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Garg M, Venugopalan V, Vouri SM, Diaby V, Iovine NM, Wilson DL, Park H. Trends in the appropriateness of oral antibiotic prescriptions dispensed in the United States from 2010 to 2018. Pharmacotherapy 2024. [PMID: 39239761 DOI: 10.1002/phar.4604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND One of the goals established by the United States National Action Plan to Combat Antibiotic-Resistant Bacteria is to reduce inappropriate outpatient antibiotic prescriptions by 50% by 2020. Recent data on the achievement of this goal is lacking. The objective of our study was to examine recent trends in the appropriateness of oral antibiotic prescriptions dispensed to a commercially insured population in outpatient settings in the United States to quantify the relative trend in inappropriate antibiotic prescribing from 2010 to 2018. METHODS Our cross-sectional analysis examined oral antibiotic prescriptions dispensed in outpatient settings using the IBM MarketScan Commercial Data from January 2010 to December 2018. Trends in the annual proportion of antibiotic prescriptions classified as appropriate, potentially appropriate, inappropriate, or without any medical visit during a 7 days look-back period were estimated using multivariable generalized linear models with Poisson distribution adjusting for beneficiaries' demographic and infectious conditions. RESULTS Approximately 170 million oral antibiotic prescriptions were dispensed to 86 million beneficiaries during 2010 to 2018. The mean age of the study population was 34.5 (±19.1) years, with 58.4% females and 24.6% children. We observed a 12.9% (95% Confidence Interval [CI] = 12.6%-13.2%; p < 0.01) decline in rates of antibiotic use, from 832 to 727 prescriptions per 1000 beneficiaries, from 2010 to 2018. The proportion of prescriptions classified as appropriate increased by 36.7% (95% CI = 36.4%-36.9%; p < 0.01); potentially appropriate prescriptions increased by 9.3% (95% CI = 9.1%-9.4%; p < 0.01); whereas inappropriate prescriptions and those without a medical visit declined by 11.3% (95% CI = 11.2%-11.4%; p < 0.01) and 14.0% (95% CI = 13.9%-14.2%; p < 0.01), respectively. Similar declining trends were observed in use and proportion of inappropriate prescriptions for broad-spectrum antibiotics. In 2018, amoxicillin and azithromycin were the most common appropriate and inappropriate prescription fills, respectively. CONCLUSION Although antibiotic use and inappropriate prescribing declined steadily from 2010 to 2018 in the United States, this study demonstrates that we have not achieved the national goal of reducing inappropriate antibiotic prescribing by 50%.
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Affiliation(s)
- Mahek Garg
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Veena Venugopalan
- Department of Pharmacy Education and Practice, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Nicole M Iovine
- Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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Al Qahtani M, AlFulayyih SF, Al Baridi SS, Alomar SA, Alshammari AN, Albuaijan RJ, Uddin MS. Exploring the Impact of Antibiotics on Fever Recovery Time and Hospital Stays in Children with Viral Infections: Insights from Advanced Data Analysis. Antibiotics (Basel) 2024; 13:518. [PMID: 38927184 PMCID: PMC11200729 DOI: 10.3390/antibiotics13060518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Antibiotic overuse in pediatric patients with upper respiratory tract infections (UR-TIs) raises concerns about antimicrobial resistance. This study examines the impact of antibiotics on hospital stay duration and fever resolution in pediatric patients diagnosed with viral infections via a multiplex polymerase chain reaction (PCR) respiratory panel. Methods: In the pediatric ward of Imam Abdulrahman Bin Faisal Hospital, a retrospective cohort analysis was conducted on pediatric patients with viral infections confirmed by nasopharyngeal aspirates from October 2016 to December 2021. Cohorts receiving antibiotics versus those not receiving them were balanced using the gradient boosting machine (GBM) technique for propensity score matching. Results: Among 238 patients, human rhinovirus/enterovirus (HRV/EV) was most common (44.5%), followed by respiratory syncytial virus (RSV) (18.1%). Co-infections occurred in 8.4% of cases. Antibiotic administration increased hospital length of stay (LOS) by an average of 2.19 days (p-value: 0.00). Diarrhea reduced LOS by 2.26 days, and higher albumin levels reduced LOS by 0.40 days. Fever and CRP levels had no significant effect on LOS. Time to recovery from fever showed no significant difference between antibiotic-free (Abx0) and antibiotic-received (Abx1) groups (p-value: 0.391), with a hazard ratio of 0.84 (CI: 0.57-1.2). Conclusions: Antibiotics did not expedite recovery but were associated with longer hospital stays in pediatric patients with acute viral respiratory infections. Clinicians should exercise caution in prescribing antibiotics to pediatric patients with confirmed viral infections, especially when non-critical.
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Affiliation(s)
| | | | | | | | | | | | - Mohammed Shahab Uddin
- Department of Pediatric, Ministry of National Guard Health Affairs, Dammam 31412, Saudi Arabia; (M.A.Q.); (S.F.A.); (S.S.A.B.); (S.A.A.); (A.N.A.); (R.J.A.)
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3
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Marchant P, Vivanco E, Silva A, Nevermann J, Fuentes I, Barrera B, Otero C, Calderón IL, Gil F, Fuentes JA. β-lactam-induced OMV release promotes polymyxin tolerance in Salmonella enterica sv. Typhi. Front Microbiol 2024; 15:1389663. [PMID: 38591031 PMCID: PMC10999688 DOI: 10.3389/fmicb.2024.1389663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
The rise of multidrug-resistant bacteria is a global concern, leading to a renewed reliance on older antibiotics like polymyxins as a last resort. Polymyxins, cationic cyclic peptides synthesized nonribosomally, feature a hydrophobic acyl tail and positively charged residues. Their antimicrobial mechanism involves initial interaction with Gram-negative bacterial outer-membrane components through polar and hydrophobic interactions. Outer membrane vesicles (OMVs), nano-sized proteoliposomes secreted from the outer membrane of Gram-negative bacteria, play a crucial role in tolerating harmful molecules, including cationic peptides such as polymyxins. Existing literature has documented environmental changes' impact on modulating OMV properties in Salmonella Typhimurium. However, less information exists regarding OMV production and characteristics in Salmonella Typhi. A previous study in our laboratory showed that S. Typhi ΔmrcB, a mutant associated with penicillin-binding protein (PBP, a β-lactam antibiotic target), exhibited hypervesiculation. Consequently, this study investigated the potential impact of β-lactam antibiotics on promoting polymyxin tolerance via OMVs in S. Typhi. Our results demonstrated that sub-lethal doses of β-lactams increased bacterial survival against polymyxin B in S. Typhi. This phenomenon stems from β-lactam antibiotics inducing hypervesiculation of OMVs with higher affinity for polymyxin B, capturing and diminishing its biologically effective concentration. These findings suggest that β-lactam antibiotic use may inadvertently contribute to decreased polymyxin effectivity against S. Typhi or other Gram-negative bacteria, complicating the effective treatment of infections caused by these pathogens. This study emphasizes the importance of evaluating the influence of β-lactam antibiotics on the interaction between OMVs and other antimicrobial agents.
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Affiliation(s)
- Pedro Marchant
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Erika Vivanco
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Andrés Silva
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Jan Nevermann
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Ignacio Fuentes
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Boris Barrera
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
| | - Carolina Otero
- Escuela de Química y Farmacia, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | - Iván L. Calderón
- Laboratorio de RNAs Bacterianos, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Fernando Gil
- Microbiota-Host Interactions and Clostridia Research Group, Universidad Andres Bello, Santiago, Chile
| | - Juan A. Fuentes
- Laboratorio de Genética y Patogénesis Bacteriana, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
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Cang HQ, Quan XH, Chu XH, Liang Y, Yang X, Li J. Carbapenems versus β-lactam and β-lactamase inhibitors for treatment of nosocomial pneumonia: A systematic review and meta-analysis. Heliyon 2023; 9:e20108. [PMID: 37767465 PMCID: PMC10520732 DOI: 10.1016/j.heliyon.2023.e20108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background Carbapenems and β-lactam and β-lactamase inhibitors (BLBLIs) have been used empirically in nosocomial pneumonia, but their efficacy and safety are controversial. Objective We carried out a systematic review with meta-analysis to evaluate the efficacy and safety of carbapenems versus BLBLIs against nosocomial pneumonia. Methods PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wangfang, VIP and Sinomed were searched systematically through April 29, 2023 for clinical trials comparing carbapenems with BLBLIs for treatment of nosocomial pneumonia. Random-effects models were used to evaluate the impact of treatment on the risk ratio (RR) of all-cause mortality, clinical response, microbiologic response, resistance by Pseudomonas aeruginosa, adverse effects (AEs), and serious adverse effects. The quality of the evidence was assessed with the Cochrane risk of bias tool. The review was registerted in the INPLASY (INPLASY202340113). Results Seven randomized controlled trials containing 3306 patients met our inclusion criteria Our meta-analysis showed no significant difference in all-cause mortality (RR = 0.88, 95% confidence interval [CI] = 0.75-1.03, I2 = 0%) or clinical cure (1.02, 0.96-1.09, 30%) or clinical failure (1.19, 0.97-1.47, 0%) or microbiologic clinical cure (0.98, 0.89-1.06, 40%) or Pseudomonas aeruginosa resistance (RR 2.43, CI 0.86-6.81, 49%, P = 0.09) or adverse events (0.98, 0.93-1.02, 0%) between carbapenems groups versus BLBLIs groups, but a significant difference was found for severe adverse events (RR 0.83, CI 0.73-0.94, 0%). Conclusion Differences in the prevalence of mortality, clinical cure, or clinical failure were not observed between carbapenems groups versus BLBLIs groups in terms of nosocomial pneumonia. The use of carbapenems was linked to a tendency towards the emergence of P. aeruginosa resistance, however, no statistically significant difference was observed.
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Affiliation(s)
- Huai Qin Cang
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
| | - Xiang Hua Quan
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
| | - Xiang Hua Chu
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
| | - Yu Liang
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
| | - Xue Yang
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
| | - Jing Li
- Department of Pharmacy, Affiliated Hospital of Qingdao University, China
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Bordi L, Vulcano A, Sberna G, Nonis M, Giacomini P, Maggi F, Fontana C, Lalle E. Co-Circulation of SARS-CoV-2 and Other Respiratory Pathogens in Upper and Lower Respiratory Tracts during Influenza Season 2022-2023 in Lazio Region. Microorganisms 2023; 11:2239. [PMID: 37764083 PMCID: PMC10536072 DOI: 10.3390/microorganisms11092239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Lower respiratory tract infections (LRTIs) occur when there is a lower airway tract infection. They are well-known for increasing the susceptibility of patients to bacterial/fungal co-infections and super-infections. In this study, we present the results of our investigation, which involved 381 consecutive patients admitted to our hospital during the Influenza season from October 2022 to April 2023. Among the 381 specimens, 75 were bronchoalveolar (BAL), and 306 were nasopharyngeal swabs (NPSs). Notably, 34.4% of the examined samples tested positive for SARS-CoV-2. Of these, we observed that 7.96% of NPSs showed positivity only for other respiratory viruses, while a substantial percentage (77%) of BAL specimens exhibited positive results only for bacterial co-infections. The results of our study not only confirm the importance of co-infections in COVID-19 but also emphasize the significance of utilizing rapid diagnostic tests (RDTs) for the timely diagnosis of LRTIs. In fact, RDTs allow for the identification of multiple pathogens, providing clinicians with useful and timely information to establish effective therapy.
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Affiliation(s)
- Licia Bordi
- Laboratory of Virology and Biosafety Laboratories, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Antonella Vulcano
- Laboratory of Microbiology and Biological Bank, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Giuseppe Sberna
- Laboratory of Virology and Biosafety Laboratories, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Marino Nonis
- Health Management Direction, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Paolo Giacomini
- Health Management Direction, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology and Biosafety Laboratories, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Carla Fontana
- Laboratory of Microbiology and Biological Bank, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
| | - Eleonora Lalle
- Laboratory of Virology and Biosafety Laboratories, National Institute of Infectious Diseases "L. Spallanzani" IRCCS, 00149 Rome, Italy
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Smith A, Kardos P, Pfaar O, Randerath W, Estrada Riolobos G, Braido F, Sadofsky L. The treatment of mild upper respiratory tract infections - a position paper with recommendations for best practice. Drugs Context 2023; 12:2023-4-2. [PMID: 37521107 PMCID: PMC10379023 DOI: 10.7573/dic.2023-4-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023] Open
Abstract
Following the waning severity of COVID-19 due to vaccination and the development of immunity, the current variants of SARS-CoV-2 often lead to mild upper respiratory tract infections (MURTIs), suggesting it is an appropriate time to review the pathogenesis and treatment of such illnesses. The present article reviews the diverse causes of MURTIs and the mechanisms leading to symptomatic illness. Different symptoms of MURTIs develop in a staggered manner and require targeted symptomatic treatment. A wide variety of remedies for home treatment is available, including over-the-counter drugs and plant-derived substances. Recent pharmacological research has increased the understanding of molecular effects, and clinical studies have shown the efficacy of certain herbal remedies. However, the use of subjective endpoints in these clinical studies may suggest limited validity of the results. In this position paper, the importance of patient-centric outcomes, including a subjective perception of improved well-being, is emphasized. A best practice approach for the management of MURTIs, in which pharmacists and physicians create an improved multi-professional healthcare setting and provide healthcare education to patients, is proposed. Pharmacists act as first-line consultants and provide patients with remedies, considering the individual patient's preferences towards chemical or plant-derived drugs and providing advice for self-monitoring. Physicians act as second-line consultants if symptoms worsen and subsequently initiate appropriate therapies. In conclusion, general awareness of MURTIs should be increased amongst medical professionals and patients, thus improving their management.
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Affiliation(s)
- Andrew Smith
- School of Psychology, Cardiff University, Cardiff, UK
| | - Peter Kardos
- Centre of Allergy, Respiratory and Sleep Medicine, Maingau Clinic of the Red Cross, Frankfurt am Main, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Winfried Randerath
- Institute of Pneumology, University of Cologne, Cologne, Germany
- Bethanien Hospital, Clinic of Pneumology and Allergology, Centre for Sleep Medicine and Respiratory Care, Solingen, Germany
| | | | - Fulvio Braido
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy
- Università di Genova, (DIMI), Genova, Italy
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7
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Li S, Ondon BS, Ho SH, Li F. Emerging soil contamination of antibiotics resistance bacteria (ARB) carrying genes (ARGs): New challenges for soil remediation and conservation. ENVIRONMENTAL RESEARCH 2023; 219:115132. [PMID: 36563979 DOI: 10.1016/j.envres.2022.115132] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
Soil plays a vital role as a nutrient source for microflora and plants in ecosystems. The accumulation and proliferation of antibiotics resistance bacteria (ARB) and antibiotics resistance genes (ARGs) causes emerging soil contamination and pollution, posing new challenges for soil remediation, recovery, and conservation. Fertilizer application in agriculture is one of the most important sources of ARB and ARGs contamination in soils. The recent existing techniques for the remediation of soil polluted with ARB and ARGs are very limited in terms of ARB and ARGs removal in soil. Bioelectrochemical remediation using bioelectrochemical systems such as microbial fuel cells and microbial electrolysis cells are promising technologies for the removal of ARB and ARGs in soil. Herein, diverse sources of ARB and ARGs in soil have been reviewed, their effects on soil microbial diversity have been analyzed, and the causes of ARB and ARGs rapid proliferation in soil are explained. Bioelectrochemical systems used for the remediation of soil contaminated with ARB and ARGs is still in its infancy stage and presents serious disadvantage and limits, therefore it needs to be well understood and implemented. In general, merging soil contamination of ARB and ARGs is an increasing concern threatening the soil ecosystem while the remediation technologies are still challenging. Efforts need to be made to develop new, effective, and efficient technologies for soil remediation and conservation to tackle the spread of ARB and ARGs and overcome the new challenges posed by ARB and ARGs contamination in soil.
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Affiliation(s)
- Shengnan Li
- Key Laboratory of Pollution Processes and Environmental Criteria at the Ministry of Education, Tianjin, China; Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin, 300350, China; State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, Heilongjiang Province, 150090, China
| | - Brim Stevy Ondon
- Key Laboratory of Pollution Processes and Environmental Criteria at the Ministry of Education, Tianjin, China; Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin, 300350, China
| | - Shih-Hsin Ho
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, Heilongjiang Province, 150090, China
| | - Fengxiang Li
- Key Laboratory of Pollution Processes and Environmental Criteria at the Ministry of Education, Tianjin, China; Key Laboratory of Environmental Remediation and Pollution Control, College of Environmental Science and Engineering, Nankai University, Tianjin, 300350, China.
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Gabutti G. Available evidence and potential for vaccines for reduction in antibiotic prescriptions. Hum Vaccin Immunother 2022; 18:2151291. [PMID: 36469620 PMCID: PMC9762846 DOI: 10.1080/21645515.2022.2151291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bacterial antibiotic resistance is a public health issue. It means that drugs become ineffective, infections persist and have a huge impact on the health of patients and their spreading increases. To address a complex threat such as bacterial antibiotic resistance different and integrated approaches are needed including discovery of new antibiotics, improvement of diagnostics tools and improvement of antibiotic stewardship. Absolutely relevant are prevention of infections as well as decrease in the use of antibiotics. Vaccines are an important tool in the fight against bacterial antibiotic resistance and can help prevent it in several ways. Indeed, vaccines are highly effective in preventing diseases that might otherwise require the use of antibiotics to treat symptoms and associated complications. Preventing infections through vaccination helps reduce the need for and widespread and inappropriate use of antibiotics, including for secondary bacterial infections.
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Affiliation(s)
- Giovanni Gabutti
- Coordinator Working Group, Vaccines and Immunization Policies of the Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Cogorno (Ge), Italy,CONTACT Giovanni Gabutti Coordinator Working Group, “Vaccines and Immunization Policies” of the Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Cogorno (Ge), Italy
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Xingrong S, Rui F, Jing C, Jing C, Oliver I, Lambert H, Wang D. Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China. Front Public Health 2022; 10:810348. [PMID: 35223737 PMCID: PMC8864097 DOI: 10.3389/fpubh.2022.810348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThis paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.ResultsAmong 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63–9.51), tonsillitis (OR: 4.63, 95% CI: 1.48–14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40–13.04), pharyngitis (OR: 3.22, 95% CI: 1.57–6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75–5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44–3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47–6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28–0.88) but not prescription of antibiotics.ConclusionsAntibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.
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Affiliation(s)
- Shen Xingrong
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Feng Rui
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, China
| | - Chai Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Cheng Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Helen Lambert
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
- *Correspondence: Debin Wang
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Sribenjalux W, Larbsida N, Khamsai S, Panyapornsakul B, Deawtrakulchai P, Meesing A. Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection. Antibiotics (Basel) 2021; 10:antibiotics10121479. [PMID: 34943691 PMCID: PMC8698948 DOI: 10.3390/antibiotics10121479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.
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Affiliation(s)
- Wantin Sribenjalux
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-4336-3664
| | - Nattawat Larbsida
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
| | - Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Benjaphol Panyapornsakul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
| | - Phitphiboon Deawtrakulchai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
| | - Atibordee Meesing
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (N.L.); (S.K.); (B.P.); (P.D.); (A.M.)
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen 40002, Thailand
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11
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Mokrzan EM, Ahearn CP, Buzzo JR, Novotny LA, Zhang Y, Goodman SD, Bakaletz LO. Nontypeable Haemophilus influenzae newly released (NRel) from biofilms by antibody-mediated dispersal versus antibody-mediated disruption are phenotypically distinct. Biofilm 2020; 2:100039. [PMID: 33447823 PMCID: PMC7798465 DOI: 10.1016/j.bioflm.2020.100039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Biofilms contribute significantly to the chronicity and recurrence of bacterial diseases due to the fact that biofilm-resident bacteria are highly recalcitrant to killing by host immune effectors and antibiotics. Thus, antibody-mediated release of bacteria from biofilm residence into the surrounding milieu supports a powerful strategy to resolve otherwise difficult-to-treat biofilm-associated diseases. In our prior work, we revealed that antibodies directed against two unique determinants of nontypeable Haemophilus influenzae (NTHI) [e.g. the Type IV pilus (T4P) or a bacterial DNABII DNA-binding protein, a species-independent target that provides structural integrity to bacterial biofilms] release biofilm-resident bacteria via discrete mechanisms. Herein, we now show that the phenotype of the resultant newly released (or NRel) NTHI is dependent upon the specific mechanism of release. We used flow cytometry, proteomic profiles, and targeted transcriptomics to demonstrate that the two NRel populations were significantly different not only from planktonically grown NTHI, but importantly, from each other despite genetic identity. Moreover, each NRel population had a distinct, significantly increased susceptibility to killing by either a sulfonamide or β-lactam antibiotic compared to planktonic NTHI, an observation consistent with their individual proteomes and further supported by relative differences in targeted gene expression. The distinct phenotypes of NTHI released from biofilms by antibodies directed against specific epitopes of T4P or DNABII binding proteins provide new opportunities to develop targeted therapeutic strategies for biofilm eradication and disease resolution.
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Affiliation(s)
- Elaine M Mokrzan
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Christian P Ahearn
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - John R Buzzo
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura A Novotny
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Yan Zhang
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,The Ohio State University Comprehensive Cancer Center (OSUCCC - James), Columbus, OH, USA
| | - Steven D Goodman
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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12
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Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study. Int J Antimicrob Agents 2020; 56:106193. [PMID: 33045344 DOI: 10.1016/j.ijantimicag.2020.106193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The assessment of antibiotic use for acute upper respiratory infections (AURIs) is important to promote the appropriateness of antibiotic prescribing. Evaluation of antibiotic prescriptions for AURIs at a national level is very limited in China. OBJECTIVE To investigate outpatient antibiotic prescriptions for AURIs in Chinese hospitals. METHODS This study used data from over 10 million outpatient and emergency department visits for AURIs, which contained information on drug prescription and diagnosis, from 94 cities and 28 provinces of mainland China. Antibiotic prescription rates for various subgroups and potential predictors of antibiotic use were estimated. Patterns of antibiotic prescriptions and proportions of individual antibiotics prescribed for different types of AURIs were analysed and reported. RESULTS In total, 10 770 219 outpatient visits for AURIs were included in this study. Of these, 40.8% (95% confidence interval 40.7-40.8%) resulted in antibiotic prescriptions. Patient characteristics, including age, gender, payment type, AURI type, department and season of visit, were significantly associated with antibiotic prescriptions for AURIs. In total, 4 984 744 antibiotic agents were prescribed, of which 87.9% were broad-spectrum antibiotics and only 36.8% were prescribed in line with the guideline recommendations. Azithromycin (13.2%), cefdinir (11.7%), cefixime (8.3%) and cefaclor (8.2%) were the most commonly prescribed antibiotics for AURIs in China. CONCLUSIONS Antibiotic prescribing for patients with AURIs in outpatient settings was prevalent nationwide in China. Antibiotic stewardship efforts targeting specific populations in outpatient settings are needed to reduce antibiotic use and promote appropriate antibiotic selection for AURIs in China.
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13
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Abstract
PURPOSE OF REVIEW The purposes of the review are as follows: (1) to define acute rhinosinusitis (ARS) and their phenotypes, (2) to highlight the ARS management according to international guidelines, (3) to compare the physicians' management with the ARS guideline recommendations, and (4) to report ARS socioeconomic burden. RECENT FINDINGS Bacterial and non-bacterial ARS have similar symptoms, although they can be discriminated by using a combination of specific signs and symptoms. The prescription of antibiotics should be limited to clearly suspected bacterial ARS. There is an overuse of diagnosis tools and treatment prescriptions. The total cost per ARS episode in Europe is over €1000. ARS is mainly an inflammatory disease triggered by viral infection, and few cases end up developing bacterial infection. In most of the cases, it is a self-resolving disease which diagnosis is mainly clinical and the treatment symptomatic. The incidence of complications is low and independent of antibiotic use. There is a high socioeconomic burden associated to ARS.
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Affiliation(s)
- Francesca Jaume
- Servei d'Otorrinolaringologia, Hospital Comarcal d'Inca, Carretera Vella de Llubí, 07300, Inca, Illes Balears, Spain.
| | - Meritxell Valls-Mateus
- Servei d'Otorrinolaringologia, Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
- Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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14
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Ali N, Alli S, Ali A, Ali A, Ali C, Abraham J, Abdool I, Antoine A, Dialsingh I, Parasram R, Pooransingh S. Antibiotic Resistance in Trinidad: A population-based survey of adults. CARIBBEAN MEDICAL JOURNAL 2020. [DOI: 10.48107/cmj.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Antibiotic resistance (ABR) is a growing public health issue globally. This study aimed to ascertain the public’s knowledge of antibiotic resistance and to determine any associated demographic factors.
Method: A cross-sectional survey was undertaken in Trinidad using a modified version of a World Health Organization questionnaire. Five hundred and fifty participants aged 16 years and older were interviewed. Data were analysed using SPSS Version-22.
Results: The response rate was 91% (502/550). Most responders (53%) reported having taken antibiotics during the 6-month period prior to the survey. Almost 60% of responders believed that sore throat and colds/flu can be treated with antibiotics. Sixty-seven percent of responders believed that they had no individual role in combating the issue. Responders with a primary level education or older respondents were more likely than responders with a higher level of education or younger to agree that antibiotic resistance only affects those who use antibiotics frequently (p= 0.002 and p=0.017 respectively). Income level was also significantly associated with knowledge levels, the higher the income the more knowledgeable the responder.
Conclusion: Our study found that public knowledge of antibiotic resistance is low. Age, income and educational levels were significantly associated with certain knowledge parameters. Much work needs to be done to change the attitudes of responders who believe they have no role to play in the fight against this national and global threat. These findings may be useful to health education professionals and government antimicrobial resistance programmes.
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Affiliation(s)
- Nyeil Ali
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Subrina Alli
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Ashley Ali
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Aleema Ali
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Chelsi Ali
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Jada Abraham
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Imtiaz Abdool
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Azalia Antoine
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
| | - Isaac Dialsingh
- Faculty of Science and Technology, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | | | - Shalini Pooransingh
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, Trinidad and Tobago
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15
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Macedo da Silva RO, Gonçalves Castro JW, de Menezes Dantas Junior O, Justino de Araújo AC, do Nascimento Silva Leandro MK, Oliveira Costa RJ, Leite Pinto L, Garcia Leandro LM, da Silva LE, do Amaral W, Parabocz LD, Ferriani AP, Garcia B, Sales Maia BHLN, Esmeraldo Rocha J, Fonseca Bezerra C, Sampaio de Freitas T, Socorro Costa M, Ferreira Campina F, Ferreira Matias EF, Iriti M, Coutinho HDM. Photoinduced Antibacterial Activity of the Essential Oils from Eugenia brasiliensis Lam and Piper mosenii C. DC. by Blue Led Light. Antibiotics (Basel) 2019; 8:antibiotics8040242. [PMID: 31795165 PMCID: PMC6963601 DOI: 10.3390/antibiotics8040242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 11/24/2022] Open
Abstract
The objective of this work was to evaluate the phytochemical composition and the antibacterial and antibiotic-modulating activities of the essential oils of Eugenia brasiliensis Lam (OEEb) and Piper mosenii C. DC (OEPm) singly or in association with blue LED (Light-emitting diode) light. The antibacterial and antibiotic-modulatory activities of the essential oils on the activity of aminoglycosides were evaluated to determine the minimum inhibitory concentration (MIC, μg/mL) in the presence or absence of exposure to blue LED light. The chemical analysis showed α-pinene and bicyclogermacrene as major constituents of OEPm, whereas α-muurolol was the main compound of OEEb. Both OEEb and OEPm showed MIC ≥ 512 μg/mL against the strains under study. However, the association of these oils with the blue LED light enhanced the action of the aminoglycosides amikacin and gentamicin. In conclusion, the association of aminoglycosides with the blue LED light and essential oils was effective against resistant bacteria.
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Affiliation(s)
- Rakel Olinda Macedo da Silva
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - José Walber Gonçalves Castro
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Orlando de Menezes Dantas Junior
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Ana Carolina Justino de Araújo
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Maria Karollyna do Nascimento Silva Leandro
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Raíra Justino Oliveira Costa
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Luciely Leite Pinto
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Lívia Maria Garcia Leandro
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Luiz E. da Silva
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Wanderlei do Amaral
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Lucas D. Parabocz
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Aurea P. Ferriani
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Bruna Garcia
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Beatriz H. L. N. Sales Maia
- Setor Litoral, Federal University of Paraná, Curitiba 80.060-000, Brazil; (L.E.d.S.); (W.d.A.); (L.D.P.); (A.P.F.); (B.G.); (B.H.L.N.S.M.)
| | - Janaína Esmeraldo Rocha
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Camila Fonseca Bezerra
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Thiago Sampaio de Freitas
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Maria Socorro Costa
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Fábia Ferreira Campina
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
| | - Edinardo Fagner Ferreira Matias
- Department of Biomedicine, University Center Dr. Leão Sampaio, Juazeiro do Norte 63040-005, Brazil; (R.O.M.d.S.); (J.W.G.C.); (O.d.M.D.J.); (M.K.d.N.S.L.); (R.J.O.C.); (L.L.P.); (L.M.G.L.); (E.F.F.M.)
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences, Milan State University, via G. Celoria 2, 20133 Milan, Italy
- Correspondence:
| | - Henrique Douglas Melo Coutinho
- Department of Biological Chemistry, Regional University of Cariri, Crato 63105-000, Brazil; (A.C.J.d.A.); (J.E.R.); (C.F.B.); (T.S.d.F.); (M.S.C.); (F.F.C.); (H.D.M.C.)
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Atif M, Asghar S, Mushtaq I, Malik I, Amin A, Babar ZUD, Scahill S. What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan. Infect Drug Resist 2019; 12:687-699. [PMID: 30988635 PMCID: PMC6440533 DOI: 10.2147/idr.s189114] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose This study investigates the knowledge, attitudes and practices of the general public regarding the use of antibiotics in community pharmacy, in Pakistan. Methods This is a mixed method study where data were collected through a validated questionnaire and semi-structured interviews. Convenience sampling techniques were used to recruit participants from the general public of Bahawalpur, Pakistan who visited pharmacies to purchase antibiotics between 1 June 2018 and 31 July 2018. Descriptive statistics and regression analyses were used to tabulate the results of quantitative data while inductive thematic analysis was used to identify themes and draw conclusions from the qualitative data. Results Over 60% of the 400 survey participants (n=246; 61.5%) had a moderate level of antibiotic knowledge; however, attitudes regarding antibiotics use were poor in half the sample (n=201; 50.3%). More than half (n=226; 56.6%) of the respondents stated that antibiotics could cure all types of infections. Just under one third (n=129; 32.3%) of respondents obtained the appropriate dosage regimen while the majority did not complete the course (n=369; 92.3%); stopping when they felt better. Inductive thematic analysis yielded four themes, 10 subthemes and 27 categories. Two subthemes were related to knowledge, one to attitude, three to practices and four subthemes were related to suggestions to improve the healthcare system. Inappropriate antibiotic practices included: lack of consultation with healthcare professionals, purchase of antibiotics without prescription or refilling of previous prescription, use of home supply of antibiotics, sharing of antibiotics with others, improper dosage regimens and early cessation of antibiotic therapy. Conclusion Level of education, low health literacy, high consultation fees of private practitioners, inadequate health facilities in government hospitals and patient overload, busy schedules of people, poor healthcare infrastructure in rural areas and unrestricted supply of antibiotics were key factors associated with inappropriate use of antibiotics in Pakistan.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,
| | - Saima Asghar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,
| | - Anum Amin
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,
| | | | - Shane Scahill
- School of Management, Massey Business School, Massey University, Auckland, New Zealand
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Uwizeyimana JD, Kim MK, Kim D, Byun JH, Yong D. Comparison of Multiplex Real-Time Polymerase Chain Reaction Assays for Detection of Respiratory Viruses in Nasopharyngeal Specimens. ANNALS OF CLINICAL MICROBIOLOGY 2019. [DOI: 10.5145/acm.2019.22.2.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jean Damascene Uwizeyimana
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
- Department of Global Health Security, Yonsei University Graduate of Public Health, Seoul, Korea
- Department of Emergency Care, Ruli Hospital, Gakenye, Rwanda
| | - Min Kyung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Daewon Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Hyun Byun
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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