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Abstract Purpose To investigate ambulatory antibiotic use in children during 1?year before and 1?year after in‐hospital antibiotic exposure compared to children from the general population that had not received antibiotics in‐ho...
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Abstract Purpose To investigate ambulatory antibiotic use in children during 1?year before and 1?year after in‐hospital antibiotic exposure compared to children from the general population that had not received antibiotics in‐hospital. Methods Explorative data‐linkage cohort study from Norway of children aged 3?months to 17?years. One group had received antibiotics in‐Hospital (H+), and one group had not received antibiotics in‐hospital (H‐). The H+ group was recruited during admission in 2017. Using the Norwegian Population Registry, 10 children from the H‐ group were matched with one child from the H+ group according to county of residence, age and sex. We used the Norwegian Prescription Database to register antibiotic use 1?year before and 1?year after the month of hospitalisation. Results Of 187 children in the H+ group, 83 (44%) received antibiotics before hospitalisation compared to 288/1870 (15%) in the H‐ group, relative risk (RR) 2.88 (95% confidence interval 2.38–3.49). After hospitalisation, 86 (46%) received antibiotics in the H+ group compared to 311 (17%) in the H‐ group, RR 2.77 (2.30–3.33). Comorbidity‐adjusted RR was 2.30 (1.84–2.86) before and 2.25 (1.81–2.79) after hospitalisation. RR after hospitalisation was 2.55 (1.99–3.26) in children 3?months‐2?years, 4.03 (2.84–5.71) in children 3–12?years and 2.07 (1.33–3.20) in children 13–17?years. Conclusions Children exposed to antibiotics in‐hospital had two to three times higher risk of receiving antibiotics in ambulatory care both before and after hospitalisation. The link between in‐hospital and ambulatory antibiotic exposure should be emphasised in future antibiotic stewardship programs.
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Introduction Antimicrobial resistance is a global public health crisis. A major driver of resistance is inappropriate antibiotic use, resulting from practices of prescribers, dispensers and patients. The purpose of this study was ...
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Introduction Antimicrobial resistance is a global public health crisis. A major driver of resistance is inappropriate antibiotic use, resulting from practices of prescribers, dispensers and patients. The purpose of this study was to identify the perception of service providers and policymakers about the inappropriate use of antibiotics in Nepal. Methods A qualitative study was conducted to explore factors influencing antibiotic use. Participants included 17 service providers and policymakers from the Rupandehi district in Nepal, with a semi-structured interview schedule adopted. Data were analysed using thematic analysis to identify themes relating to the inappropriate use of antibiotics. Results Inappropriate use of antibiotics was found to result from the interaction of demand and supply factors, together with a weak regulatory environment. Lack of knowledge by consumers and financial constraints resulted in practices such as self-medication and pressure being placed on providers to prescribe or dispense antibiotics. An insufficient choice of antibiotics, and health services not having investigation facilities, was also factors leading to inappropriate use of antibiotics. Additionally, in the private sector, the profit motive arising from incentives provided by pharmaceutical companies contributed to prescribing or dispensing antibiotics inappropriately. Conclusion Promoting appropriate antibiotic use is critical to reduce the growing public health threat of antibiotic resistance. A multi-faceted approach involving policymakers, providers, and the general public using both educational and regulatory measures is required to address this problem in Nepal, and potentially also in other low-income countries with a similar healthcare system.
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Over 90% of antibiotic use data is now captured within UK poultry, pig and aquaculture sectors. While dairy, beef and sheep lag behind, a new database promises to change this. So how - and why - should veterinary surgeons engage w...
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Over 90% of antibiotic use data is now captured within UK poultry, pig and aquaculture sectors. While dairy, beef and sheep lag behind, a new database promises to change this. So how - and why - should veterinary surgeons engage with the new MedicineHub?
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BACKGROUND:Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology rese...
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BACKGROUND:Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology research approach.METHODS:This was an explorative study involving 15 in-depth interviews among health professionals and private dispensers and eight focus group discussions among 55 community members. Qualitative data were coded using Nvivo 12, thematically analysed and presented as narratives with quotes to support the findings.RESULTS:Self-medication was common and antibiotics were used to treat specific diseases but respondents were not aware these were 'antibiotics'. Various antibiotics were used for indications that in principle do not require systemic antibiotics, like stomach ache and sores on the body. Antibiotics, in particular tetracycline and metronidazole, were poured into "akpeteshie" (local gin) to treat hernia and perceived stomach sores (stomach ulcer). These practices were copied/learnt from various sources like over-the-counter medicine sellers, family, friends, radio/television, drug peddlers, pharmacies and doctors. Medicines in capsules were referred to as 'topaye' or 'abombelt' in Twi (local dialect) and perceived to treat pain associated with diseases. Antibiotics in capsules were described with colours which appeared confusing as some capsules with different drugs in them have similar colours.CONCLUSION:Inappropriate antibiotic use were influenced by general lack of knowledge on antibiotics and identification of antibiotics by colours of capsules which leads to confusion and could lead to inappropriate antibiotic use. There is the need for public health education on appropriate antibiotic use and standardization of appearance of antibiotics and other drugs to optimize use.
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Bacteria are said to be resistant if their growth is not halted by the maximum level of an antibiotic that is tolerated by the host. Antimicrobial agents are among the most frequently prescribed and inappropriate use of these agen...
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Bacteria are said to be resistant if their growth is not halted by the maximum level of an antibiotic that is tolerated by the host. Antimicrobial agents are among the most frequently prescribed and inappropriate use of these agents are associated with allergic reactions, toxicities, super infection and more importantly the development of antimicrobial resistance. Antibiotics are frequently prescribed inappropriately in terms of type, dose, duration and indication. The excessive and inappropriate use of antibiotics add unnecessary economic burden to the healthcare system and cause increasing antibiotic resistant organisms which result use more of expensive and toxic drugs. It is known that patients infected with drug-resistant organisms are more likely to require hospitalization, have a longer hospital stay and death. And all efforts to contain the problem must include manufacturers, prescribers, dispensers and consumers of antimicrobial agents to work must work in cooperation for prevention of antibiotic resistance.
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Abstract Background The use of the term ‘antimicrobial stewardship’ has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although antimicrobial stew...
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Abstract Background The use of the term ‘antimicrobial stewardship’ has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term ‘antimicrobial stewardship’ becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not. Aims To review the emergence and evolution of the term ‘antimicrobial stewardship’. Sources We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We contacted the authors of the first publications that mentioned antimicrobial stewardship. Content We describe the historical background behind how antimicrobial stewardship came into use in clinical settings. We discuss challenges emerging from the varied descriptions of antimicrobial stewardship in the literature, including an over-emphasis on individual prescriptions, an under-emphasis on the societal implications of antimicrobial use, and language translation problems. Implications To help address these challenges, we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for ‘responsible use’ to be defined and translated into context-specific and time-specific actions. Furthermore, we present examples of actions that can be undertaken within antimicrobial stewardship across human and animal health.
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Objectives: This study was conducted to examine level of knowledge and attitudes regarding antibiotic use and drug resistance among society. The objective of this study was to identify awareness, knowledge and attitude regarding a...
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Objectives: This study was conducted to examine level of knowledge and attitudes regarding antibiotic use and drug resistance among society. The objective of this study was to identify awareness, knowledge and attitude regarding antimicrobial use and resistance to antimicrobial agent. Methods: A pilot study was conducted on ten peoples and suggestions were sought. Questionnaire was revised by incorporation of different suggestions. Questions were divided into following category of 1) Awareness of antibiotics use 2) Knowledge of antibiotics use and antibiotic resistance 3) Attitude of surveyed people regarding rational use of antibiotic. Analysis was performed based on grouping of questions using descriptive statistics. Most respondents i.e., 33% did not know that antibiotics are ineffective in treating coughs and colds. Some of the respondents were unaware of the conditions under which antibiotic resistance occurs, despite understanding of the concept of resistance. Lower education level and old age were independently associated with inadequate knowledge. Total 55% surveyed population used antibiotics. Awareness about antibiotic was observed among peoples and methods to overcome the lack of awareness were discussed. Among surveyed population 76.66% peoples were aware about safe use of antibiotics. 59.83% of surveyed populations have knowledge about antibiotics. Results: Results of this study demonstrate that the general public was unaware and lack of knowledge with regard to antibiotic use. However, the survey may create awareness, knowledge and attitude may develop toward the antibiotics among rational use of society. Results of surveyed population showed that 63.83% peoples have knowledge and awareness about the unnecessary use of antibiotics. Conclusion: Surveyed population is least familiar with the adverse effects and role of antibiotics in the infective disease. Hence there is scope to develop awareness, knowledge and attitude about rational use of antibiotic use among society.
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Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is d...
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Measurement of antimicrobial use before and after an intervention and the associated outcomes are key activities of antimicrobial stewardship programs. In the United States, the recommended metric for aggregate antibiotic use is days of therapy/1000 patient-days. Clinical outcomes, including response to therapy and bacterial resistance, are critical measures but are more difficult to document than economic outcomes. Interhospital benchmarking of risk adjusted antimicrobial use is possible, although several obstacles remain before it can have an impact on patient care. Many challenges for stewardship programs remain, but the methods and science to support their efforts are rapidly evolving.
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With the onset of the coronavirus disease 2019 (COVID-19) pandemic, changes in patient care and antibiotic use have occurred in hospitals. The data of the National Health Insurance System’s claims of inpatients from all hospitals...
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With the onset of the coronavirus disease 2019 (COVID-19) pandemic, changes in patient care and antibiotic use have occurred in hospitals. The data of the National Health Insurance System’s claims of inpatients from all hospitals in Korea between January 2019 and December 2020 were obtained from the Health Insurance Review & Assessment Service and analyzed. The trend in the use of all antibacterial agents in both hospitals declined for the total number of COVID-19 patients at the bottom 10% and those in the top 10%. Specifically, a decreasing trend in the use of broad-spectrum antibacterial agents predominantly prescribed for community-acquired cases and narrow-spectrum beta-lactam agents were observed in both hospitals. In the aftermath of the COVID-19 pandemic, the total use of antibacterial agents has gradually decreased among patients with pneumonia and those with severe COVID-19. In contrast, its use has increased gradually among those with mild to moderate COVID-19. A decreasing trend in overall antibiotic use was observed during the COVID-19 pandemic, and an increasing trend in antibiotic use was observed in patients with mild to moderate COVID-19 in Korean hospitals.
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Objectives: To identify the antibiotics potentially the most involved in the occurrence of antibiotic-resistant bacteria from an ecological perspective in French healthcare facilities (HCFs). Methods: This study was based on data ...
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Objectives: To identify the antibiotics potentially the most involved in the occurrence of antibiotic-resistant bacteria from an ecological perspective in French healthcare facilities (HCFs). Methods: This study was based on data from the French antimicrobial surveillance network (ATB-RAISIN, 2007-09). Antibiotics were expressed in defined daily doses per 1000 patient-days. Antibiotic-resistant bacteria were considered as count data adjusted for patient-days. These were third-generation cephalosporin (3GC)- and ciprofloxacin-resistant Escherichia coli, cefotaxime-resistant Enterobacter cloacae, methicillin-resistant Staphylococcus aureus and ceftazidime-, imipenem- and ciprofloxacin-resistant Pseudomonas aeruginosa. Three-level negative binomial regression models were built to take into account the hierarchical structure of data: level 1, repeated measures each year (count outcome, time, antibiotics); level 2, HCFs (type and size); and level 3, regions (geographical area). Results: A total of 701 HCFs from 20 French regions and up to 1339 HCF-years were analysed. The use of ceftriaxone, but not of cefotaxime, was positively correlated with incidence rates of 3GC- and ciprofloxacin-resistant E. coli. In contrast, both 3GCs were positively correlated with the incidence rate of cefotaxime-resistant E. cloacae. Higher levels of use of ciprofloxacin and/or ofloxacin, but not of levofloxacin, were associated with higher incidence rates of 3GC- and ciprofloxacin-resistant E. coli, cefotaxime-resistant E. cloacae, methicillin-resistant S. aureus and ceftazidime- and ciprofloxacin-resistant P. aeruginosa. Conclusions: Our study suggests differences within antibiotic classes in promoting antibiotic resistance. We identified ceftriaxone, ciprofloxacin and ofloxacin as priority targets in public health strategies designed to reduce antibiotic use and antibiotic-resistant bacteria in French HCFs.
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