First Major Practical Step toward Appropriate Antimicrobial Use by the Government of Japan

Abstract The current antimicrobial market and old (pre-2000) in vitro antimicrobial susceptibility test interpretative criteria (STIC) are not working properly. Malfunctioning susceptibility breakpoints and antimicrobial markets have serious implications for both patients (ie, from a safety and efficacy perspective) and antibiotic-focused pharmaceutical and biotechnology company economic viability. Poorly functioning STIC fail both patients and clinicians since they do not discriminate between likely effective and ineffective antimicrobial regimens. Poor economic viability fails patients and clinicians as it decreases the industry’s ability to develop antimicrobial agents that clinicians and patients urgently require now and in the future. Herein, we review how STIC for older antimicrobial agents were determined and how their correction can impact the perceived utility of old relative to new antimicrobial agents. Moreover, we describe the data and analysis needs to systematically reevaluate older STIC values. We call for professional infectious diseases societies, government agencies, and other consensus bodies interested in the appropriate use of antimicrobial agents to join an effort to systematically evaluate and, where warranted, correct STIC for all relevant antimicrobial agents. This effort will amplify the effects of other measures designed to increase appropriate antimicrobial use (ie, good antimicrobial stewardship), development, and regulation.

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A trend in prevalence of antimicrobial use and appropriateness of antimicrobial therapy in an acute care hospital from 2018 to 2019: repeated prevalence surveys in Japan

BMC Research Notes ◽

10.1186/s13104-019-4849-0 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Junpei Komagamine ◽

Taku Yabuki ◽

Taku Hiraiwa

Keyword(s):

Drug Use ◽

Acute Care ◽

Antimicrobial Therapy ◽

Acute Care Hospital ◽

Antimicrobial Drug ◽

Antimicrobial Use ◽

Care Hospital ◽

Antimicrobial Drugs ◽

Inappropriate Use ◽

Appropriate Antimicrobial Use

Abstract Objectives The supply of cefazolin has been reduced dramatically since March 2019 in Japan. However, no studies have evaluated the effects of cefazolin shortage on the appropriateness of antimicrobial use. Therefore, we compared the appropriateness of inpatient antimicrobial drug use between the two surveys conducted in August 2018 and August 2019 in a Japanese hospital with no supply of cefazolin since the cefazolin shortage. Results In the 2019 survey, a total of 275 patients were included, and 256 patients were included in the 2018 survey. The prevalence of antimicrobial drug use did not change from 2018 to 2019 (28.5% versus 28.7%; p = 0.96). The proportion of cefazolin in all antimicrobial drugs used on the survey date significantly decreased from 2018 to 2019 (24.1% versus 0.0%; p < 0.001). The proportion of appropriate antimicrobial use in all antimicrobial therapies tended to be lower in 2019 than in 2018 (41.2% versus 60.6%; p = 0.06), and the proportion of unnecessary use of a broader spectrum of antimicrobial drugs significantly increased from 2018 to 2019 (4.7% versus 37.3%; p = 0.002). The shortage of cefazolin might lead to inappropriate use of other antimicrobial drugs.

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Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box

Clinical Infectious Diseases ◽

10.1093/cid/ciw658 ◽

2016 ◽

Vol 63 (12) ◽

pp. 1-6 ◽

Cited By ~ 48

Author(s):

Emily S. Spivak ◽

Sara E. Cosgrove ◽

Arjun Srinivasan

Keyword(s):

Public Health ◽

Black Box ◽

Antimicrobial Use ◽

Reference Standard ◽

Consensus Definition ◽

Antimicrobial Prescribing ◽

Life Saving ◽

Public Health Officials ◽

Appropriate Antimicrobial Use

Abstract Indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. Infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. With rising burden of antimicrobial-resistant organisms and Clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. Inappropriate antimicrobial use has been quantified in various settings using numerous definitions; however, no established reference standard exists. With mounting national efforts to improve antimicrobial use, a consensus definition and standard method of measuring appropriate antimicrobial use is imperative. We review existing literature on systematic approaches to define and measure appropriate antimicrobial use, and describe a collaborative effort at developing standardized audit tools for assessing the quality of antimicrobial prescribing.

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Perception, Attitude, and Knowledge Regarding Antimicrobial Resistance, Appropriate Antimicrobial Use, and Infection Control Among Future Medical Practitioners: A Multicenter Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.8 ◽

2016 ◽

Vol 37 (5) ◽

pp. 603-605 ◽

Cited By ~ 14

Author(s):

Nuttagarn Chuenchom ◽

Visanu Thamlikitkul ◽

Romanee Chaiwarith ◽

Rawisut Deoisares ◽

Pinyo Rattanaumpawan

Keyword(s):

Medical Students ◽

Antimicrobial Resistance ◽

Infection Control ◽

Multicenter Study ◽

Control Unit ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Medical Practitioners ◽

Stewardship Program ◽

Appropriate Antimicrobial Use

A questionnaire-based study was conducted among final-year Thai medical students. The problem of antimicrobial resistance is well recognized, but their knowledge of antimicrobial resistance, appropriate antimicrobial use, and infection control was substantially limited. Only half of these students recognized existence of an antimicrobial stewardship program or infection control unit in their hospitals.Infect Control Hosp Epidemiol 2016;37:603–605

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Assessment of antimicrobial use in private and government hospitals, a comparative study in central kerala, using who indicators

International Journal of Indigenous Herbs and Drugs ◽

10.46956/ijihd.v6i4.236 ◽

2021 ◽

pp. 88-92

Author(s):

Chinnu Roy ◽

Shaji George ◽

Aleena Issac ◽

Arya Ponnappan ◽

Dhanya Paul

Keyword(s):

Broad Spectrum ◽

Average Cost ◽

Private Hospital ◽

Antimicrobial Treatment ◽

Antimicrobial Use ◽

Government Hospital ◽

Prescribing Pattern ◽

Government Hospitals ◽

The Government ◽

Who Indicators

Background: Irrational use of antimicrobial can cause various unwanted and untoward events. It may diminish the quality of patient care, increase the cost of therapy, and involvement in various side effects. Thus, the appropriateness of antimicrobial use in hospitals plays a pivotal role in patient safety. Objective: To analyze and assess the prescribing pattern of antimicrobials in private and government hospitals as per the WHO indicators. Methodology: A prospective comparative observational study was carried out for 6 months, with the patient diagnosed with an infectious disease admitted to the medical ward of both the hospitals during the study period. The data obtained from the study sites were Compared and analyzed using WHO indicators described in WHO’s “How to Investigate Antimicrobial use in Hospitals: Selected Indicators, Feb 2012”. Results: The study involved 216 patients and the average number of antimicrobials prescribed was found to be 1.73 in a private hospital and 2.07 in the government hospital, average cost of antimicrobials was found to be 86.48 INR in private and 31.04 INR in the government hospital, average duration of antimicrobial treatment was 4.8 in private and 5.2 in the government hospital, and the percentage of antimicrobials prescribed in generic was 33.33% in private and 87.83% in the government hospital. Considering the spectrum of antibiotics, both private (94.7%) and government (88.8%) used broad-spectrum antimicrobials. In both hospitals, cephalosporins were the most frequently prescribed class of antimicrobials. Comparing the dosage of antimicrobials given, injection usage is at the highest in government (59.5%) as well as in the private hospital (68.4%). Conclusion: This study indicates that the average cost of antimicrobials was more in a private hospital than that in a government hospital and other indicators such as the number of antimicrobials per hospitalization, duration of antimicrobial treatment, and the percentage of generic antimicrobials prescribed were all found to be more in a government hospital. In both private and government hospitals broad-spectrum antimicrobials were widely used, with cephalosporin as the most prescribed class.

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AMR: major milestone reached as Targets Taskforce presents its proposals

Veterinary Record ◽

10.1136/vr.j5086 ◽

2017 ◽

Vol 181 (18) ◽

pp. 487.1-487

Keyword(s):

Antimicrobial Use ◽

The Past ◽

Veterinary Profession ◽

The Government ◽

Farming Industry

Over the past year, the veterinary profession has been working with the Government and the farming industry to develop specific targets for antimicrobial use in the different livestock sectors. The targets were announced last week at a conference organised by the Responsible Use of Medicines in Agriculture Alliance (RUMA).

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Critical evaluation of antimicrobial use - A Turkish university hospital example

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2921 ◽

2013 ◽

Vol 7 (11) ◽

pp. 873-879 ◽

Cited By ~ 8

Author(s):

Salih Hosoglu ◽

Zafer Parlak ◽

Mehmet Faruk Geyik ◽

Yilmaz Palanci

Keyword(s):

Infectious Diseases ◽

Critical Evaluation ◽

Positive Culture ◽

Antimicrobial Treatment ◽

Influential Factors ◽

University Hospital ◽

Antimicrobial Use ◽

Tract Infections ◽

Appropriate Antimicrobial Use

Introduction: Antimicrobials are being used unnecessarily for different reasons. The aims of this study were: assessment of the quality of antimicrobial use and determination of the factors related to correct use. Method: Antimicrobial practice at Dicle University Hospital (DUH) was evaluated with a point prevalence approach. Using a standardized data collection form, the patients’ data (clinic, epidemiology, laboratory and antimicrobial use) was collected. Possible influential factors on antimicrobial use were examined. Results: In the surveillance study 1,350 inpatients were evaluated; 461 (34.1%) of them were using antimicrobials for treatment and 187 (13.9%) for prophylaxis. Antimicrobial indication was found in 355 of 461 patients (77.0%), and the number of antimicrobials was 1.8 per patient in the treatment group. The most common reason for antimicrobial use was community-acquired infection (57.9%). Pneumonia (20.4%), skin and soft tissue infections (9.11%) and urinary tract infections (7.9%) were the most common infectious diseases. Positive culture results were available for 39 patients (8.5.0%) when antimicrobial treatment started. All steps of antimicrobial use were found appropriate in 243 patients (52.7%). In multivariate analyses, clinical manifestation of infection at the beginning (p<0.001), presence of leukocyte counting (p<0.001) and prescription by an infectious disease specialist were found significantly positive factors for wholly appropriate antimicrobial use. Hospitalization with a diagnosis other than infection was found a significantly negative factor for appropriate antimicrobial use (p=0.001). Conclusion: The quality of antimicrobial use could be improved with better clinical and laboratory diagnosis and consultation with infectious diseases specialists

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The Hospital Antimicrobial Use Process: From Beginning to End

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy098 ◽

2018 ◽

Vol 5 (6) ◽

Cited By ~ 2

Author(s):

William R Truong ◽

Jason Yamaki

Keyword(s):

Antimicrobial Resistance ◽

Patient Outcomes ◽

Adverse Drug Reactions ◽

Antimicrobial Stewardship ◽

Antimicrobial Use ◽

Drug Reactions ◽

Improve Patient ◽

Appropriate Antimicrobial Use

Abstract Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use.

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