Antibiotic use in Moshi Urban: A cross-sectional Study of Knowledge and Practices among Caretakers of Children in Kilimanjaro Tanzania

IntroductionAntibiotics are commonly accessed and used for the management of illness in children without a prescription. We investigated the caretaker’s knowledge and practices on antibiotics and antibiotics use to their children.MethodThis was the hospital-based cross-sectional study conducted from April to July 2017 in three facilities located in Moshi Municipality. A convenience sampling was employed to select for caretakers with their sick children at KCMC, Mawenzi hospital, and Longuo dispensary. Face-to-face interviews were conducted with 224 caretakers who had visited health facilities with their children seeking health care.ResultsThe majority (87.9%, 197/224) of all interviewed caretakers had good knowledge of the use of antibiotics. Irrespective of knowing that it is not safe to self-medicate a child with any antibiotics (95.1%, 213/224), most (61.6%, 138/224) caretakers practiced self-medication with the medicines. Having two children (aOR = 7.75, 95% CI: 1.89-31.67) and having three children (aOR=7.23, 95%CI: 1.08-48.51) were significantly associated with good knowledge of antibiotics.ConclusionThis study has revealed that caretakers in Moshi had a good knowledge of antibiotic use. However, despite such good knowledge, malpractices were observed. We call upon the use of media campaigns to advocate for the importance of the rational use of antibiotics and its effect on human health and the risk of antimicrobial resistance development.Rwanda J Med Health Sci 2021;4(3):347-356

Effect of Monthly Evaluations on Irrational Rates of Antimicrobial Drug Prescription in Outpatient and Emergency Departments

Reduction of the excessive rate of antibiotic prescription is needed to curb antibiotic resistance. This retrospective study was conducted to verify whether monthly evaluations of antibiotic prescriptions could improve clinical antibiotic use in outpatient and emergency departments. Every month, from July 2016 to June 2019, 25% of the antibacterial prescriptions from the outpatient and emergency departments in our hospital were randomly selected. The hospital formed an evaluation team that conducted preliminary evaluations of these prescriptions and an expert team that re-evaluated any problematic prescriptions. We analysed the irrational prescription rate, proportion of antibiotic use, and consistency between the evaluation and expert teams. At the end of the evaluation period, the utilisation rate of single antibiotics in the outpatient and emergency departments increased, the irrational prescription rate decreased, and the proportion of sold antibiotics gradually decreased. In addition, the consistency of prescription evaluation results between the evaluation and expert groups increased over time. In conclusion, monthly evaluation of antibiotic prescriptions is an effective management tool for the rational use of antibiotics in clinical practice and plays an important role in safe clinical drug use.

Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017

Background Lack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017. Methods An AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017. Results One month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5. Conclusions Although progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals’ ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

Drug Utilization Evaluation of Vancomycin among Patients in Jafar Ibn Auf Pediatric Hospital, 2018

Background: Vancomycin is an antibiotic of growing importance in the treatment of hospital-acquired infections; with a particular emphasis on its value in the fight against Methicillin-resistant Staphylococcus aureus. Increasing reports of Vancomycin resistance have raised concerns about the effectiveness of this drug. Drug utilization evaluation has an important role in controlling rational use of antibiotics to prevent the emergence of resistance. Methods: We conducted a retrospective 6-months study at Jafar Ibn Auf pediatric hospital. Data including patient's demographics, diagnosis, Dosage regimen, and treatment duration were reviewed. The concordance of practice with the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and principles of antibiotic therapy was assessed. Results: 127 medical records were reviewed in this study. Sepsis (29%) and Pneumonia (19.6%) were the most common indications. Culture test was requested in 20.5% of patients. Monitoring of serum creatinine was carried in 81.1% of patients. Based on HICPAC guidelines vancomycin was administered appropriately in 67.7% percent of cases. Considering the infusion rate, most of patients with specific order were received vancomycin in 1 hour. Conclusions: The results showed that vancomycin was used empirically without subsequent adjustment of the antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to the infusion rate and serum creatinine monitoring.

Antibiotic Susceptibility Patterns of Bacterial Isolates from Infected Wounds in a Tertiary Health Care Center, India

Background: An infected wound prolongs the period of stay in hospital which results in further chances of getting affected by nosocomial infection leading to increased number of comorbidities. Hence adequate and appropriate treatment of the infective organism is of prime importance. Objectives: To find out the most common antibiotics susceptible to the bacterial isolates from the pus samples. Materials and Methods: A cross sectional study was conducted of the bacterial isolates from pus samples in a hospital setup of Saveetha medical college and hospital, Chennai for 100 patients. Pus samples were collected from patients who came to the surgery OPD with complaints of ulcer and discharge were subjected to culture and sensitivity after obtaining proper consent and the bacterial growths were noted. Antibiotic susceptibilities of the isolates were determined according to disk diffusion method recommended by the Clinical and Laboratory Standard institute [1]. Results: Out of the total samples collected (n=200) 90% of the samples showed bacterial growth and the remaining 10% of the samples showed no growth. The most predominant bacteria in our study was found to be E. coli (33%) being most susceptible to Amikacin followed by S. aureus (19%) which was highly susceptible to Linezolid and Vancomycin. Conclusion: There is a peak in the incidence of antimicrobial resistant cases which is a great threat for human mankind. Hence emphasis should be laid on rational use of antibiotics and proper sterile techniques to be followed.

A cross-sectional assessment of Indonesian female health cadres’ knowledge and attitude towards antibiotics

Introduction: Health cadres have a key role in building awareness related to irrational antibiotic use and antibiotic resistance in Indonesia. Cadres help to bridge the gap between the shortage of health professionals and the need to reach the broader population. This study aimed to identify cadres’ background, antibiotic knowledge and attitudes in an Indonesian setting. Methodology: A paper-based questionnaire survey was validated and conducted among purposefully selected cadres attending a seminar in Malang Indonesia. A 5-point Likert scale was used to identify attitudes, while true/false statements determined their knowledge. A total of 112 cadres responded, giving a 100% response rate. Results: The majority had been cadres for >2 years with previous counseling experience. Their attitudes on antibiotic use, were shown by the lower levels of disagreement to the statements “when I get a sore throat, I prefer to use antibiotics” (37.5%); “I would take antibiotics if I have had a cough for more than one week” (41.1%); and, “when I get influenza, I would take antibiotics to help me recover sooner” (47.3%), within the “indications” domain. For knowledge, lower scores were reported for domains related to “indications” (mean 1.49 ± 0.82/3), “resistance” (mean 1.06 ± 0.94/3), and “storage and disposal” (mean 1.23 ± 0.78/3). Conclusions: These findings indicated a need to improve cadres’ attitudes and knowledge prior their involvement as change agents for improving the rational use of antibiotics to minimise antibiotic resistance in Indonesia.

Antibiotic Overuse for COVID-19: Are We Adding Insult to Injury?

In this study, we described the proportion of COVID-19 patients started on antibiotics empirically and the work-ups performed to diagnose bacterial superinfection. We used a retrospective cohort study design involving medical records of symptomatic, hospitalized COVID-19 patients who were admitted to these centers. A total of 481 patients were included, with a median age of 41.0 years (interquartile range, 28-58.5 years). A total of 72.1% (N = 347) of COVID-19 patients received antibiotics, either before or during admission. This is troublesome because none of the patients’ bacterial culture or inflammatory markers, such as the erythrocyte sedimentation rate or C-reactive protein, were evaluated, and only 73 (15.2%) underwent radiological investigations. Therefore, national COVID-19 guidelines should emphasize the rational use of antibiotics for the treatment of COVID-19, a primarily viral disease. Integrating antimicrobial stewardship into the COVID-19 response and expanding microbiological capacities in low-income countries are indispensable. Otherwise, we risk one pandemic aggravating another.

Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions

The COVID-19 pandemic is expected to worsen the global problem of antimicrobial resistance (AMR). There is a heightened interest in understanding this effect and to develop antimicrobial stewardship (AMS) interventions accordingly to curb this threat. Our paper aims to evaluate the potential magnitude of COVID-19 on AMR and AMS with a focus on the countries of the Arab league, given the social, political, and economic environments. We also evaluate obstacles in applying the rational use of antibiotics, monitoring resistance trends in the midst of the pandemic, and evaluating the impact of the economic crisis in some countries. We aim to raise awareness about the potential effects of antibiotic overuse during the pandemic and to propose practical approaches to tackle this issue.

Usage of antibiotics and monitoring of drug interactions in pediatrics at a tertiary care teaching hospital

Background: Respiratory tract infections (RTI) are more common in pediatrics. Especially in developing countries like India, RTI causes more death in children. Antibiotics are used to treat RTI even in case of viral infections. Hence rational use of antibiotics is very much needed to avoid antibiotic resistance. In this study we have analysed the prescribing pattern of antibiotics and their drug interactions involved in the management of respiratory tract infections in a tertiary care teaching hospital.Methods: A prospective observational study was conducted in the department of pediatrics at a tertiary care teaching hospital for a period of 6 months (November 2019-April 2020). A total of 144 patients were included in the study and their prescription was analysed for their antibiotic prescribing pattern and interactions.Results: Infants were more prone to RTI infections. Among RTI, lower RTI were more common in children. We have analysed prescribing pattern of antibiotics in which, mono antibiotic therapy were more commonly used. Ampicillin was the frequently prescribed antibiotic. Azithromycin had the most possible interactions among the antibiotics prescribed.Conclusions: More than 336 antibiotics were used for all types of RTI, even in the case of viral infections. So rational use of antibiotics is needed. Among 144 children who were enrolled in the study, none of them were subjected to culture sensitivity test. As of which, all of them were treated empirically. Penicillin and cephalosporin are the mostly prescribed antibiotics in RTI. Cephalosporin prescribed children had less hospital stay and hardly interactions were found.