scholarly journals Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa

2021 ◽  
Vol 21 (4) ◽  
pp. 1651-61
Author(s):  
Nahyan Almansoori ◽  
Nivisha Parag
Keyword(s):  
Emergency Department ◽  
Antimicrobial Resistance ◽  
Care Pathway ◽  
Prescribing Patterns ◽  
Health Concern ◽  
Antibiotic Prescribing ◽  
National Guidelines ◽  
Common Indication ◽  
Male Predominance ◽  
Surgical Conditions

Background: Antibiotic resistance is a major public health concern. The Emergency department (ED) is the community gate for healthcare where antibiotics are often prescribed. However, there is a paucity of data regarding antibiotic prescriptionpractices in Africa. Objectives: To describe the use of antibiotics in an ED and level of prescribing adherence to national guidelines. Methods: Retrospective observational study of antibiotic practice in ED. All patients who presented to ED during the study period and were prescribed an anti-microbial agent were included. Data on demographics, working diagnosis, anti-microbialprescribed, dose, route and prescriber level were used to provide descriptive statistics of these parameters. Results: We identified 195 (13.4%) patients who received anti-microbial therapy among 1454 charts reviewed. The mean age was 34.8 with male predominance. The most common indication identified was abscess in 37 (30.8%) patients and in general surgical conditions had the highest rate of antimicrobials prescribed at 54.3%. In addition, co-amoxiclav was the most commonly prescribed anti-microbial (72.15%). We found that combination therapy was not common practice in ED, with majority of the patients having received single anti-microbial therapy (87.18%). The appropriateness of antimicrobial prescriptions was (46.2%) and not statistically significant (P = 0.654). Conclusion: The most commonly prescribed anti-microbial was co amoxiclav and the most common indication was abscess. It was found that antibiotic prescription appropriateness was acceptable when compared to studies conducted in developedcountries. However, further research within other hospital departments will add to the study to determine the adherence as an institution rather than the Emergency department alone, as antimicrobial resistance is a major global healthcare problemand impacts patient care throughout the care pathway. Keywords: Antimicrobial resistance; antibiotic stewardship; emergency department.

Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department

2020 ◽  
pp. 089719002095303
Author(s):  
Jessica Yu ◽  
Gillian Wang ◽  
Ann Davidson ◽  
Ivy Chow ◽  
Ada Chiu
Keyword(s):  
Emergency Department ◽  
Community Hospital ◽  
Community Acquired Pneumonia ◽  
Antibiotic Usage ◽  
Prescribing Patterns ◽  
Local Health Authority ◽  
Antibiotic Prescribing ◽  
Local Health ◽  
Moderate Severity ◽  
Stewardship Program

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital’s emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.

Antimicrobial Stewardship in the Emergency Department

2016 ◽  
Vol 29 (6) ◽  
pp. 556-563 ◽  
Author(s):  
Bryan M. Bishop
Keyword(s):  
Emergency Department ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Health Concern ◽  
Antimicrobial Use ◽  
Upper Respiratory Infection ◽  
Diagnostic Uncertainty ◽  
National Public Health ◽  
Inpatient Settings ◽  
Tract Infections

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.

Antimicrobial use at the end of life: a scoping review

2020 ◽  
pp. bmjspcare-2020-002558
Author(s):  
Jack Fairweather ◽  
Lesley Cooper ◽  
Jacqueline Sneddon ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Resistance ◽  
Adverse Effects ◽  
End Of Life ◽  
Scoping Review ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Cochrane Library ◽  
Antibiotic Prescribing ◽  
Ovid Medline ◽  
Tract Infections

ObjectiveTo examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.DesignScoping reviewData sourcesAn information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.Study selectionStudies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this populationData extractionTwo reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.ResultsEighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.ConclusionsUse of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.

Antimicrobial Stewardship

2019 ◽  
Author(s):  
Sarfaraz Ameen ◽  
Caoimhe NicFhogartaigh
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Length Of Hospital Stay ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Global Public Health ◽  
National Guidelines ◽  
Minor Operations ◽  
The Right

Antimicrobial stewardship (AMS) is a healthcare- system- wide approach to promoting and monitoring the judicious use of antimicrobials (including antibiotics) to preserve their future effectiveness and optimize outcomes for patients. Put simply, it is using the right antibiotic, at the right dose, via the right route, at the right time, for the right duration (Centres for Disease Control, 2010). Antimicrobial resistance (AMR) is a serious and growing global public health concern. Antibiotics are a unique class of drug as their use in individual patients may have an impact on others through the spread of resistant organisms. Antibiotics are essential for saving lives in conditions such as sepsis, and without effective antibiotics even minor operations could be life-threatening due to the risk of resistant infections. Across Europe approximately 25,000 people die each year as a result of hospital infections caused by resistant bacteria, and others have more prolonged and complicated illness. By 2050, AMR is predicted to be one of the major causes of death worldwide. Protecting the use of currently available antibiotics is crucial as discovery of new antimicrobials has stalled. Studies consistently demonstrate that 30–50% of antimicrobial prescriptions are unnecessary or inappropriate. Figure 18.1 shows some of the reasons behind this. As well as driving increasing resistance, unnecessary prescribing leads to unwanted adverse effects, including avoidable drug reactions and interactions, Clostridium difficile-associated diarrhoea, and healthcare-associated infections with resistant micro-organisms, all of which are associated with adverse clinical outcomes, including increased length of hospital stay and mortality, with increased cost to healthcare systems. Prudent use of antibiotics improves patient care and clinical outcomes, reduces the spread of antimicrobial resistance, and saves money. There are a number of global and national guidelines outlining what a robust AMS programme should consist of (see Further reading and useful resources), including: ● Infectious Diseases Society of America (IDSA): Guidelines for Developing an Institutional Programme to Enhance Antimicrobial Stewardship. ● National Institute for Health and Care Excellence (NICE): Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use [NG15]. ● Department of Health (DoH): Start Smart Then Focus, updated 2015. ● DoH: UK 5- Year Antimicrobial Resistance Strategy 2013 to 2018.

scholarly journals To GP or not to GP: a natural experiment in children triaged to see a GP in a tertiary paediatric emergency department (ED)

2017 ◽  
Vol 27 (7) ◽  
pp. 521-528 ◽  
Author(s):  
Laurie Smith ◽  
Yajur Narang ◽  
Ana Belen Ibarz Pavon ◽  
Karl Edwardson ◽  
Simon Bowers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Natural Experiment ◽  
Care Pathway ◽  
Waiting Times ◽  
Sensitivity Analyses ◽  
Antibiotic Prescribing ◽  
Paediatric Hospital ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
The Impact

ObjectiveTo evaluate the impact of integrating a general practitioner (GP) into a tertiary paediatric emergency department (ED) on admissions, waiting times and antibiotic prescriptions.DesignRetrospective cohort study.SettingAlder Hey Children’s NHS Foundation Trust, a tertiary paediatric hospital in Liverpool, UK.ParticipantsFrom October 2014, a GP was colocated within the ED, from 14:00 to 22:00 hours, 7 days a week. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’. The natural experiment compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ seen outside of the hours when a GP was available (ED group). Intention-to-treat (ITT) analysis was used to assess the main outcomes.Results5223 patients were designated as ‘GP appropriate’—18.2% of the total attendances to the ED over the study period. There were 2821 (54%) in the GP group and 2402 (46%) in the ED group. The median duration of stay in the ED was 94 min (IQR 63–141) for the GP group compared with 113 min (IQR 70–167) for the ED group (p<0.0005). Using the ITT analysis equivalent, we demonstrated that the GP group were less likely to: be admitted to hospital (2.2% vs 6.5%, OR 0.32, 95% CI 0.24 to 0.44), wait longer than 4 hours (2.3% vs 5.1%, OR 0.45, 95% CI 0.33 to 0.61) or leave before being seen (3.1% vs 5.7%, OR 0.53, 95% CI 0.41 to 0.70), but more likely to receive antibiotics (26.1% vs 20.5%, OR 1.37, 95% CI 1.10 to 1.56). Sensitivity analyses yielded similar results.ConclusionsIntroducing a GP to a paediatric ED service can significantly reduce waiting times and admissions, but may lead to more antibiotic prescribing. This study demonstrates a novel, potentially more efficient ED care pathway in the current context of rising demand for children’s emergency services.

scholarly journals Antibiotic Prescribing Patterns for Childhood infections in Ambulatory Settings

2021 ◽  
Author(s):  
Samah Al-Shatnawi ◽  
Sanabel Alhusban ◽  
Shoroq Altawalbeh ◽  
Rawand Khasawneh
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Action Plan ◽  
Prescribing Patterns ◽  
World Health ◽  
Low Income Countries ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Tract Infections ◽  
The Impact

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

018 Management of migraine in the australian emergency department

2018 ◽  
Vol 89 (6) ◽  
pp. A8.2-A9
Author(s):  
Lakshini Gunasekera ◽  
Christina Sun-Edelstein ◽  
John Heywood ◽  
Lauren Sanders
Keyword(s):  
Emergency Department ◽  
Prescribing Patterns ◽  
Migraine Treatment ◽  
Primary Headaches ◽  
Opioid Use ◽  
National Guidelines ◽  
Chi Square ◽  
Opioid Prescription ◽  
Work Related ◽  
Icd 10

IntroductionAcute migraine commonly causes significant personal, economic and work-related disability. Australian guidelines recommend treating mild migraine with aspirin and metoclopramide, and moderate-severe migraine with prochlorperazine, chlorpromazine or sumatriptan. Stratified treatment based on severity is preferred to step-wise treatment. Australian data regarding Emergency Department (ED) migraine treatment are scarce. We evaluated prescribing patterns at a Melbourne hospital against national guidelines.MethodsRetrospective cohort study of migraine (G439 ICD-10-AM) between 2012–2016. Exclusion criteria included migraine without headache, other primary headaches and secondary headaches. Demographic and prescribing data were extracted from medical records. Proportions were calculated with 95% confidence intervals using Wilson’s method. Comparisons were made between groups using Mann-Whitney and Chi-square tests.ResultsOf 214,932 ED presentations, 744 with headache presentation received a G439 diagnosis. Most were female (75%; 558/744), young (mean age 34±13 years) and self-reported migraine history (75%; 558/744). There were 55 different medications prescribed. Paracetamol was more frequently prescribed (52%; 385/744) than aspirin (10.6%; 78/744). Opioid prescription occurred in 46% (345/744), single opioid 36% (267/744),>1 opioid 10% (78/744). Median time-to-discharge was 38 min longer with opioid prescription compared with no opioid (222; IQR 164–309 vs 184; 122–258; p<0.01). Just 6.85% (51/744) received triptans. Other treatments were prochlorperazine (14%; 97/744), metoclopramide (38%; 286/744) and chlorpromazine (44%; 3 25/744). Overall, 25.4% (189/744) received no guideline-recommended medication.ConclusionWe observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications are infrequently used. Opioid use is common and associated with increased time-to-discharge. Failure of ED staff to follow guidelines is unexplained, and requires further investigation.

scholarly journals 1384. Conceptual Economic Model Methodology for Infant Pneumococcal Conjugate Vaccine Program and its Impact on Antimicrobial Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S701-S702
Author(s):  
Raymond Farkouh ◽  
Arianna Nevo ◽  
Jennifer Uyei ◽  
Benjamin Althouse ◽  
Cassandra Hall-Murray ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resource Utilization ◽  
Economic Model ◽  
Pneumococcal Disease ◽  
Data Sources ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Effective Prevention ◽  
Material Support ◽  
Antimicrobial Prescribing

Abstract Background Antimicrobial resistance (AMR) is a global threat to effective prevention and treatment of an ever-increasing range of infections. Pneumococcal conjugate vaccines (PCV) used in infant national immunization programs have been shown to decrease AMR pneumococci. Cost-effectiveness models evaluating the value for money of PCV programs have not considered the economic impact of reducing antimicrobial prescribing or prolonged infections due to treatment failures. Standardized frameworks are needed for models to address outcomes and impact on health resource utilization related to AMR. Methods We developed a conceptual modeling methodology suitable for a health economic evaluation of an infant PCV program. We considered impact of PCVs on pneumococcal disease (PD) specifically related to clinical management of AMR-PD, including AMR epidemiology, antibiotic prescribing patterns, and healthcare resource utilization. Model inputs were evaluated regarding optimal and available data sources considering the complex nature of AMR at the national, regional, and global level. Results The proposed framework considers impact of PCVs on antimicrobial prescribing due to invasive pneumococcal disease (IPD), community acquired pneumonia (CAP), and acute otitis media (AOM) across 3 pathways (Figure 1). The population and pathogen-level pathway describe epidemiology and vaccine impact. The care level pathway describes clinical disease management. The health outcomes pathway characterizes resistant or successfully treated PD costs and quality of life. Conceptual Economic Model Methodology Conclusion We present a generalizable methodology to quantify impact of PCVs on cases and outcomes of PD related to AMR. Modelling vaccine-preventable burden of AMR-PD requires data extrapolations and assumptions due to the myriad of interconnected pathways (i.e. microbiology, epidemiology, environment, health systems). Further work is needed to validate assumptions and linkages across incomplete data sources. Disclosures Raymond Farkouh, PhD, Pfizer (Employee) Arianna Nevo, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Jennifer Uyei, PhD, MPH, Pfizer, Inc. (Other Financial or Material Support, I am an employee of IQVIA. IQVIA received funding from Pfizer to carry out the project.) Cassandra Hall-Murray, PharmD, Pfizer, Inc. (Employee) Joseph Lewnard, PhD, Pfizer, Inc. (Consultant, Grant/Research Support, Advisor or Review Panel member) Matthew Wasserman, MSc., Pfizer Inc. (Employee)

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