community.

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Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Science Advances ◽

10.1126/sciadv.aau9124 ◽

2019 ◽

Vol 5 (3) ◽

pp. eaau9124 ◽

Cited By ~ 83

Author(s):

Katariina M. M. Pärnänen ◽

Carlos Narciso-da-Rocha ◽

David Kneis ◽

Thomas U. Berendonk ◽

Damiano Cacace ◽

...

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plants ◽

Action Plan ◽

Quantitative Polymerase Chain Reaction ◽

Antibiotic Use ◽

Control Measures ◽

World Health ◽

Global Action ◽

Health Organization

Integrated antibiotic resistance (AR) surveillance is one of the objectives of the World Health Organization global action plan on antimicrobial resistance. Urban wastewater treatment plants (UWTPs) are among the most important receptors and sources of environmental AR. On the basis of the consistent observation of an increasing north-to-south clinical AR prevalence in Europe, this study compared the influent and final effluent of 12 UWTPs located in seven countries (Portugal, Spain, Ireland, Cyprus, Germany, Finland, and Norway). Using highly parallel quantitative polymerase chain reaction, we analyzed 229 resistance genes and 25 mobile genetic elements. This first trans-Europe surveillance showed that UWTP AR profiles mirror the AR gradient observed in clinics. Antibiotic use, environmental temperature, and UWTP size were important factors related with resistance persistence and spread in the environment. These results highlight the need to implement regular surveillance and control measures, which may need to be appropriate for the geographic regions.

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