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Mohamadloo A, Ramezankhani A. The strategies of the preventing induced demand for medicine prescription: A qualitative study. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2020. [DOI: 10.4103/iahs.iahs_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chatterjee P, Kanungo S, Bhattacharya SK, Dutta S. Mapping cholera outbreaks and antibiotic resistant Vibrio cholerae in India: An assessment of existing data and a scoping review of the literature. Vaccine 2019; 38 Suppl 1:A93-A104. [PMID: 31883807 DOI: 10.1016/j.vaccine.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/18/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022]
Abstract
Although fluid and electrolyte replenishment remains the mainstay of clinical management of cholera, antibiotics are an important component of the strategy for clinical management of moderate to severe cases of cholera. The emergence of antibiotic resistance (ABR) in Vibrio cholerae has led to difficulties in case management. The past decade has also seen the development of cheap and effective oral cholera vaccines (OCVs). In addition to the two-dose strategy for widespread immunization, OCVs have also been shown to be effective in containing outbreaks using a single-dose schedule. In this scoping review we map the states and union territories (SUTs) of India which are prone to cholera outbreaks followed by a scoping review of peer-reviewed publications about ABR outbreaks of cholera employing the Arksey and O'Malley framework. Using the data reported by the Integrated Disease Surveillance Program (IDSP), we identified 559 outbreaks of cholera between 2009 and 2017, affecting 27 SUTs. We defined SUTs which had reported outbreaks in at least three out of the last five years (2012-2016) or had experienced two or more outbreaks in the same year in at least two of the last five years to be outbreak-prone. The scoping review identified 62 ABR outbreaks, with four SUTs accounting for two-thirds of them: West Bengal (14), Maharashtra (10), Odisha (10) and Delhi (7). Overall, this scoping review suggests that there is an increasing trend of ABR in Vibrio cholerae isolated from outbreaks in India. This opens up avenues for exploring the role of antibiotic stewardship in the clinical management of diarrhea, the institution of vaccination as an infection prevention intervention to reduce selection pressure, and the deployment of high quality surveillance systems which report accurate, real-time data allowing appropriate and timely public health responses. It is crucial to counter the issue of ABR in cholera before it assumes a menacing magnitude.
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Affiliation(s)
- Pranab Chatterjee
- Division of Epidemiology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India.
| | - Suman Kanungo
- Division of Epidemiology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India.
| | | | - Shanta Dutta
- Division of Bacteriology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, India
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Farooqui HH, Mehta A, Selvaraj S. Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data. PLoS One 2019; 14:e0224848. [PMID: 31721809 PMCID: PMC6853304 DOI: 10.1371/journal.pone.0224848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health). We coded the diagnosis provided in the medical audit data to International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the prescribed antibiotics for the diagnosis to Anatomic Therapeutic Chemical (ATC) classification of World Health Organization (ATC index-2016). We calculated and reported antibiotic prescription rate per 1,000 persons per year, by age groups, antibiotic class and disease conditions. Our main findings are-approximately 519 million antibiotic prescriptions were dispensed in the private sector, which translates into 412 prescriptions per 1,000 persons per year. Majority of the antibiotic prescriptions were dispensed for acute upper respiratory infections (J06) (20.4%); unspecified acute lower respiratory infection (J22) (12.8%); disorders of urinary system (N39) (6.0%); cough (R05) (4.7%); and acute nasopharyngitis (J00) (4.6%) and highest antibiotic prescription rates were observed in the age group 0-4 years. To conclude our study reports first ever country level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-10 mapped disease conditions.
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Affiliation(s)
- Habib Hasan Farooqui
- Indian Institute of Public Health –Delhi, Public Health Foundation of India, Gurugram, Haryana, India
| | - Aashna Mehta
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
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Veterinary Drug Shops as Main Sources of Supply and Advice on Antimicrobials for Animal Use in the Mekong Delta of Vietnam. Antibiotics (Basel) 2019; 8:antibiotics8040195. [PMID: 31731499 PMCID: PMC6963485 DOI: 10.3390/antibiotics8040195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 01/04/2023] Open
Abstract
In the Mekong Delta of Vietnam, small-scale poultry farmers use large amounts of antimicrobials to raise their flocks, and veterinary drug shops owners and their staff are a key source of advice to farmers on antimicrobial use (AMU). We described the network of veterinary drug shops (n = 93) in two districts within Dong Thap province (Mekong Delta). We also interviewed a randomly selected sample of chicken farmers (n = 96) and described their linkages with veterinary drug shops. Antimicrobials represented 15.0% [inter quartile range (IQR) 6.0–25.0] of the shops’ income. Fifty-seven percent shop owners had been/were affiliated to the veterinary authority, 57% provided diagnostic services. The median number of drug shops supplying antimicrobials to each farm during one production cycle was 2 [IQR 1–2]. Visited shops were located within a median distance of 3.96 km [IQR 1.98–5.85] to farms. Drug shops owned by persons affiliated to the veterinary authority that did not provide diagnostic services had a higher fraction of their income consisting of antimicrobial sales (β = 1.913; p < 0.001). These results suggest that interventions targeting veterinary drug shop owners and their staff aiming at improving their knowledge base on livestock/poultry diseases and their diagnosis may contribute to reducing overall levels of AMU in the area.
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Rose J, Crosbie M, Stewart A. A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing. Perspect Public Health 2019; 141:19-27. [PMID: 31633458 DOI: 10.1177/1757913919879183] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This qualitative literature review aims to critically assess and analyse published literature to determine drivers influencing over-prescribing by general practitioners (GPs) in primary care, exploring their views and opinions, and also to determine how antibiotic prescribing can be improved and unnecessary prescribing reduced, thus reducing the threat to public health from antibiotic resistance. It is intended to develop new thinking in this area and add to existing knowledge concerning GPs' antibiotic prescribing behaviour. METHODS Thematic analysis following Braun and Clarke's 2006 framework was used to analyse 17 qualitative studies chosen from EBSCOhost databases, focusing on GPs' views of antibiotic prescribing in primary care, with specific search strategies and inclusion criteria to ensure study quality and trustworthiness. RESULTS Three main themes and nine sub-themes were generated from the studies. The first main theme discussed GP factors related to over-prescribing, the main drivers being GP attitudes and feelings and anxiety/fear concerning prescribing. The second theme highlighted external factors, with pressures from time and financial issues as the main drivers within this theme. The final theme marked patient pressure, demand and expectation with lack of patient education as the major drivers affecting GP over-prescribing. CONCLUSION The findings of this research show GPs' antibiotic prescribing in primary care is complex, being influenced by many internal and external factors. A multifaceted approach to interventions targeting the drivers identified could significantly reduce the level of antibiotic prescribing thus minimising the impact of antibiotic resistance and promoting a more efficient working environment for GPs and patients alike.
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Affiliation(s)
- Joanna Rose
- University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK
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Dyar OJ, Yin J, Ding L, Wikander K, Zhang T, Sun C, Wang Y, Greko C, Sun Q, Stålsby Lundborg C. Antibiotic use in people and pigs: a One Health survey of rural residents' knowledge, attitudes and practices in Shandong province, China. J Antimicrob Chemother 2019; 73:2893-2899. [PMID: 30053125 DOI: 10.1093/jac/dky240] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/27/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate rural residents' knowledge, attitudes and practices (KAP) towards antibiotic use in humans and pigs, among individuals with and without backyard pig farms living in Shandong province, China. Methods We conducted a cross-sectional questionnaire study among residents in 12 villages, and directly observed medicines stored in households for humans and pigs. Results In total, 769 residents participated, including 330 backyard pig farmers. Respondents had low levels of knowledge about antibiotics. A quarter of participants had bought one or more antibiotics from a pharmacy without a prescription in the previous year, and this was more common among pig farmers who had bought antibiotics for their pigs without consulting a vet (49% versus 25%, P < 0.001). Stored antibiotics for human use were found in 42% of households, and 70% of participants from these households did not know they were storing antibiotics. Thirty-one percent of backyard pig farmers were storing antibiotics for pig use. Farmers who thought it was good to store leftover antibiotics for their pigs were more likely to have stored antibiotics for pigs (41% versus 20%) and for humans (47% versus 32%; both P < 0.01). A fifth of participants thought their own actions were important for controlling antibiotic resistance. Conclusions We found differences in the KAP of backyard pig farmers and non-pig farmers to antibiotics, and parallels between pig farmers' attitudes and behaviours towards antibiotic use in pigs and in humans. Our findings reinforce the need for context-adapted multifaceted interventions to improve antibiotic use and provide suggestions for targeting educational approaches.
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Affiliation(s)
- Oliver J Dyar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jia Yin
- School of Health Care Management, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China
| | - Lilu Ding
- School of Health Care Management, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China
| | - Karin Wikander
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tianyang Zhang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Chengtao Sun
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yang Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | | | - Qiang Sun
- School of Health Care Management, Shandong University; Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University; Center for Health Management and Policy Research, Shandong University, Jinan, Shandong, China
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Mekuria LA, de Wit TFR, Spieker N, Koech R, Nyarango R, Ndwiga S, Fenenga CJ, Ogink A, Schultsz C, van’t Hoog A. Analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: A mixed-methods study. PLoS One 2019; 14:e0222651. [PMID: 31557170 PMCID: PMC6762089 DOI: 10.1371/journal.pone.0222651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Knowledge of antibiotic prescription practices in low- and middle-income countries is limited due to a lack of adequate surveillance systems. OBJECTIVE To assess the prescription of antibiotics for the treatment of acute respiratory tract infections (ARIs) in primary care. METHOD An explanatory sequential mixed-methods study was conducted in 4 private not-for-profit outreach clinics located in slum areas in Nairobi, Kenya. Claims data of patients who received healthcare between April 1 and December 27, 2016 were collected in real-time through a mobile telephone-based healthcare data and payment exchange platform (branded as M-TIBA). These data were used to calculate the percentage of ARIs for which antibiotics were prescribed. In-depth interviews were conducted among 12 clinicians and 17 patients to explain the quantitative results. RESULTS A total of 49,098 individuals were registered onto the platform, which allowed them to access healthcare at the study clinics through M-TIBA. For 36,210 clinic visits by 21,913 patients, 45,706 diagnoses and 85,484 medication prescriptions were recorded. ARIs were the most common diagnoses (17,739; 38.8%), and antibiotics were the most frequently prescribed medications (21,870; 25.6%). For 78.5% (95% CI: 77.9%, 79.1%) of ARI diagnoses, antibiotics were prescribed, most commonly amoxicillin (45%; 95% CI: 44.1%, 45.8%). These relatively high levels of prescription were explained by high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests, offloading near-expiry drugs, absence of policy and surveillance, and the use of treatment guidelines that are not up-to-date. Clinicians in contrast reported to strictly follow the Kenyan treatment guidelines. CONCLUSION This study showed successful quantification of antibiotic prescription and the prescribing pattern using real-world data collected through M-TIBA in private not-for-profit clinics in Nairobi.
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Affiliation(s)
- Legese A. Mekuria
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Location AMC, Meibergdreef, Amsterdam, The Netherlands
| | - Tobias FR de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Location AMC, Meibergdreef, Amsterdam, The Netherlands
- PharmAccess Foundation, Amsterdam, The Netherlands
| | | | | | | | | | | | - Alice Ogink
- PharmAccess Foundation, Amsterdam, The Netherlands
| | - Constance Schultsz
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Location AMC, Meibergdreef, Amsterdam, The Netherlands
| | - Anja van’t Hoog
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Location AMC, Meibergdreef, Amsterdam, The Netherlands
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Machowska A, Sparrentoft J, Dhakaita SK, StålsbyLundborg C, Sharma M. Perioperative antibiotic prescribing in surgery departments of two private sector hospitals in Madhya Pradesh, India. Perioper Med (Lond) 2019; 8:10. [PMID: 31523421 PMCID: PMC6734588 DOI: 10.1186/s13741-019-0121-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Single-dose perioperative antibiotic prophylaxis (PAP) is recommended for clean, non-infectious surgeries to prevent surgical site infections. However, the common practice of unindicated use and prolonged use of antibiotics contributes to the development and spread of antibiotic resistance (ABR). The present study explores the perioperative use of antibiotics among inpatients with surgical indications at surgery departments of a teaching (TH) and a non-teaching (NTH) tertiary care hospital in Madhya Pradesh, India. METHODS Data was collected manually for all inpatients for 3 years (April 2008-August 2011). Patients with non-infectious surgical indications were selected for detailed analysis at the diagnosis group level. RESULTS Out of 12,434 enrolled inpatients (TH 6171 and NTH 6263), the majority (> 85%) received antibiotics. None of the inpatients received the recommended single-dose PAP. The average duration of antibiotic treatment was significantly longer at the TH compared to the NTH (9.5 vs 4.4 days, p < 0.001). Based on the study aim, 5984 patients were classified in four diagnosis groups: upper or lower urinary tract surgery indications (UUTSI and LUTSI), and routine or emergency abdominal surgery indications (RASI and EASI). In both hospitals, quinolones were the most prescribed antibiotics for UUTSI (TH 70%, NTH 37%) and LUTSI (TH 70%, NTH 61%) antibiotic. In the TH, aminoglycosides (TH 32%) were commonly prescribed for RASI and imidazole derivatives (75%) for EASI. In the NTH, cephalosporins (39%) and imidazole derivatives (56%) were the most prescribed in RASI and EASI, respectively. CONCLUSIONS AND RECOMMENDATIONS High prescribing of antibiotics in all four selected diagnoses groups was observed at both hospitals. In spite of the recommended single-dose PAP, antibiotics were mainly prescribed for longer durations. The unrecommended use of antibiotics is a risk factor for the development of AMR. Improving the quality of antibiotic prescribing by a stewardship program focusing on the development and implementation of local prescribing guidelines is needed.
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Affiliation(s)
- Anna Machowska
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jonatan Sparrentoft
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shyam Kumar Dhakaita
- Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain, 456006 India
| | - Cecilia StålsbyLundborg
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Megha Sharma
- Department of Public Health Sciences, Global Health - Health Systems and Policy, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Surasa, Ujjain, 456006 India
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Tay KH, Ariffin F, Sim BL, Chin SY, Sobry AC. Multi-Faceted Intervention to Improve the Antibiotic Prescriptions among Doctors for Acute URI and Acute Diarrhoea Cases: The Green Zone Antibiotic Project. Malays J Med Sci 2019; 26:101-109. [PMID: 31496899 PMCID: PMC6719880 DOI: 10.21315/mjms2019.26.4.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/20/2019] [Indexed: 01/21/2023] Open
Abstract
Background Antimicrobial resistance is a global problem that is perpetuated by the inappropriate use of antibiotics among doctors. This study aims to assess the antibiotic prescription rate for patients with acute upper respiratory infection (URI) and acute diarrhoea. Methods A completed clinical audit cycle was conducted in 2018 in the busy emergency department of a public hospital in Malaysia. Pre- and post-intervention antibiotic prescription data were collected, and changes were implemented through a multifaceted intervention similar to Thailand’s Antibiotics Smart Use programme. Results Data from a total of 1,334 pre-intervention and 1,196 post-intervention patients were collected from the hospital’s electronic medical records. The mean (SD) age of participants was 19.88 (17.994) years. The pre-intervention antibiotic prescription rate was 11.2% for acute diarrhoea and 29.1% for acute URI, both of which are above the average national rates. These antibiotic prescription rates significantly reduced post-intervention to 6.2% and 13.7%, respectively, falling below national averages. Antibiotic prescription rate was highest for young children. There were no significant changes in rates of re-attendance or hospital admission following the intervention. Conclusion The multifaceted intervention, which included continuing medical education, physician reminders and patient awareness, was effective in improving the antibiotic prescription rates for these two conditions.
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Affiliation(s)
- Kim Heng Tay
- Infectious Disease Unit, Medical Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Farnaza Ariffin
- Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Benedict Lh Sim
- Infectious Disease Unit, Medical Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Sheau Yin Chin
- Paediatrics Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Ammar Che Sobry
- Emergency Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
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Thompson W, Tonkin-Crine S, Pavitt SH, McEachan RRC, Douglas GVA, Aggarwal VR, Sandoe JAT. Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. J Antimicrob Chemother 2019; 74:2139-2152. [PMID: 31002336 PMCID: PMC6640312 DOI: 10.1093/jac/dkz152] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION One way to slow the spread of resistant bacteria is by improved stewardship of antibiotics: using them more carefully and reducing the number of prescriptions. With an estimated 7%-10% of antibiotic prescriptions globally originating from dental practices and up to 80% prescribed unnecessarily, dentistry has an important role to play. To support the design of new stewardship interventions through knowledge transfer between contexts, this study aimed to identify factors associated with the decision to prescribe antibiotics to adults presenting with acute conditions across primary care (including dentistry). METHODS Two reviews were undertaken: an umbrella review across primary healthcare and a systematic review in dentistry. Two authors independently selected and quality assessed the included studies. Factors were identified using an inductive thematic approach and mapped to the Theoretical Domains Framework (TDF). Comparisons between dental and other settings were explored. Registration number: PROSPERO_CRD42016037174. RESULTS Searches identified 689 publications across primary care and 432 across dental care. Included studies (nine and seven, respectively) were assessed as of variable quality. They covered 46 countries, of which 12 were low and middle-income countries (LMICs). Across the two reviews, 30 factors were identified, with 'patient/condition characteristics', 'patient influence' and 'guidelines & information' the most frequent. Two factors were unique to dental studies: 'procedure possible' and 'treatment skills'. No factor related only to LMICs. CONCLUSIONS A comprehensive list of factors associated with antibiotic prescribing to adults with acute conditions in primary care settings around the world has been collated and should assist theory-informed design of new context-specific stewardship interventions.
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Affiliation(s)
- W Thompson
- University of Leeds, School of Dentistry, Leeds, UK
| | - S Tonkin-Crine
- University of Oxford, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK
| | - S H Pavitt
- University of Leeds, School of Dentistry, Leeds, UK
| | - R R C McEachan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - V R Aggarwal
- University of Leeds, School of Dentistry, Leeds, UK
| | - J A T Sandoe
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Nair M, Tripathi S, Mazumdar S, Mahajan R, Harshana A, Pereira A, Jimenez C, Halder D, Burza S. "Without antibiotics, I cannot treat": A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India. PLoS One 2019; 14:e0219002. [PMID: 31247028 PMCID: PMC6597109 DOI: 10.1371/journal.pone.0219002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Misuse of antibiotics is a well-known driver of antibiotic resistance. Given the decentralized model of the Indian health system and the shortage of allopathic doctors in rural areas, a wide variety of healthcare providers cater to the needs of patients in urban and rural settings. This qualitative study explores the drivers of antibiotic use among formal and informal healthcare providers as well as patients accessing care at primary health centers across Paschim Bardhaman district in West Bengal. MATERIALS AND METHODS We conducted 28 semi-structured, in-depth interviews with four groups of healthcare providers (allopathic doctors, informal health providers, nurses, and pharmacy shopkeepers) as well as patients accessing care at primary health centers and hospitals across Paschim Bardhaman district. Qualitative data was analyzed using the framework method in an inductive and deductive manner. RESULTS Our results indicate that patients demand antibiotics from healthcare providers and seek the fastest cure possible, which influences the prescription choices of healthcare providers, particularly informal health providers. Many allopathic doctors provide antibiotics without any clinical indication due to inconsistent follow up, lack of testing facilities, risk of secondary infections, and unhygienic living conditions. Pharmaceutical company representatives actively network with informal health providers and formal healthcare providers alike, and regularly visit providers even in remote areas to market newer antibiotics. Allopathic doctors and informal health providers frequently blame the other party for being responsible for antibiotic resistance, and yet both display interdependence in referring patients to one another. CONCLUSIONS A holistic approach to curbing antibiotic resistance in West Bengal and other parts of India should focus on strengthening the capacity of the existing public health system to deliver on its promises, improving patient education and counseling, and including informal providers and pharmaceutical company representatives in community-level antibiotic stewardship efforts.
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Affiliation(s)
- Mohit Nair
- Medecins Sans Frontieres, New Delhi, India
| | | | - Sumit Mazumdar
- Centre for Health Economics, University of York, York, United Kingdom
| | | | | | | | | | | | - Sakib Burza
- Medecins Sans Frontieres, New Delhi, India
- * E-mail:
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Knowledge, attitudes, and practices related to antibiotic use in Paschim Bardhaman District: A survey of healthcare providers in West Bengal, India. PLoS One 2019; 14:e0217818. [PMID: 31150515 PMCID: PMC6544287 DOI: 10.1371/journal.pone.0217818] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Antibiotic misuse is widespread and contributes to antibiotic resistance, especially in less regulated health systems such as India. Although informal providers are involved with substantial segments of primary healthcare, their level of knowledge, attitudes, and practices is not well documented in the literature. Objectives This quantitative study systematically examines the knowledge, attitudes, and practices of informal and formal providers with respect to antibiotic use. Methods We surveyed a convenience sample of 384 participants (96 allopathic doctors, 96 nurses, 96 informal providers, and 96 pharmacy shopkeepers) over a period of 8 weeks from December to February using a validated questionnaire developed in Italy. Our team created an equivalent, composite KAP score for each respondent in the survey, which was subsequently compared between providers. We then performed a multivariate logistic regression analysis to estimate the odds of having a low composite score (<80) based on occupation by comparing allopathic doctors (referent category) with all other study participants. The model was adjusted for age (included as a continuous variable) and gender. Results Doctors scored highest in questions assessing knowledge (77.3%) and attitudes (87.3%), but performed poorly in practices (67.6%). Many doctors knew that antibiotics were not indicated for viral infections, but over 87% (n = 82) reported prescribing them in this situation. Nurses, pharmacy shopkeepers, and informal providers were more likely to perform poorly on the survey compared to allopathic doctors (OR: 10.4, 95% CI 5.4, 20.0, p<0.01). 30.8% (n = 118) of all providers relied on pharmaceutical company representatives as a major source of information about antibiotics. Conclusions Our findings indicate poor knowledge and awareness of antibiotic use and functions among informal health providers, and dissonance between knowledge and practices among allopathic doctors. The nexus between allopathic doctors, pharmaceutical company representatives, and informal health providers present promising avenues for future research and intervention.
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Physician perception of patients’ requests for medications in Yemen. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guan X, Tian Y, Song J, Zhu D, Shi L. Effect of physicians' knowledge on antibiotics rational use in China's county hospitals. Soc Sci Med 2019; 224:149-155. [PMID: 30784853 DOI: 10.1016/j.socscimed.2019.01.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/19/2018] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Irrational prescriptions of antibiotics have received significant international attention. In China, previous studies have described the impact of physicians' knowledge on antibiotic use, however, empirical studies of the relationship between physician knowledge and antibiotic prescription behavior are limited. OBJECTIVE This study aimed to examine physicians' knowledge of antibiotic and explore the effects of physicians' knowledge on rational antibiotic use in county hospitals in China. METHOD A sample of 360 physicians from 60 county hospitals was designed. Questionnaires were used to evaluate the physicians' knowledge of antibiotic use. We assessed the rationality of antibiotic use by evaluating the physicians' prescriptions. Antibiotic prescriptions were evaluated according to percentage of encounters where an antibiotic was prescribed, percentage of encounters with combined antibiotics prescriptions and the percentage of encounters treated in accordance with a standard treatment guideline. General linear model (GLM) was performed to analyze the factors influencing rational antibiotic use. RESULT A total of 58,512 valid antibiotic prescriptions by 280 physicians were included in the analysis. The average score of 62.2 The average percentage of encounters with an antibiotic and combined antibiotics prescribed were 70.1% and 40.2%, respectively. 37.9% of antibiotic prescriptions were in accordance with standard treatment guidelines. GLM analysis showed that physicians with scores exceeding 80 used less antibiotics than those who score lower than 60 (P = 0.005). The percentage of combination antibiotic therapies of those who achieved scores above 80 or in the range from 60 to 80 were lower than that of physicians in low score groups (P = 0.002, P = 0.025), and higher compliance with the guidelines than those received a score below 60 (P = 0.001, P = 0.047). CONCLUSION Results confirmed that physicians' knowledge significantly influences rational antibiotic use. Targeted training programs to promote physicians' knowledge of antibiotic especially at county hospitals in the western regions of China are urgently needed.
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Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Ye Tian
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jiafang Song
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dawei Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration, Peking University, Beijing, China.
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Wilkinson A, Ebata A, MacGregor H. Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems. Antibiotics (Basel) 2018; 8:antibiotics8010002. [PMID: 30583566 PMCID: PMC6466578 DOI: 10.3390/antibiotics8010002] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 01/11/2023] Open
Abstract
This review identifies evidence on supply-side interventions to change the practices of antibiotic prescribers and gatekeepers in low- and middle-income countries (LMICs). A total of 102 studies met the inclusion criteria, of which 70 studies evaluated interventions and 32 provided insight into prescribing contexts. All intervention studies were from human healthcare settings, none were from animal health. Only one context study examined antibiotic use in animal health. The evidence base is uneven, with the strongest evidence on knowledge and stewardship interventions. The review found that multiplex interventions that combine different strategies to influence behaviour tend to have a higher success rate than interventions based on single strategies. Evidence on prescribing contexts highlights interacting influences including health system quality, education, perceptions of patient demand, bureaucratic processes, profit, competition, and cultures of care. Most interventions took place within one health setting. Very few studies targeted interventions across different kinds of providers and settings. Interventions in hospitals were the most commonly evaluated. There is much less evidence on private and informal private providers who play a major role in drug distribution in LMICs. There were no interventions involving drug detailers or the pharmaceutical companies despite their prominent role in the contextual studies.
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Affiliation(s)
- Annie Wilkinson
- Institute of Development Studies, University of Sussex, Brighton BN1 NRE, UK.
| | - Ayako Ebata
- Institute of Development Studies, University of Sussex, Brighton BN1 NRE, UK.
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton BN1 NRE, UK.
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Labi AK, Obeng-Nkrumah N, Sunkwa-Mills G, Bediako-Bowan A, Akufo C, Bjerrum S, Owusu E, Enweronu-Laryea C, Opintan JA, Kurtzhals JAL, Newman MJ. Antibiotic prescribing in paediatric inpatients in Ghana: a multi-centre point prevalence survey. BMC Pediatr 2018; 18:391. [PMID: 30572851 PMCID: PMC6302438 DOI: 10.1186/s12887-018-1367-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/05/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Excessive and inappropriate use of antibiotics in hospitalised patients contributes to the development and spread of antibiotic resistance. Implementing a stewardship programme to curb the problem requires information on antibiotic use. This study describes a multicentre point prevalence of antibiotic use among paediatric inpatients in Ghana. METHODS Data were extracted from a multicentre point prevalence survey of hospital acquired infections in Ghana. Data were collected between September 2016 and December 2016 from ten hospitals through inpatient folder and chart reviews using European Centre for Disease Control (ECDC) adapted data collection instrument. From each site, data were collected within a 12-h period (8 am to 8 pm) by a primary team of research investigators and a select group of health professionals from each participating hospital. RESULTS Among 716 paediatric inpatients, 506 (70.6%; 95% confidence interval (CI): 67.2 to 74.0%) were on antibiotics. A significant proportion of antibiotics (82.9%) was prescribed for infants compared to neonates (63.9%) and adolescents (60.0%). The majority of patients (n = 251, 49.6%) were prescribed two antibiotics at the time of the survey. The top five classes of antibiotics prescribed were third generation cephalosporins (n = 154, 18.5%) aminoglycosides (n = 149, 17.9%), second generation cephalosporins (n = 103,12.4%), beta lactam resistant penicillins (n = 83, 10.0%) and nitroimidazoles (n = 82, 9.9%). The majority of antibiotics (n = 508, 61.0%) were prescribed for community acquired infections. The top three agents for managing community acquired infections were ceftriaxone (n = 97, 19.1%), gentamicin (n = 85, 16.7%) and cefuroxime (n = 73, 14.4%). CONCLUSION This study points to high use of antibiotics among paediatric inpatients in Ghana. Cephalosporin use may offer an important target for reduction through antibiotic stewardship programmes.
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Affiliation(s)
- Appiah-Korang Labi
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Microbiology, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences College of Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Gifty Sunkwa-Mills
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box 143, Accra, Korle-Bu, Ghana
| | - Antoinette Bediako-Bowan
- Department of Animal Science, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P. O. Box 4326, Accra, Ghana
- Department of Surgery, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Christiana Akufo
- Institutional Care Division, Ghana Health Service, PMB Ministries-Accra, Accra, Ghana
| | - Stephanie Bjerrum
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences College of Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Christabel Enweronu-Laryea
- Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O.Box 4326, Accra, Ghana
| | - Japheth Awuletey Opintan
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box 143, Accra, Korle-Bu, Ghana
| | - Jorgen Anders Lindholm Kurtzhals
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Mercy Jemima Newman
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box 143, Accra, Korle-Bu, Ghana
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Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health 2018; 6:370. [PMID: 30619809 PMCID: PMC6304439 DOI: 10.3389/fpubh.2018.00370] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify determinants of self-medication with antibiotics via a systematic literature review. Methods: A comprehensive search on determinants of self-medication with antibiotics in the ambulatory care was conducted in PubMed, Scopus, and Embase for studies published between January 2000 and March 2017. There was no limit on the language nor on the type of study. The search was restricted to European and Anglo-Saxon countries. Pairs of reviewers independently screened the abstracts and full texts and performed a quality assessment. Results: From the initial 664 abstracts, 54 publications that included 44 countries were retrieved of which most identified patient related determinants. Important determinants include storing antibiotics at home, poor access to healthcare, and having the intention to self-medicate. Healthcare professionals contribute to the practice of self-medication when catering for demanding and socially vulnerable patients. Healthcare system related determinants include dispensing antibiotics in whole packages and the lack of enforcement of medicine regulations. For some determinants (e.g., patients' age) contradictory results were found. Conclusion: Self-medication with antibiotics is driven by a variety of determinants on the patient, healthcare professional, and system levels. Policy makers should recognise the complexity of self-medication in order to develop multifaceted interventions that target healthcare professionals and patients simultaneously.
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Affiliation(s)
- Dominique Lescure
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - John Paget
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Francois Schellevis
- Department of General Practice and Elderly Care Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Liset van Dijk
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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68
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Adisa R, Orherhe OM, Fakeye TO. Evaluation of antibiotic prescriptions and use in under-five children in Ibadan, SouthWestern Nigeria. Afr Health Sci 2018; 18:1189-1201. [PMID: 30766585 PMCID: PMC6354862 DOI: 10.4314/ahs.v18i4.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Irrational antibiotic prescriptions for children is a global concern requiring periodic evaluation and monitoring. Objectives To assess appropriateness of antibiotic prescribing for under-five children, as well as evaluating mothers' usage of antibiotics for their under-five and reason(s) for use. Method Cross-sectional review of out-patient case-notes of under-five using principles of antibiotic prescribing and a questionnaire-guided interaction with under-five mothers. Results Nearly all (445;98.9%) antibiotic prescriptions were based on signs and symptoms indicative of bacterial infection. Only 3(0.7%) had the initial antibiotic regimen modified. Nine (2.0%) had documented evidence of sensitivity test requested before antibiotic prescribing. Presence of infection or need for antibiotic therapy was established in 190(42.2%). Majority (324;72.0%) of mothers had administered antibiotics to their under-five. Of these, 157(48.5%) were prescribed by physicians and 79(24.4%) were self-recommended. Educational status of mothers significantly influenced antibiotic usage. Conclusion Antibiotic prescriptions for under-fives was largely based on symptoms indicative of bacterial infections, thereby corroborating the widespread empirical antibiotic prescribing. Considerable number of mothers engaged in self-recommendation of antibiotics for their under-fives. Thus, there is a need for continuous enlightenment of prescribers and mothers on rational use of antibiotics, while microbiological confirmation of clinical diagnosis is encouraged for evidence-based antibiotic prescribing.
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Affiliation(s)
- Rasaq Adisa
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ochuko M Orherhe
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Titilayo O Fakeye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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69
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Sakeena M, Bennett AA, McLachlan AJ. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. Int J Antimicrob Agents 2018; 52:771-782. [DOI: 10.1016/j.ijantimicag.2018.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
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70
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Dehn Lunn A. Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India. BMJ Open Qual 2018; 7:e000217. [PMID: 30555928 PMCID: PMC6267302 DOI: 10.1136/bmjoq-2017-000217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 12/30/2022] Open
Abstract
Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.
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71
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Kotwani A, Joshi PC, Jhamb U, Holloway K. Prescriber and dispenser perceptions about antibiotic use in acute uncomplicated childhood diarrhea and upper respiratory tract infection in New Delhi: Qualitative study. Indian J Pharmacol 2018; 49:419-431. [PMID: 29674796 PMCID: PMC5892023 DOI: 10.4103/ijp.ijp_508_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior. MATERIALS AND METHODS: Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8–12 participants and lasted 2 h. Furthermore, 22 individual face-to-face semi-structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done. RESULTS: All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow-up and in addition for GDs, workload, no diagnostic facility, and pressure to use near-expiry medicines. Knowledge was gained through self-experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations. CONCLUSIONS: A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use.
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Affiliation(s)
- Anita Kotwani
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, New Delhi, India
| | - P C Joshi
- Department of Anthropology, University of Delhi, New Delhi, India
| | - Urmila Jhamb
- Department of Paediatrics, L. N. Hospital, New Delhi, India
| | - Kathleen Holloway
- Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India.,Department of Health and Nutrition, Institute of Development Studies, University of Sussex, Brighton, UK
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72
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Lee CHJ, Norris P, Duck IM, Sibley CG. Demographic and Psychological Factors Associated with Feelings of Antibiotic Entitlement in New Zealand. Antibiotics (Basel) 2018; 7:E82. [PMID: 30189653 PMCID: PMC6165134 DOI: 10.3390/antibiotics7030082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/21/2022] Open
Abstract
Patients' expectations of being prescribed antibiotics can have an important influence on inappropriate prescribing. Therefore, it is important to understand the drivers of patients' antibiotic expectations. The 2015/16 New Zealand Attitudes and Values Study measured sense of entitlement to antibiotics in a nationally representative sample of New Zealanders (n = 13,484). Participants were asked to rate their agreement with the statement "If I go to my doctor/GP with a minor illness (e.g., sore throat, cough, runny nose, etc.), I think that I should be prescribed antibiotics by default." Eighty percent of participants showed low feelings of antibiotic entitlement, while 18.5% exhibited moderate and 3.7% high feelings of entitlement. People of ethnic minority, lower socio-economic status, and with diabetes expressed higher expectations of being prescribed antibiotics. This may be partially based on a higher risk of rheumatic fever or other complications. Men, religious people, those with lower educational attainment and self-rated health, but greater psychological distress and feelings of control over their health exhibited higher feelings of antibiotic entitlement. Those high on Extraversion, Conscientiousness, and Narcissism, but low on Agreeableness and Openness, also showed greater feelings of entitlement. Our findings help identify key characteristics of those more likely to express inappropriate expectations of antibiotic prescription.
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Affiliation(s)
- Carol H J Lee
- School of Psychology, University of Auckland, Auckland 1010, New Zealand.
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin 9016, New Zealand.
| | | | - Chris G Sibley
- School of Psychology, University of Auckland, Auckland 1010, New Zealand.
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73
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Urbiztondo I, de Oliveira SM, Hernández-Flores N, Caballero L, Suarez MA, Bjerrum L, Cordoba G. General Practitioners' Views on the Acceptability and Applicability of Using Quality Indicators as an Intervention to Reduce Unnecessary Prescription of Antibiotics in Four South American Countries. Antibiotics (Basel) 2018; 7:antibiotics7030057. [PMID: 29976893 PMCID: PMC6163160 DOI: 10.3390/antibiotics7030057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022] Open
Abstract
As part of the quality improvement program “Health Alliance for Prudent Prescribing, Yield And Use of anti-microbial Drugs In the Treatment of respiratory tract infections” (HAPPY AUDIT) South America, we planned to implement an intervention based on the use of quality indicators as a means to influence General Practitioners’ (GPs) prescribing decision. Knowledge on the acceptability and applicability of an intervention is crucial to decide whether the intervention is suitable and will achieve the expected outcomes. This study explores GPs’ views about the acceptability and applicability of using quality indicators as an intervention to influence their prescribing decision in patients with suspected Respiratory Tract Infections (RTIs) across four countries in South-America. In March 2015, GPs that were participating in HAPPY AUDIT South America were invited to participate in focus groups. A discussion guide covering the domains acceptability and applicability was used. Data was analyzed through systematic text condensation with an inductive approach. 171 GPs were invited and 48% participated. Acceptability ranged from totally acceptable to slightly acceptable. This spectrum of GPs views on acceptability was influenced by themes concerning applicability. In conclusion, there is a positive attitude towards the use of quality indicators. Nonetheless, applicability challenges have to be taken into consideration and solved if we are to achieve a large effect with the implementation of this intervention.
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Affiliation(s)
- Inés Urbiztondo
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
| | - Sandi Michele de Oliveira
- The Institute for English, Germanic and Romance Studies, University of Copenhagen, 2300 Copenhagen, Denmark.
| | - Nieves Hernández-Flores
- The Institute for English, Germanic and Romance Studies, University of Copenhagen, 2300 Copenhagen, Denmark.
| | - Lidia Caballero
- Dr. Pedro Baliña Hospital, Public Health Ministry, 3300 Posadas, Misiones, Argentina.
| | | | - Lars Bjerrum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
| | - Gloria Cordoba
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
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Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography. Br J Gen Pract 2018; 68:e633-e645. [PMID: 29914880 DOI: 10.3399/bjgp18x697889] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/15/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Reducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections. AIM The authors sought to update a 2011 qualitative synthesis of GPs' experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists). DESIGN AND SETTING Systematic review and meta-ethnography of qualitative studies. METHOD A systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed. RESULTS In all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, 'supportive aids', source of distress, and unnecessary). CONCLUSION Contrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs' varying roles and changing priorities.
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75
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Chem ED, Anong DN, Akoachere JFKT. Prescribing patterns and associated factors of antibiotic prescription in primary health care facilities of Kumbo East and Kumbo West Health Districts, North West Cameroon. PLoS One 2018; 13:e0193353. [PMID: 29505584 PMCID: PMC5837085 DOI: 10.1371/journal.pone.0193353] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
Background Inappropriate use of antibiotics is a global public health challenge and has been associated with antibiotic resistance. WHO reports show that efforts to promote rational antibiotic use in developing countries are poor. With the growing number of infections with antibiotic resistant bacteria, rational drug use becomes imperative and studies that promote rational drug use are highly necessary. Considering this, we investigated prescribing patterns and predictors of antibiotic prescription in primary health care facilities in Kumbo East (KE) and Kumbo West (KW) health districts in North West Cameroon, to contribute data which could influence policy on antibiotic use. Methods and findings A cross sectional retrospective study was conducted from April 2014 to April 2015 in 26 randomly selected primary care facilities. Questionnaires were administered to 59 antibiotic prescribers to determine factors that predict antibiotic prescribing. Data on antibiotic prescription were collected by review of consultation registers. Prescription rates and demographics, prescriber and institution factors were analyzed using ANOVA. The best predictor of prescription was determined using multiple linear regression analysis. Results A total of 30,096 prescriptions were reviewed. Overall antibiotic prescription rate was 36.71%, with a mean of 1.14 antibiotics prescribed per patient. Amoxicillin was the most prescribed (29.9%). The most prevalent indications for prescribing were respiratory tract infections (21.27%). All antibiotics prescribed were broad-spectrum. Antibiotics were prescribed for patients with malaria and also in situations where diagnosis was uncertain. Prescribing by generic name was 98.36% while 99.87% was from Essential Drug List. Use of laboratory results, patient turnout and Performance Based Financing (PBF) were significantly associated with antibiotic prescribing rates (p < 0.05). PBF moderated prescribing. Conclusion There was misuse of antibiotics in primary care facilities in study area. We recommend all primary care health facilities in study area to be included in the PBF scheme and that prescribing should only be done by physicians as the have adequate training.
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Affiliation(s)
- Elvis Dzelamonyuy Chem
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Damian Nota Anong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
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Labi AK, Obeng-Nkrumah N, Bjerrum S, Aryee NAA, Ofori-Adjei YA, Yawson AE, Newman MJ. Physicians' knowledge, attitudes, and perceptions concerning antibiotic resistance: a survey in a Ghanaian tertiary care hospital. BMC Health Serv Res 2018; 18:126. [PMID: 29458432 PMCID: PMC5819203 DOI: 10.1186/s12913-018-2899-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/29/2018] [Indexed: 01/16/2023] Open
Abstract
Background Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians’ knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana. Methods We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives. Results The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE. Conclusions Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians. Electronic supplementary material The online version of this article (10.1186/s12913-018-2899-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Appiah-Korang Labi
- Department of Microbiology, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, P.O Box 143, Korle-Bu, Accra, Ghana.
| | - Stephanie Bjerrum
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Nii Armah Adu Aryee
- Department of Surgery, University of Ghana School of Medicine and Dentistry, P.O. Box 4326, Accra, Ghana
| | | | - Alfred E Yawson
- Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mercy J Newman
- Department of Medical Microbiology, School of Biomedical and Allied Sciences, P.O. Box KB, 143, Accra, Ghana
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Al-Qahtani MA, Amin HS, Al-Qahtani AA, Alshahrani AM, Alghamdi HA, Althwayee MS, Alzahrani AA. Self-medication with Antibiotics in a primary care setting in King Khalid University Hospital, Riyadh, Saudi Arabia. J Family Community Med 2018; 25:95-101. [PMID: 29922109 PMCID: PMC5958530 DOI: 10.4103/jfcm.jfcm_124_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES: The objectives of this study are to estimate the prevalence of self-medication with antibiotics in King Khalid University Hospital population and evaluate the factors affecting this behavior. MATERIALS AND METHODS: This was a cross-sectional study conducted at King Khalid university hospital from April to May 2016. A pretested self-administered questionnaire was handed to a random selection of 519 patients attending the primary care clinics . Data were entered into Microsoft Office Excel 2007 and sent to SPSS version 20 for analysis. Descriptive statistics and logistic regression were applied. RESULTS: The prevalence rate of self-medication with antibiotics was 40.8%. Older patients and males were most likely to use antibiotics without a prescription. The most common illnesses that made patients use antibiotics was upper respiratory tract infections (73.2%). Commercial pharmacies were the major source 82.8%. Only 27.8% patients consulted their physicians for the correct dosage . The previous experience with a similar illness (67.2%) and difficulty in obtaining medical help (29.3%) were the most common reasons for self-administration of antibiotics. Improved health condition (57.8%) was the main reason for stopping the use of antibiotics while lack of improvement in health status led to a shift to another antibiotic in 62.5% of the respondents. CONCLUSION: The prevalence of using antibiotics without a prescription is relatively high. Proper education of the public on the dangers of the misuse of antibiotics through the media might help to reduce this practice.
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Affiliation(s)
- Mohammed A Al-Qahtani
- Department of Family and Community Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hussein S Amin
- Department of Family and Community Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Al-Qahtani
- Department of Family and Community Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M Alshahrani
- Department of Family and Community Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hani A Alghamdi
- Department of Family and Community Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Musa S Althwayee
- Department of Family and Community Medicine, Prince Sultan Military Medical Center, Riyadh, Saudi Arabia
| | - Ahmed A Alzahrani
- Department of Family and Community Medicine, Prince Sultan Military Medical Center, Riyadh, Saudi Arabia
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Murshid MA, Mohaidin Z. A systematic review of the influence of medical representatives and promotional tools on prescribing. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-09-2016-0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine reported literature on the influence of medical representatives (MRs) and other promotional tools on drug prescribing behaviour, and to assess whether this effect is different in developed and developing countries.
Design/methodology/approach
A survey of the literature was conducted across online databases from 2000 to 2016. Eligible studies addressed MRs and other promotion tools used to influence drug prescribing in developed and developing countries.
Findings
A total of 40 reviewed studies met the inclusion requirements. In total, 22 of the studies were conducted in developed countries and 18 in developing countries. Out of ten studies that examined the influence of MRs on drug prescribing in developed countries, eight found a positive influence, one found only moderate and one finds no influence. Analogous results were found in developing countries. Six out of ten studies on the influence of MRs conducted in developing countries found a positive effect, three found only moderate effects, while one finds no influence. The influence of promotion tools on prescribing varied in developed countries, five found positive influence, four reported a small effect and one found negative influence. In developing countries, the size of effect also varied, five studies found positive influence of promotion tools on drug prescribing behaviour, five found a negligible or small effect, and one found no association. However, marked differences were observed between two sectors. In the developed countries, MRs are valued as a source of information and can have an effect on prescribing, while it is unreliable in developing countries. Sample drugs are more generally seen as an important promotional tool for prescribing in developed countries than developing countries.
Research limitations/implications
The results derived from this review are based on studies with varying methodological consistency. The review provides the crucial information that will be valuable to researchers working on comparative analysis of marketing efforts in developing and developed countries.
Originality/value
This paper is one of the few systematic reviews on the influence of MRs and other promotional tools on prescribing. It compares the influence of MRs and promotional efforts in both developed and developing countries.
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Libertin CR, Watson SH, Tillett WL, Peterson JH. Dramatic effects of a new antimicrobial stewardship program in a rural community hospital. Am J Infect Control 2017; 45:979-982. [PMID: 28526311 DOI: 10.1016/j.ajic.2017.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015). RESULTS The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only. CONCLUSIONS Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials.
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Thakolkaran N, Shetty AV, D’Souza NDR, Shetty AK. Antibiotic prescribing knowledge, attitudes, and practice among physicians in teaching hospitals in South India. J Family Med Prim Care 2017; 6:526-532. [PMID: 29417002 PMCID: PMC5787949 DOI: 10.4103/2249-4863.222057] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Antibiotic overuse is a major public health challenge worldwide. Data from India related to physician antibiotic prescribing patterns are limited. AIMS We assessed antibiotic prescribing knowledge, attitudes, and practices among physicians in Mangalore, South India. MATERIALS AND METHODS Using a cross-sectional descriptive study design, physicians at academic tertiary hospitals completed an anonymous on-site survey. The survey items incorporated Likert scales, and data were analyzed using SPSS version 15.0. RESULTS Of the 350 physicians approached using a convenient sampling method, 230 (66%) consented and interviewed. The physician's knowledge of resistance patterns of common bacteria was related to receiving periodic updates on resistance patterns of bacteria (P = 0.019) and participation in courses on antibiotics (P = 0.026). Individuals with more number of years of experience (mean of 11 years) were less likely to justify antibiotic use for uncomplicated bronchitis (P = 0.015) and acute gastroenteritis (P = 0.001). Most respondents (n = 204, 89%) believed that physicians overprescribed antibiotics in routine clinical practice. Forty-five percent (n = 104) stated that their hospitals did not have an infection control policy in place. CONCLUSIONS This study provides some understanding of physician's antibiotic prescribing patterns from teaching hospitals in India. Judicious antimicrobial use through educational and antimicrobial stewardship programs remains critical to control the spread of antibiotic resistance.
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Affiliation(s)
- Nimmy Thakolkaran
- Department of Microbiology, K.S. Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India
| | - A. Veena Shetty
- Department of Microbiology, K.S. Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India
| | - Neevan D. R. D’Souza
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
| | - Avinash K. Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
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81
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Murshid MA, Mohaidin Z. Models and theories of prescribing decisions: A review and suggested a new model. Pharm Pract (Granada) 2017; 15:990. [PMID: 28690701 PMCID: PMC5499356 DOI: 10.18549/pharmpract.2017.02.990] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/25/2017] [Indexed: 11/14/2022] Open
Abstract
To date, research on the prescribing decisions of physician lacks sound theoretical foundations. In fact, drug prescribing by doctors is a complex phenomenon influenced by various factors. Most of the existing studies in the area of drug prescription explain the process of decision-making by physicians via the exploratory approach rather than theoretical. Therefore, this review is an attempt to suggest a value conceptual model that explains the theoretical linkages existing between marketing efforts, patient and pharmacist and physician decision to prescribe the drugs. The paper follows an inclusive review approach and applies the previous theoretical models of prescribing behaviour to identify the relational factors. More specifically, the report identifies and uses several valuable perspectives such as the ‘persuasion theory - elaboration likelihood model’, the stimuli–response marketing model’, the ‘agency theory’, the theory of planned behaviour,’ and ‘social power theory,’ in developing an innovative conceptual paradigm. Based on the combination of existing methods and previous models, this paper suggests a new conceptual model of the physician decision-making process. This unique model has the potential for use in further research.
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Affiliation(s)
- Mohsen Ali Murshid
- Graduate School of Business, Universiti Sains Malaysia. Penang, (Malaysia).
| | - Zurina Mohaidin
- PhD. Graduate School of Business, Universiti Sains Malaysia. Penang, (Malaysia).
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A Systematic Review of Main Factors leading to Irrational Prescription of Medicine. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2017. [DOI: 10.5812/ijpbs.10242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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83
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Lee TH, Wong JG, Lye DC, Chen MI, Loh VW, Leo YS, Lee LK, Chow AL. Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis. Br J Gen Pract 2017; 67:e168-e177. [PMID: 28093423 PMCID: PMC5325658 DOI: 10.3399/bjgp17x688885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/30/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Acute upper respiratory infections (AURI) are the leading causes of antibiotic prescribing in primary care although antibiotics are often not indicated. AIM To gain an understanding of the knowledge, attitudes, and practices (KAP) of GPs in Singapore and the associated latent factors to guide the implementation of an effective programme to reduce antibiotic use in primary care. DESIGN AND SETTING An anonymous survey on the KAP of antibiotic use in AURI of GPs in Singapore. METHOD KAP survey questionnaires were posted to all GPs from a database. To ascertain the latent factors affecting prescribing patterns, exploratory factor analysis was performed. RESULTS Among 427 responses, 351 (82.2%) were from GPs working in private practice. It was found that 58.4% of GPs in the private versus 72.4% of those in the public sector recognised that >80% of AURIs were caused by viruses (P = 0.02). The majority of GPs (353/427; 82.7%) felt that antibiotics were overprescribed in primary care. Significant factors associated with low antibiotic prescribing were good medical knowledge and clinical competency (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] = 2.4 to 4.3), good clinical practice (aOR 2.7 [95% CI = 2.0 to 3.6]), availability of diagnostic tests (aOR 1.4 [95% CI = 1.1 to 1.8]), and desire to improve clinical practice (aOR 1.5 [95% CI = 1.2 to 1.9]). The conservative practice of giving antibiotics 'to be on the safe side' is significantly less likely to be associated with low antibiotic prescribing (aOR 0.7 [95% CI = 0.5 to 0.9]). CONCLUSION This is the first KAP survey on antibiotic prescribing for AURI among GPs in Singapore. With the latent factors identified, future interventions should be directed at addressing these factors to reduce inappropriate antibiotic prescribing.
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Affiliation(s)
- Tau-Hong Lee
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Joshua Gx Wong
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - David Cb Lye
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital; Yong Loo Lin School of Medicine, Singapore
| | - Mark Ic Chen
- Saw Swee Hock School of Public Health, National University of Singapore; Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Victor Wk Loh
- Division of Family Medicine, Department of Medicine, University Medicine Cluster, National University Hospital System, Singapore
| | - Yee-Sin Leo
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Linda K Lee
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Angela Lp Chow
- Saw Swee Hock School of Public Health, National University of Singapore; Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
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Om C, Daily F, Vlieghe E, McLaughlin JC, McLaws ML. "If it's a broad spectrum, it can shoot better": inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control 2016; 5:58. [PMID: 28031814 PMCID: PMC5170903 DOI: 10.1186/s13756-016-0159-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Cambodia is affected by antibiotic resistance but interventions to reduce the level of resistance require knowledge of the phenomena that lead to inappropriate prescribing. We interviewed physicians working in public hospitals to explore the drivers of inappropriate antibiotic prescribing. Methods Hospitals participating in a knowledge, attitudes and practices survey prior to this study were purposively selected and physicians were randomly recruited to participate in focus group discussions. Nvivo version 10 was used to inductively code the qualitative transcripts and manage thematic data analysis. Results Inappropriate antibiotic prescribing was a common practice and driven by seven factors: prescribing habit, limited diagnostic capacity, lack of microbiology evidence, non-evidence-based clinical guidelines, perceived patient demand, poor hygiene and infection control, and perceived bacterial resistance to narrow spectrum antibiotics.“Every day, doctors are not performing appropriately. We have made lots of mistakes with our antibiotic prescribing.” When a patient’s clinical condition was not responsive to empiric treatment, physicians changed to a broader spectrum antibiotic and microbiology services were sought only after failure of a treatment with a broad-spectrum antibiotic. This habitual empirical prescribing was a common practice regardless of microbiology service accessibility. Poor hygiene and infection control practices were commonly described as reasons for ‘preventive’ prescribing with full course of antibiotics while perception of bacterial resistance to narrow-spectrum antibiotics due to unrestricted access in the community resulted in unnecessary prescribing of broad spectrum antibiotics in private practices. Conclusions The practice of prescribing antibiotics by Cambodian physicians is inappropriate and based on prescribing habit rather than microbiology evidence. Improvement in prescribing practice is unlikely to occur unless an education program for physicians focuses on the diagnostic capacity and usefulness of microbiology services. In parallel, hygiene and infection control in hospital must be improved, evidence-based antibiotic prescribing guidelines must be developed, and access to antibiotics in community must be restricted.
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Affiliation(s)
- Chhorvoin Om
- School of Public Health and Community Medicine, UNSW Medicine, UNSW, Level 3 Samuels Building, Sydney, NSW 2052 Australia
| | - Frances Daily
- Diagnostic Microbiology Development Program, # 23 (First Floor), Street 310, BKK 1, Khan Chamcar Morn, Phnom Penh, Cambodia
| | - Erika Vlieghe
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000 Belgium
| | - James C McLaughlin
- Diagnostic Microbiology Development Program, # 23 (First Floor), Street 310, BKK 1, Khan Chamcar Morn, Phnom Penh, Cambodia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, UNSW, Level 3 Samuels Building, Sydney, NSW 2052 Australia
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Murshid MA, Mohaidin Z, Yen Nee G. The influence patient’s characteristics “requests and expectations” on physician prescribing behavior. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2016. [DOI: 10.1108/ijphm-01-2016-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The role of patient’s characteristics in the prescribing decision of physicians comprises two major constructs: drug request and expectations. The purpose of this paper was to examine the existing literature on patient characteristics and then explore the circumstances that reinforce the connection between patient characteristics (drug requests and expectations) and physician prescribing decision.
Design/methodology/approach
A survey of the literature was carried out across online databases from 1994 to 2015, and 25 reviewed articles were identified. The influence of patient factors on physician prescribing decisions was identified in the articles. A conceptual model to investigate the patient characteristics that influence physicians’ prescribing decision was the developed.
Findings
There have been numerous studies on the effect of patient characteristics on physician prescription decision. Some studies discovered patient’s request for drug and expectations strongly influence physicians’ prescribing decision, whereas others found only minor or no relation. To resolve this ambiguity, there is a need to precisely understand how patient factors affect prescribing decisions of physicians, under different contexts and conditions. This review contends that contextual variables – drug characteristics, drug cost/benefits ratio and physician habit persistence – are determining factors in this debate.
Research limitations/implications
The study recommends further studies on the influence of each factor on physician prescribing behaviour and an evaluation of the proposed model and moderating variables.
Originality/value
This paper is the first significant step towards recognizing contextual variables that may moderate the relationship between a patient’s drug request and expectations and prescribing behaviour. This research contributes to resolving the debate on the ways patient factors affect prescribing behaviour.
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Thillaivanam S, Amin AM, Gopalakrishnan S, Ibrahim B. The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward. Pediatr Res 2016; 80:516-20. [PMID: 27331353 DOI: 10.1038/pr.2016.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/01/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia. METHOD This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation. RESULTS Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to McIsaac rule criteria was 45% before implementation of the McIsaac rule, but improved to 67.9% (P = 0.0005) after implementation. DISCUSSION The McIsaac rule is an effective tool for the management of sore throat in children in Malaysia.
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Affiliation(s)
| | - Arwa M Amin
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Minden, Pulau Pinang, Malaysia
| | | | - Baharudin Ibrahim
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Minden, Pulau Pinang, Malaysia
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Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015). BMC Public Health 2016; 16:724. [PMID: 27545670 PMCID: PMC4993007 DOI: 10.1186/s12889-016-3428-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.
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Affiliation(s)
| | - Petra Brhlikova
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Allyson M Pollock
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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Zhang Z, Zhan X, Zhou H, Sun F, Zhang H, Zwarenstein M, Liu Q, Li Y, Yan W. Antibiotic prescribing of village doctors for children under 15 years with upper respiratory tract infections in rural China: A qualitative study. Medicine (Baltimore) 2016; 95:e3803. [PMID: 27281082 PMCID: PMC4907660 DOI: 10.1097/md.0000000000003803] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to explore the knowledge, attitudes, and practices of village doctors regarding the prescribing of antibiotics for children under 15 years with upper respiratory tract infections (URTIs) in rural China. Twelve focus group discussions (FGDs) were conducted in Xianning, a prefecture-level city in rural China, during December 2014. We conducted 6 FGDs with 35 village doctors, 3 with 13 primary caregivers (11 parents), and 3 with 17 directors of township hospitals, county-level health bureaus, county-level Centers for Disease Control and Prevention, or county-level Chinese Food and Drug Administration offices. Audio records of the interviews were transcribed verbatim and analyzed using the thematic analysis approach. Participants believed that unnecessary antibiotic prescribing for children under 15 years with The occurrence of URTIs was a problem in village clinics in rural China. The discussions revealed that most of the village doctors had inadequate knowledge and misconceptions about antibiotic use, which was an important factor in the unnecessary prescribing. Village doctors and directors reported that the doctors' fear of complications, the primary caregivers' pressure for antibiotic treatment, and the financial considerations of patient retention were the main factors influencing the decision to prescribe antibiotics. Most of the primary caregivers insisted on antibiotics, even when the village doctors were reluctant to prescribe them, and they preferred to go to see those village doctors who prescribed antibiotics. The interviewees also gave their opinions on what would be the most effective measures for optimizing antibiotic prescriptions; these included educational/training campaigns, strict regulations on antibiotic prescription, and improved supervision. Findings emphasized the need to improve the dissemination of information and training/education, and implement legislation on the rational use of antibiotics. And it also provided helpful information to guide the design of more effective interventions to promote prudent antibiotic use and good antimicrobial stewardship.
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Affiliation(s)
- Zhixia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Xingxin Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Hongjun Zhou
- Xianning Center for Disease Control and Prevention, Xianning, P.R. China
| | - Fang Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Heng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Xianning Center for Disease Control and Prevention, Xianning, P.R. China
| | - Merrick Zwarenstein
- Schulich School of Medicine & Dentistry Western University, Richmond, London, UK
| | - Qian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yingxue Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Weirong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- ∗Correspondence: Weirong Yan, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, Hubei, P.R. China (e-mail: )
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Teixeira Rodrigues A, Ferreira M, Piñeiro-Lamas M, Falcão A, Figueiras A, Herdeiro MT. Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal. Curr Med Res Opin 2016; 32:949-57. [PMID: 26878083 DOI: 10.1185/03007995.2016.1154520] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use. Methods A 3 year cohort study including all primary-care physicians working in Portugal's Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians' attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we've calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models. Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16-0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94-1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97-0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31-3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01-1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10-3.06]). Conclusions The above results serve to emphasize workload, working at emergency departments and physicians' attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and economic outcomes of antibiotic use. Key limitations of the study included the difficulty of results extrapolation and the limitations of the stratification method based on the antibiotic prescribing quality indicators.
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Affiliation(s)
- António Teixeira Rodrigues
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
- b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal
| | - Mónica Ferreira
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
| | - Maria Piñeiro-Lamas
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain
| | - Amílcar Falcão
- b Faculty of Pharmacy , University of Coimbra (Faculdade de Farmácia da Universidade de Coimbra - FFUC) , Coimbra , Portugal
- d Centre for Neuroscience and Cell Biology, University of Coimbra (CNC/UC) , Coimbra , Portugal
| | - Adolfo Figueiras
- c Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP) , Santiago de Compostela , Spain
- e University of Santiago de Compostela , Santiago de Compostela , Spain
| | - Maria T Herdeiro
- a Department of Medical Sciences and Institute for Biomedicine - iBiMED , University of Aveiro , Aveiro , Portugal
- f CESPU, IINFACTS, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde , Gandra , Portugal
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90
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Attard Pizzuto M, Camilleri L, Serracino-Inglott A, Azzopardi LM. Practices and perceptions of medical practitioners on potential antibiotic prescribing by pharmacists. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2016. [DOI: 10.1111/jphs.12135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Liberato Camilleri
- Department of Statistics and Operations Research; University of Malta; Msida MSD 2080 Malta
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Premanandh J, Samara BS, Mazen AN. Race Against Antimicrobial Resistance Requires Coordinated Action - An Overview. Front Microbiol 2016; 6:1536. [PMID: 26869998 PMCID: PMC4736432 DOI: 10.3389/fmicb.2015.01536] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/21/2015] [Indexed: 01/21/2023] Open
Abstract
Resistance developed by microbes is challenging success stories of treatment of infectious diseases with anti-microbials. Developing new antimicrobials against these resistant organisms does not progress at the same speed. In an effort to address this key issue, this work overviews the role of different stakeholders and discusses preventative and control measures for effective management of available resources. Roles and concerns of physicians, pharmacists and the public are also discussed. More than anything, this situation requires immediate action to establish antimicrobial stewardship program, control over the counter sale and promote public awareness. The paper also confronts the idea of curbing the use of antimicrobials using mass media, while detailing the consequences of non-therapeutic use. The role of policy makers in taking global action is essential to establishing authority or agency for formulating national guidelines and regulations for prudently using antimicrobials. To do this, this paper recommend the establishment of a global fund. In conclusion, the race against resistance is a collective responsibility requiring coordinated action at local, national, regional and international levels to ensure sustained utilization of antimicrobials.
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Affiliation(s)
- J Premanandh
- Central Testing Laboratories, Quality and Conformity Council Abu Dhabi, UAE
| | - B S Samara
- Central Testing Laboratories, Quality and Conformity Council Abu Dhabi, UAE
| | - A N Mazen
- Central Testing Laboratories, Quality and Conformity Council Abu Dhabi, UAE
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Mendelson M, Røttingen JA, Gopinathan U, Hamer DH, Wertheim H, Basnyat B, Butler C, Tomson G, Balasegaram M. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet 2016; 387:188-98. [PMID: 26603919 DOI: 10.1016/s0140-6736(15)00547-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Access to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. The key global enablers of sustainable financing, governance, and leadership will be necessary to achieve access while preventing excess antimicrobial use.
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Affiliation(s)
- Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Unni Gopinathan
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia; Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Heiman Wertheim
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Diseases, Oxford, UK
| | - Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Göran Tomson
- Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Bhojani U, Kolsteren P, Criel B, De Henauw S, Beerenahally TS, Verstraeten R, Devadasan N. Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India. Glob Health Action 2015; 8:28762. [PMID: 26578110 PMCID: PMC4649018 DOI: 10.3402/gha.v8.28762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. OBJECTIVE To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. DESIGN A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. RESULTS Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. EFFECTIVENESS The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. IMPLEMENTATION There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. CONCLUSIONS Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.
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Affiliation(s)
- Upendra Bhojani
- Institute of Public Health, Bangalore, India.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium;
| | - Patrick Kolsteren
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Roos Verstraeten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Sharma M, Damlin A, Pathak A, Stålsby Lundborg C. Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India. PLoS One 2015; 10:e0142317. [PMID: 26540104 PMCID: PMC4634959 DOI: 10.1371/journal.pone.0142317] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/19/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Infectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India. Methods Data from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008–2011) using a customized form. Data from inpatients aged 0–18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant. Results Oftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95%confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral- and enteric fever were frequently prescribed antibiotics at both hospitals, yet higher proportion were prescribed antibiotics at the NTH compared to the TH. Broad-spectrum antibiotics were the most commonly prescribed antibiotic class in both hospitals, namely third generation cephalosporins, J01DD (69%) at the TH, and new fixed dose combinations of antibiotics J01R (FDCs, 42%) at the NTH. At the TH, 37% of the antibiotic prescriptions were comprised of antibiotics listed in the IAP-LEM, compared to 24% at the NTH (p<0.05). Conclusions Broad-spectrum antibiotics were prescribed frequently in both hospitals also for the un-indicated conditions such as viral fever and enteric fever. At the NTH, new FDCs were more frequently prescribed and adherence to the IAP-LEM was substantially lower at the NTH compared to the TH. The results demonstrate need to develop diagnosis-specific prescribing guidelines to facilitate rational use of antibiotics and implement antibiotic stewardship program.
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Affiliation(s)
- Megha Sharma
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
- * E-mail:
| | - Anna Damlin
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
| | - Ashish Pathak
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, SE 751 85 Uppsala, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
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95
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Porter G, Grills N. Medication misuse in India: a major public health issue in India. J Public Health (Oxf) 2015; 38:e150-7. [PMID: 26060236 DOI: 10.1093/pubmed/fdv072] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In India, it has been estimated that 50% of family spending on healthcare is on unnecessary medications or investigations. This, combined with the wide availability of medications, has seemingly contributed to increasing rates of antibiotic resistance and further impoverishment. In this literature review, we aim to characterize the extent of misuse and describe underlying factors contributing to the misuse of medication in India. METHODS This literature review included relevant articles published after 2000 that assessed medication use and misuse in India. A narrative review framework was used to analyse each article, confirm its inclusion, extract relevant information and group the findings under thematic areas. RESULTS There were 115 articles included in this literature review. The literature demonstrated that the misuse of medications in India is widespread. The factors resulting in this involves all levels of the health system including regulation, enforcement and policy, healthcare providers and consumers. CONCLUSIONS This is one of the most comprehensive reviews of medication misuse in India. It indicates the widespread nature of the problem and so highlights the need for action. This review provides a detailed understanding as to the complex interplay of factors that result in medication misuse in India.
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Affiliation(s)
- Gillian Porter
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Nathan Grills
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Pradipta IS, Ronasih E, Kartikawati AD, Hartanto H, Amelia R, Febrina E, Abdulah R. Three years of antibacterial consumption in Indonesian Community Health Centers: The application of anatomical therapeutic chemical/defined daily doses and drug utilization 90% method to monitor antibacterial use. J Family Community Med 2015; 22:101-5. [PMID: 25983606 PMCID: PMC4415124 DOI: 10.4103/2230-8229.155385] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Irrational use of antibacterial drugs in Community Health-Care Centers (CHCs) may lead to increased resistance, morbidity, and mortality. AIMS The aim of this study was to determine patterns of antibacterial use at CHCs in a district of Indonesia and use this as data for an antibiotic policy. SETTINGS AND DESIGN The observational-descriptive study was conducted in a district of Indonesia to obtain antibacterial use from 2008 to 2010. SUBJECTS AND METHODS The data obtained from the report on the use of medicines were classified and processed using the anatomical therapeutic chemical (ATC) and defined daily doses (DDD) method, with DDD/1000 patients as a unit measurement. The number of patients was obtained from attending patients in that research period. The most abundant antibacterial drugs use segment was identified by the drug utilization 90% (DU90%) method. STATISTICAL ANALYSIS USED Descriptive analysis were performed in this study. RESULTS Fourteen kinds of antibacterial drugs were used in 61 CHCs. The total of antibacterial drug use during the period 2008-2010 was 871.36 DDD/1000 patients/day. Declining antibacterial use was observed between 2008 and 2010. Six kinds of antibacterial drugs were the most commonly used. The data show that the average use per visit was as high as 24.41 DDD. CONCLUSIONS Amoxicillin, sulfamethoxazole and trimethoprim are antibacterials that have to be reconsidered by physicians for use in the Bandung CHC. The high use of antibacterial drugs, as described in the study, can be used as reference to develop an antimicrobial stewardship program and increase awareness of resistance, adverse drug reaction and drug interaction of antibacterial drugs.
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Affiliation(s)
- Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Elis Ronasih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Arrum D Kartikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Hartanto Hartanto
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Rizki Amelia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Ellin Febrina
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
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Md Rezal RS, Hassali MA, Alrasheedy AA, Saleem F, Md Yusof FA, Godman B. Physicians’ knowledge, perceptions and behaviour towards antibiotic prescribing: a systematic review of the literature. Expert Rev Anti Infect Ther 2015; 13:665-80. [PMID: 25813839 DOI: 10.1586/14787210.2015.1025057] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rabiatul Salmi Md Rezal
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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Hassali MA, Kamil TKT, Yusof FAM, Alrasheedy AA, Yusoff ZM, Saleem F, AL-Tamimi SK, Wong ZY, Aljadhey H, Godman B. General practitioners’ knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications. Expert Rev Anti Infect Ther 2015; 13:511-20. [DOI: 10.1586/14787210.2015.1012497] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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McIntosh W, Dean W. Factors associated with the inappropriate use of antimicrobials. Zoonoses Public Health 2014; 62 Suppl 1:22-8. [PMID: 25470319 DOI: 10.1111/zph.12169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Indexed: 11/30/2022]
Abstract
Antimicrobial resistance continues to grow and antimicrobial use in food animal production and to a lesser extent in human patients is under fire. Much of the criticism has to do with the misapplication of these drugs in both settings. Research indicates that patients, food animal producers, physicians and veterinarians have all played a part in misusing antimicrobials, often because of mistaken beliefs. This paper reviews this research and introduces a theoretical perspective, the Theory of Planned Behavior (TPB), which broadens our understanding of the motivations for misuse. In particular this approach shows that individuals making decisions about antimicrobial use take into account social pressures from and a sense of obligation to significant others in their social networks. Our own work summarized in this paper indicates that both feedlot veterinarians and feedlot managers' antimicrobial decisions are influenced by both expectations from and obligations to a variety of actors in the feedlot network (other veterinarians, feedlot clients, consumers, pharmaceutical companies, and regulatory bodies). Generally across 4 circumstances of antimicrobial use (for acutely sick cattle, chronically-sick cattle, at-risk cattle, high-risk cattle), it is largely the perception that peers and clients expect feedlot veterinarians to use antimicrobials and feedlot veterinarians sense of obligation to these groups that have the most influence on their decisions to recommend antimicrobials. Based on these findings, the question of engaging in changing the choices made by those working with food animals must start with those who influence the decision to proscribe or use antimicrobials. As our data come from the United States and may be unique relative to other countries, these efforts should begin by ascertaining who influences these decisions. The next step is to then change the beliefs of these significant others.
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Affiliation(s)
- W McIntosh
- Texas A&M University - Sociology, College Station, TX, USA
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