Prescribing Practice of Third Generation Cephalosporins in Medical Wards at Hospital Queen Elizabeth II (HQEII)

2021 ◽  
pp. 25-36
Author(s):  
Nur Fairuz Sabrina Hashim ◽  
Qishtina Mizan ◽  
Hong Tshun Kuan ◽  
Dina Cyla Danny ◽  
Lai Shuhua ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Empirical Therapy ◽  
Third Generation ◽  
Prescribing Pattern ◽  
Pharmacy Department ◽  
Patients With Diabetes ◽  
Prescribing Practice ◽  
The Mean ◽  
Medical Wards ◽  
Third Generation Cephalosporins

Cephalosporins are amongst the most used antibiotics in hospital settings worldwide. The antibiotic report collated by the Pharmacy Department from Hospital Queen Elizabeth II(HQEII) in 2018 reflected high usage of third generation cephalosporins in medical wards, and indeed HQE II was one of the top users nationwide. This study aimed to evaluate the prescribing pattern of third-generation cephalosporins in medical wards as per National Antimicrobial Guidelines (NAG) 2019. A prospective, observational study was conducted in medical wards from June 2019 till January 2020. Patients who were started with third-generation cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefoperazone/sulbactam)were recruited, where 137 patients were enrolled with 60.6% were males. The mean age of patients was 53+16.8 years old. Antibiotics were initiated as per NAG recommendation. Cultures were taken before antibiotic initiation. Respiratory-related infections (n = 54, 39.4%) were the main indication and, antibiotics were continued as definite therapy in 38 patients (27.7%). The median duration of antibiotic treatment was 5 days (interquartile range = 3). Ceftazidime (n = 85, 62%) was most prescribed followed by ceftriaxone (n = 48, 35%)and cefotaxime (n = 4, 2.9%) respectively. It was worth noting that ceftazidime was primarilyused as empirical therapy for melioidosis (n = 64, 75.3%), particularly in patients with diabetes mellitus (n = 40, 62.5%), chronic kidney disease (n = 27, 42.2%), and/or occupational exposure (n = 4, 6.3%). The mean ceftazidime duration for empirical melioidosis was 3.2+1.6 days. Overall, third-generation cephalosporins were appropriately prescribed in medical wards as per NAG 2019. Further exploration of ceftazidime usage in empirical melioidosis is warranted.  

scholarly journals A prospective observational study of prescription pattern in a tertiary care teaching hospital of Jharkhand

2019 ◽  
Vol 8 (12) ◽  
pp. 2620
Author(s):  
Abha Kumari ◽  
Keshav Kumar ◽  
Manju Gari ◽  
Kumari Pallavi ◽  
Subhankar Choudhury
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Tertiary Care ◽  
Health Care Delivery System ◽  
World Health ◽  
Fixed Dose ◽  
Prescribing Pattern ◽  
Prescribing Practice ◽  
Health Organization

Background: Prescription error and irrational prescribing are the avoidable problems imposed on health care delivery system from prescriber side which must be addressed. Periodic prescription audit helps to curtail the error and irrational prescribing.Methods: A prospective observational study was conducted on patients visiting various Outpatient Department of RIMS, Ranchi, Jharkhand on all working days at 11:00 AM to 12:00 PM from 1 August 2018 to 31 July 2019. Various aspects of collected prescriptions were analyzed by using World Health Organization (WHO) prescribing indicators.Results: In this study, out of 700 prescriptions collected, 76 were excluded. Out of total 624 patients analyzed, 382 (61.28%) were male and 242 (38.72%) were female. 48 (7.69%) patients belonged to ≤18, 464 (74.36%) to 19-64 and 112 (17.95%) to ≥65 years of age group. Tablet (71%) was the most common dosage form. None of prescriptions were having registration number of the doctor. 242 (38.78%) prescriptions did not have a diagnosis duly written. The total no. of drugs prescribed in 624 prescriptions was 2176. Only 32 (5.13%) prescriptions were found to have medicines prescribed in block letters. Antibiotics (29%) were the most common class of drugs prescribed. Average number of drugs per prescription was 3.47. Only 48 (2.20%) drugs were prescribed by their generic name while total of injectables prescribed were 102 (4.68%). Total number of drugs from NLEM was 848 (38.97%). 196 (9.00%) drugs were fixed-dose combination.Conclusions: In our study, we found deficiencies in various parts of prescriptions. Prescribing pattern was not in accordance with WHO recommendation for prescribing practice.

scholarly journals Empirical Therapy of Complicated Pyelonephritis

2019 ◽  
Vol 4 (5) ◽  
pp. 26-30 ◽  
Author(s):  
V. A. Beloborodov ◽  
V. A. Vorobev ◽  
P. V. Opanasyuk
Keyword(s):  
Urinary Tract Infection ◽  
Impaired Renal Function ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Upper Urinary Tract ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Close Attention ◽  
Irkutsk Region ◽  
Third Generation Cephalosporins

The aim of the research was to analyze the effectiveness of empirical therapy in patients with established complicated upper urinary tract infection (complicated pyelonephritis).Materials and methods. 51 patients who were treated in 2018 in the urological department of the Irkutsk City Clinical Hospital N 1 were subjected to a retrospective study. The average age of patients was 55.9 ± 16.9 years.Results. Successful empirical therapy was considered in the absence of correction of the treatment regimen and the normalization of clinical blood and urine tests. Of the patients included in the study, successful empirical therapy was found in 24 (47%) patients, and required correction in 27 (52.9 %) patients. Cephalosporins as monotherapy were ineffective in 24 (57.1 %) patients, carbopenems – in one (25 %), fluoroquinolones – in all (100 %). Aminoglycosides showed the best result as a combination therapy with cephalosporins – 100 % (n = 3) of success. Based on multivariate logistic regression analysis, it was established that the detection of microhematuria and uremia in clinical analyzes upon admission to the hospital increases the likelihood of empirical monotherapy with third-generation cephalosporins by 20 % and 27 %, respectively.Conclusion. It is advisable to refrain from the use of monotherapy with fluoroquinolones and third-generation cephalosporins until more information is available about the resistance of uropathogens in the population of the Irkutsk region. Patients with impaired renal function require particularly close attention of the clinician when choosing a scheme for the empirical treatment of complicated pyelonephritis.

scholarly journals The role of prophylactic antibiotics in hepatitis B virus-related acute-on-chronic liver failure patients at risk of bacterial infection: a retrospective study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Xiao-Qin Liu ◽  
Xue-Yun Zhang ◽  
Yue Ying ◽  
Jian-Ming Zheng ◽  
Jian Sun ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Clinical Course ◽  
Prophylactic Antibiotics ◽  
Third Generation ◽  
Chronic Liver Failure ◽  
Free Survival ◽  
B Virus ◽  
Third Generation Cephalosporins

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by an excessive systemic inflammatory response and organ failure and has high mortality. Bacterial infections (BIs) worsen the clinical course of ACLF and carry a poor prognosis in ACLF patients. The efficacy of third-generation cephalosporins has been challenged in recent years. The aim of this study was to characterize the difference between ACLF patients with and without BIs and to provide a reference for medical intervention. Methods A total of 140 patients with hepatitis B virus-related ACLF (HBV-ACLF) hospitalized at the Department of Infectious Diseases, Huashan Hospital, Fudan University (Shanghai, China) between May 2013 and January 2020 were enrolled. Mann-Whitney U test was used to compare the baseline characteristics of HBV-ACLF patients with and without BIs. Univariate and multivariate analyses were performed to find predictors of BIs. The characteristics of BIs and the role of prophylactic antibiotics were profiled. Results A total of 97 episodes of BIs occurred in patients during the course of HBV-ACLF. Patients with and without BIs differed in clinical characteristics. The incidence of BIs showed a positive correlation with the ACLF grade (P = 0.003) and the clinical course (P = 0.003). The 90-day transplant-free survival of patients with BIs was lower than those without BIs (P < 0.0001). Patients administered prophylactic antibiotics showed a lower incidence of BIs and had a higher transplant-free survival probability than those who did not (P = 0.046). No statistical differences in antibiotic efficacy between third-generation and other antibiotics were observed (P = 0.108). Conclusions BIs affected the clinical course and prognosis of patients with HBV-ACLF. Prophylactic antibiotics were of potential clinical importance in the prevention of BIs and improving the clinical course and prognosis in HBV-ACLF patients. Third-generation cephalosporins were qualified for use in antibiotic prophylaxis.

scholarly journals Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junya Kusumoto ◽  
Atsushi Uda ◽  
Takeshi Kimura ◽  
Shungo Furudoi ◽  
Ryosuke Yoshii ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Oral Surgery ◽  
Maxillofacial Surgery ◽  
Antibiotic Use ◽  
Oral And Maxillofacial Surgery ◽  
Third Generation ◽  
Oral Antibiotics ◽  
Appropriate Use ◽  
Before And After ◽  
Third Generation Cephalosporins

Abstract Background In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. Methods The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. Results After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). Conclusions This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.

Third-Generation and Investigational Cephalosporins: I. Structure-Activity Relationships and Pharmacokinetic Review

1983 ◽  
Vol 17 (7-8) ◽  
pp. 507-515 ◽  
Author(s):  
Pamela Garzone ◽  
James Lyon ◽  
Victor L. Yu
Keyword(s):  
Classification Scheme ◽  
Third Generation ◽  
Serum Concentrations ◽  
New Agents ◽  
The Third ◽  
Structure Activity ◽  
Pharmacokinetic Properties ◽  
Fluid Penetration ◽  
Third Generation Cephalosporins ◽  
Antibacterial Spectrum

The structure-relationships and pharmacokinetic properties of the new second- and third-generation cephalosporins are reviewed. The new second-generation cephalosporins include ceforanide, cefotiam, and cefuroxime. The third-generation cephalosporins include cefmenoxime, cefoperazone, cefotaxime, cefsulodin, ceftazidime, ceftizoxime, ceftriaxone, and moxalactam. These new cephalosporins are semisynthetic analogs with different chemical substitutions on a 7-aminocephalosporanic nucleus. As a result of these chemical modifications, improvements in the antibacterial spectrum as well as pharmacokinetic properties have occurred. In general, the new cephalosporins have longer half-lives, higher and prolonged serum concentrations, and increased cerebrospinal fluid penetration. Selected cephalosporins also have increased biliary tract concentrations. A classification scheme for these new agents, based on generation and susceptibility to Pseudomonas aeruginosa, is presented.

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