Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the RxOUTMAP trial

BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists’ antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88%), sulfamethoxazole–trimethoprim (TMP–SMX) (8%), and fosfomycin (2%); in the physician-initial arm, nitrofurantoin (55%), TMP–SMX (26%), and fluoroquinolones (11%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm ( p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 46% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.

Gambaran Kerasionalan Resep Antibiotik Dengan Diagnosa ISPA Di Poli Anak Rumah Sakit Prikasih Jakarta Selatan Periode Januari – Maret 2020

Irrational drug use is a major problem in the world. Irrational prescribing of drugs can be described as medically inaccurate and ineffective in financing, treatment There are many studies that describe the treatment of ARD (Acute Respiratory Disease) patients who tend to use antibiotics which lead to overprescription and become irrational. This research was to descripte of a rational antibacterial prescription with a diagnosis of upper Acute Respiratory Tract Infection (ARI) at Prikasih Hospital Children's Clinic. Methods for this research is descriptive method using retrospective data. Samples in this study were 380 recipes. The results showed that there were 79.7% rational recipes and 20.3% irrational recipes. Based on the choice of drug type, cefixime is the most widely used antibiotic with a rule of 3 times a day.Keywords: Rationality Antibiotic PrescriptionISPA Children ClinicalABSTRAKPenggunaan obat yang tidak rasional adalah suatu masalah utama di dunia ini. Peresepan obat yang tidak rasional bisa digambarkan sebagai tidak tepanya obat secara medis dan tidak efektif dalam pembiayaan pengobatan. Banyaknya penelitian yang menggambarkan penyembuhan penyakit untuk pasien ISPA adalah hampir keseluruhan menggunakan antibiotik dengan peresepan ysng berlebihan dan menjadi tidak rasional dalam pengobatan . Tujuan penelitian ini adalah untuk mengetahui kerasionalan resep obat antibiotik dengan diagnosa Infeksi Saluran Pernapasan Akut (ISPA) bagian atas di Poli Anak Rumah Sakit Prikasih. Dalam penelitian ini metode yang digunakan adalah metode deskriptif dengan menggunakan data retrospektif. Jumlah sampel dalam penelitian ini sejumlah 380 resep. Hasil penelitian menunjukkan bahwa terdapat 79.7% resep rasional dan 20.3% resep tidak rasional. Berdasarkan pemilihan jenis obat, cefixime merupakan antibiotik yang paling banyak digunakan dengan aturan pemakaian 3 x sehari.Kata Kunci:KerasionalanResep AntibiotikISPAPoli Anak

Antibacterial prescription in Italian preschool children: analysis of 7 years of data from the Emilia-Romagna region reimbursement database

Objectives To describe antibacterial prescribing patterns in outpatients aged 0–5 years from 2007 to 2013 in the Emilia-Romagna region, assessing sex- and age-specific consumption over time. Methods All children aged 0–5 years resident in the Emilia-Romagna region who received at least one prescription of a systemic antibacterial in the period 2007–13 were enrolled. The prescriptions of systemic antibacterials to children were collected from the regional prescription database. Data were stratified by year, sex and age, and analysed in terms of periodic prevalence and of annual prescription rate per 1000 person-years. Results The prevalence of children receiving at least one prescription per year varied from 68.0% in 2007 to 59.0% in 2013, while the average prevalence of children receiving five or more prescriptions per year was 6.96%. The annual prescription rate varied from 1621.26 in 2007 to 1372.27 in 2013. Penicillins + β-lactamase inhibitors accounted for 35.3% of total prescriptions, followed by extended-spectrum penicillins (28.6%), macrolides (17.0%) and third-generation cephalosporins (13.9%). Conclusions Despite recommendations, a significant overprescription of antibacterials to children still exists, showing no satisfactory improvements over the years. In contrast to Northern European countries, adherence to evidence-based guidelines was poor, with frequent prescribing of broad-spectrum agents for the treatment of mostly viral childhood infectious disease.