Antibiotics prescription practices for provisional malaria cases in three hospitals in Moshi, northern Tanzania

Background: Irrational antibiotic use is an important factor for development and spread of resistance to currently used antibiotics. This study was carried out to assess antibiotic prescribing practices among cases diagnosed as malaria at three hospitals in Moshi Municipality in northern Tanzania.Methods: This was a cross sectional, retrospective study that included patients files from Kilimanjaro Christian Medical Centre (KCMC), Mawenzi Regional Hospital and St Joseph Hospital. Patient files whose primary provisional diagnosis was malaria were analysed using a convenient sampling method. Variables of interest were the types of medications prescribed, whether or not a laboratory test was requested and treatment was initiated before laboratory reports.Results: A total of 250 patients’ files were included in the analysis (KCMC=62.8%; Mawenzi=23.2%; St. Joseph=14.0%). In 232 (92.8%) prescriptions made in the three hospitals, laboratory tests were requested to confirm diagnoses. Among laboratory tests requested, 89.2% were blood slides for microscopic detection of malaria parasites, 3.01% malaria rapid diagnostic tests and 3.01% other tests. The majority of prescriptions across all three hospitals (KCMC=86.4%; Mawenzi=91.4%; St. Joseph= 72.4%; X2=7.787). Clinicians at Mawenzi were more likely to start treatment before laboratory findings than their counterparts at KCMC and St Joseph hospitals (X2=7.787, p≤0.05). A significantly higher number of prescriptions made before laboratory findings were observed at KCMC than Mawenzi and St. Joseph hospitals (X2=7.787, p<0.05). Prescriptions from KCMC were more likely to include at least one type of antibiotic than in the other two facilities. Over one third (KCMC=34.0%; St. Joseph=42.1%; Mawenzi=38.1%) of the prescriptions made contained at least one type of an antibiotic. There was a strong association between health facilities and antibiotics prescription in which KCMC prescribed antibiotics at the highest rate while Mawenzi Regional Hospital prescribed antibiotics at the lowest rates (X2=29.234, p<0.001).Conclusion: Antibiotics are prescribed at a high rate among provisionally diagnosed malaria cases before availability of laboratory results. Efforts should be made to improve laboratory services in terms of trained personnel and equipment to reduce irrational use of antibiotics in provisionally diagnosed malaria cases.

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Prescribers’ Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

Antibiotics ◽

10.3390/antibiotics10070858 ◽

2021 ◽

Vol 10 (7) ◽

pp. 858

Author(s):

Reema A. Karasneh ◽

Sayer I. Al-Azzam ◽

Mera Ababneh ◽

Ola Al-Azzeh ◽

Ola B. Al-Batayneh ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Online Questionnaire ◽

Cross Sectional ◽

Attitudes And Behaviors ◽

And Behaviors ◽

Ease Of Access

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

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Young doctors’ perspectives on antibiotic use and resistance: a multinational and inter-specialty cross-sectional European Society of Clinical Microbiology and Infectious Diseases (ESCMID) survey

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz375 ◽

2019 ◽

Vol 74 (12) ◽

pp. 3611-3618 ◽

Cited By ~ 1

Author(s):

Bojana Beović ◽

May Doušak ◽

Céline Pulcini ◽

Guillaume Béraud ◽

Jose Ramon Paño Pardo ◽

...

Keyword(s):

Antibiotic Resistance ◽

Principal Component ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Self Assessment ◽

Cross Sectional ◽

Web Based ◽

Five Dimensions ◽

And Gender

Abstract Background Postgraduate training has the potential to shape the prescribing practices of young doctors. Objectives To investigate the practices, attitudes and beliefs on antibiotic use and resistance in young doctors of different specialties. Methods We performed an international web-based exploratory survey. Principal component analysis (PCA) and bivariate and multivariate [analysis of variance (ANOVA)] analyses were used to investigate differences between young doctors according to their country of specialization, specialty, year of training and gender. Results Of the 2366 participants from France, Greece, Italy, Portugal, Slovenia and Spain, 54.2% of young doctors prescribed antibiotics predominantly as instructed by a mentor. Associations between the variability of answers and the country of training were observed across most questions, followed by variability according to the specialty. Very few differences were associated with the year of training and gender. PCA revealed five dimensions of antibiotic prescribing culture: self-assessment of knowledge, consideration of side effects, perception of prescription patterns, consideration of patient sickness and perception of antibiotic resistance. Only the country of specialization (partial η2 0.010–0.111) and the type of specialization (0.013–0.032) had a significant effect on all five identified dimensions (P < 0.01). The strongest effects were observed on self-assessed knowledge and in the perception of antibiotic resistance. Conclusions The country of specialization followed by the type of specialization are the most important determinants of young doctors’ perspectives on antibiotic use and resistance. The inclusion of competencies in antibiotic use in all specialty curricula and international harmonization of training should be considered.

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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.

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Antibiotic Prescribing Practice in Chronic Kidney Disease Patients in a Tertiary Care Teaching Hospital: Analysis Based on 2019 WHO AWaRe Classification

International Journal of Pharma and Bio Sciences ◽

10.22376/ijpbs/lpr.2021.11.4.p49-57 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Mahin Juveriya ◽

Peddireddy Mounika ◽

Mangalapalli Venkataramana ◽

SV Padi Satyanarayana

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Tertiary Care ◽

Antibiotic Use ◽

High Rate ◽

Essential Medicines ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Prescription Pattern ◽

Prescribing Practice

Chronic kidney disease (CKD) patients are prone to infections and inevitably require antibiotics. Antimicrobial resistance (AMR) is a global threat to humans. Indeed, the most important cause for spread of AMR is irrational use of antibiotics. Therefore, the present study evaluates prescribing practice of antibiotics in CKD patients. A cross-sectional study was carried out in 382 CKD in-patients prescribed with antibiotics. The data were analysed using the WHO prescribing indicators and the WHO Access, Watch, and Reserve (AWaRe) classification. The average number of drugs prescribed per encounter was 3.1. Antibiotics prescribed by generic name and prescribed from the Essential Medicines List were 52.9% and 47.1%, respectively. % Encounters with antibiotics and parenteral antibiotics were 59.2% and 77.4%, respectively. Third generation cephalosporins (76.9%), particularly cefoperazone (40%) and ceftriaxone (21.2%), were the most commonly prescribed antibiotics. A total of 19 specific antibiotics (Access 5, Watch 13, Reserve 1, and Not Recommended 0) were prescribed. According to WHO AWaRe classification, 10.6%, 89%, and 0.4% of antibiotics prescribed were from the ‘Access’, ‘Watch’, ‘Reserve’ categories, respectively. ‘Watch’ category antibiotics, particularly cephalosporins (98%), were prescribed in high rate. The most commonly prescribed ‘Access’ and ‘Watch’ category antibiotics were amikacin (37%) and cefoperazone (44.9%), respectively. Amoxicillin index was 1.6 and ‘Access-to-Watch’ index was 0.1, which were below the priority values. Prescription pattern of antibiotics observed in this study was not fully met the WHO recommendations. Additionally, ‘Watch’ category antibiotics, particularly cephalosporins, were prescribed frequently. Changes in prescription pattern and monitoring of antibiotic use are essential to preserve effectiveness and promote rational use of antibiotics, and to overcome AMR.

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Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia

BMJ Open ◽

10.1136/bmjopen-2017-020439 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020439 ◽

Cited By ~ 7

Author(s):

Annie Zhuo ◽

Maurizio Labbate ◽

Jacqueline M Norris ◽

Gwendolyn L Gilbert ◽

Michael P Ward ◽

...

Keyword(s):

Policy Development ◽

One Health ◽

Tertiary Care ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Appropriate Prescribing ◽

Context Specific

ObjectivesTo explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach.DesignA cross-sectional survey conducted online.SettingDoctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia.Participants547 doctors, 380 dentists and 403 veterinarians completed the survey.Main outcome measuresPrescribers’ knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice.ResultsThere was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice.ConclusionsThe results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.

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Exploring Information Available to and Used by Physicians on Antibiotic Use and Antibiotic Resistance in Jordan

Antibiotics ◽

10.3390/antibiotics10080963 ◽

2021 ◽

Vol 10 (8) ◽

pp. 963

Author(s):

Reema A. Karasneh ◽

Sayer I. Al-Azzam ◽

Mera A. Ababneh ◽

Iman A. Basheti ◽

Ola Al-Azzeh ◽

...

Keyword(s):

Antibiotic Use ◽

Cross Sectional Study ◽

Medical Professional ◽

Antibiotic Prescribing ◽

Action Plans ◽

Sources Of Information ◽

Prescribing Practices ◽

Online Questionnaire ◽

Cross Sectional ◽

Professional Body

Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians’ preferred sources of information and evaluate physicians’ awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers’ views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately.

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An Evaluation of Antibiotic Prescribing Practices in a Rural Refugee Settlement District in Uganda

Antibiotics ◽

10.3390/antibiotics10020172 ◽

2021 ◽

Vol 10 (2) ◽

pp. 172

Author(s):

Matua Bonniface ◽

Winnie Nambatya ◽

Kalidi Rajab

Keyword(s):

Treatment Guidelines ◽

Inappropriate Prescribing ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Health Facilities ◽

World Health ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

National Treatment ◽

Cross Sectional

Ensuring access to effective antibiotics and rational prescribing of antibiotics are critical in reducing antibiotic resistance. In this study, we evaluated antibiotic prescribing practices in a rural district in Uganda. It was a cross-sectional study that involved a retrospective review of 500 outpatient prescriptions from five health facilities. The prescriptions were systematically sampled. World Health Organization core medicine use prescribing and facility indicators were used. Percentage of encounters with one or more antibiotics prescribed was 23% (10,402/45,160). The mean number of antibiotics per prescription was 1.3 (669/500). About 27% (133/500) of the diagnoses and 42% (155/367) of the prescriptions were noncompliant with the national treatment guidelines. Prescribing antibiotics for nonbacterial infections such as malaria 32% (50/156) and noninfectious conditions such as dysmenorrhea and lumbago 15% (23/156) and nonspecific diagnosis such as respiratory tract infection 40% (59/133) were considered noncompliant with the guidelines. On average, 68% (51/75) of the antibiotics were available on the day of the visit. Inappropriate prescribing practices included excessive use of antibiotics and failure to diagnose and prescribe in compliance with treatment guidelines. There is a need to strengthen antibiotic use in the health facilities through setting up stewardship programs and interventions to promote adherence to national treatment guidelines.

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A retrospective audit of antibiotic prescriptions in a Lebanese Hospital

International Journal of Infection Control ◽

10.3396/ijic.v15i1.001.19 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Mohamad Ibrahim ◽

Zeinab Bazzi

Keyword(s):

Epidemiological Data ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Team Approach ◽

Strong Correlations ◽

Prescribing Practices ◽

Antimicrobial Drugs ◽

Stewardship Program ◽

Retrospective Audit ◽

Attending Physician

Despite the frequent alarms that have been published about the adverse effects of antibiotic use and misuse, physicians prescribe to patients approximately fifty percent of unnecessary antimicrobials. In an attempt to decrease the emergence of antimicrobial resistance and increase awareness, a team approach is required to address this prescribing phenomenon in a feasible manner. A retrospective study was done at a one-hundred-forty-bed hospital with a representative sample size of 368 patients. Patient data was collected and analyzed by a stewardship team. The overall antibiotic inappropriate rate was 45.8%, which is relatively high and consistent with the findings of other studies mentioned in the literature. This study aimed to provide baseline epidemiological data on the use of antibiotics in a Lebanese hospital and has revealed several notable patterns of antibiotic prescribing practices among Lebanese physicians such as the use of antimicrobial drugs example penicillin was consistently high. Strong correlations were identified between the type of attending physician and antibiotic appropriateness. These findings will be important in constructing an antimicrobial stewardship program to reduce antibiotic misuse.

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Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

BMC Family Practice ◽

10.1186/s12875-021-01371-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Aleksandra J. Borek ◽

◽

Anne Campbell ◽

Elle Dent ◽

Christopher C. Butler ◽

...

Keyword(s):

Focus Groups ◽

Point Of Care ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Focus Group Study ◽

Clinical Uncertainty ◽

Reactive Protein ◽

Clinical Tools ◽

The Many

Abstract Background Trials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use. Methods This was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically. Results Nine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies. Conclusions High-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibiotic use. Attention should also focus on the many ambiguities (concerns and questions) about, and contextual barriers to, using these strategies that need addressing to support wider and more consistent implementation.

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Antibiotic use in goats: role of experience and education of Missouri veterinarians

Veterinary Record ◽

10.1136/vr.105455 ◽

2020 ◽

Vol 186 (11) ◽

pp. 349-349

Author(s):

Lauren Landfried ◽

Patrick Pithua ◽

Roger D Lewis ◽

Steven Rigdon ◽

Jonathan Jacoby ◽

...

Keyword(s):

Continuing Education ◽

Health Management ◽

Intestinal Parasites ◽

Antibiotic Use ◽

Herd Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

Prescription Practices

BackgroundIn a previous study, we found that rates of antibiotic residues in goat carcasses in Missouri were three times the published national average, warranting further research in this area.MethodsWe conducted a cross-sectional survey of goat veterinarians to determine attitudes and practices regarding antibiotics, recruiting 725 veterinarians listed on the American Association of Small Ruminant Practitioners (AASRP) website and 64 Missouri Veterinary Medical Association (MVMA) veterinarians.ResultsWe collected 189 responses (26.1%) from AASRP members (170 valid) and 8 (12.5%) from MVMA veterinarians totalling 178 responses. While the vast majority of all veterinarians indicated that they prescribed antibiotics less than half of the time, Missouri veterinarians indicated that they spent more time treating goats for overt disease like intestinal parasites and less time on proactive practices such as reproductive herd health management comparatively. While veterinarians agreed that antibiotic resistance was a growing concern, veterinarians outside of Missouri seemed more confident that their own prescription practices was not a contributor. Although nationally most veterinarians felt that attending continuing education classes was beneficial, 73.4% in other states attended classes on antibiotic use compared to only four of the nine Missouri veterinarians.ConclusionMissouri veterinarians had less veterinary experience than veterinarians in other states, and this, in conjunction with low continuing education requirements in Missouri relative to most other states, may hinder development of more proactive and effective client–veterinary relationships.

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