Out-Patient Antimicrobial Prescribing Practices Using WHO Prescribing Indicators

Abstract Objectives: To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. Design: Retrospective comparative analysis of a national prospectively collected database. Methods: Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. Results: In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). Conclusions: This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.

Download Full-text

The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

Pharmacy ◽

10.3390/pharmacy8020107 ◽

2020 ◽

Vol 8 (2) ◽

pp. 107 ◽

Cited By ~ 2

Author(s):

Jeffrey W. Hall ◽

Jeannette Bouchard ◽

P. Brandon Bookstaver ◽

Matthew S. Haldeman ◽

Peter Kishimbo ◽

...

Keyword(s):

South Carolina ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Community Pharmacies ◽

Prescribing Practices ◽

University Of South Carolina ◽

Antimicrobial Prescribing ◽

Resistance Rates ◽

The University ◽

New Generation

Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

Download Full-text

Respiratory Tract Infections and Antimicrobial Prescribing Practices for Children with Tracheostomies

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a7167 ◽

2020 ◽

Author(s):

K.D. Graw-Panzer ◽

K. Malik ◽

V. Cooley ◽

E. Matta ◽

A. Haber ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Prescribing Practices ◽

Antimicrobial Prescribing ◽

Tract Infections

Download Full-text

Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0620-5 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Nebyu Daniel Amaha ◽

Dawit G. Weldemariam ◽

Nuru Abdu ◽

Eyasu H. Tesfamariam

Keyword(s):

Sampling Technique ◽

Cross Sectional Study ◽

Essential Medicines ◽

Community Pharmacies ◽

Antibiotic Prescribing ◽

Sectional Study ◽

Prescribing Practices ◽

Cross Sectional ◽

Prescribing Indicators ◽

Factors Affecting

Abstract Background Antibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines. Methods A prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22). Results The average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71–5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10–2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35–3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62–2.52). Conclusions This study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20–26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4–24.0%. Patients’ age, gender and number of medicines were significantly associated with antibiotic prescribing.

Download Full-text

Survey on antimicrobial prescribing patterns in small animal veterinary practice in Emilia Romagna, Italy

Veterinary Record ◽

10.1136/vr.104128 ◽

2017 ◽

Vol 181 (3) ◽

pp. 69-69 ◽

Cited By ~ 3

Author(s):

A. Barbarossa ◽

J. Rambaldi ◽

V. Miraglia ◽

M. Giunti ◽

G. Diegoli ◽

...

Keyword(s):

Small Animal ◽

Laboratory Diagnosis ◽

Prescribing Patterns ◽

General View ◽

Microbiological Analysis ◽

Human Beings ◽

Prescribing Practices ◽

Online Questionnaire ◽

Antimicrobial Prescribing ◽

Hygiene Measures

This investigation provides for the first time a general view of the prescribing patterns of antimicrobials in small animal practice in Emilia Romagna, Italy. In the context of a project on antimicrobial resistance managed by the Regional Veterinary Service, veterinary clinicians were invited to voluntarily complete an online questionnaire. This was designed to gather information on antimicrobial prescribing practices and biosecurity measures and to understand the perception of the issue specific to this region of Italy. In total, 266 questionnaires correctly completed were collected. Although clinicians seemed to follow different approaches when using antimicrobials, the data analysis revealed a general awareness on resistance. Penicillins were the most commonly prescribed class, followed by (fluoro)quinolones and cephalosporins. Among those who use laboratory testing more or less frequently (microbiological analysis and susceptibility testing) to support their prescribing habits, only 7 per cent make a habit of always waiting for the results before starting the treatment. Seventy-eight per cent of the respondents declared the use of antimicrobials licensed for human beings. Biosecurity measures were carefully taken into account by the majority of the veterinarians. The results identified the antimicrobial classes that are commonly prescribed and highlighted that perioperative hygiene measures and the use of laboratory diagnosis are critical aspects that need to be emphasised in drawing up guidelines on the prudent use of these drugs in pets.

Download Full-text

Assessment of Rational Antibiotic Prescribing in Public Hospitals in Nasarawa State, Nigeria

European Journal of Biology and Biotechnology ◽

10.24018/ejbio.2020.1.4.31 ◽

2020 ◽

Vol 1 (4) ◽

Author(s):

Rejoice Abimiku Helma ◽

Yakubu Boyi Ngwai ◽

Istifanus Haruna Nkene ◽

Sabiu Adamu

Keyword(s):

International Development ◽

Essential Medicine ◽

Antibiotic Use ◽

Antimicrobial Treatment ◽

Public Hospitals ◽

World Health ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional ◽

Prescribing Indicators

Antibiotics are the most commonly used medicines in healthcare facilities globally; and they are often misused, especially in developing countries. Periodic assessment of antibiotic prescribing practices is essential to improve prescribing standards and ensure rational use. A cross-sectional, retrospective evaluation of antibiotic prescribing in public secondary and tertiary hospitals in Nasarawa State, Nigeria was carried out. A total of 2800 case sheets of patients who accessed the hospitals under review during the period 2008-2018 were randomly sampled and evaluated. Prescribing indicators of World Health Organization (WHO) and Strengthening Pharmaceutical System/United States Agency for International Development (SPS/USAID) were evaluated and compared with published standards for each of the indicators to identify irrational antibiotic use. Percentage of hospitalization with one or more antimicrobials prescribed was 75.6%. Average number of antimicrobials prescribed per hospitalization in which antibiotics were used was 1.75±0.66. Percentage of antibiotic prescribed consistent with hospital formulary was 100.0%. Average duration of prescribed antimicrobial treatment was 5.57±2.42 days. Percentage of antimicrobials prescribed by generic name was 45.8%. Percentage of injectable antibiotic used was 36.4%. Percentage of antimicrobials prescribed from the national essential medicine list was 85.7%. Average encounter with antibiotic was 0.82±0.2. Many of the prescribing indicators deviated from the WHO or SPS/USAID optimal values; and thus, were predictors of irrational antibiotic prescribing. Continuous education and re-training of prescribers in public hospitals in Nasarawa State to comply with approved standards of prescribing should be emphasized in to ensure rational antibiotic use.

Download Full-text