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Vanbaelen T, Manoharan-Basil SS, Kenyon C. Four recent insights suggest the need for more refined methods to assess the resistogenicity of doxycycline post exposure prophylaxis. CURRENT RESEARCH IN MICROBIAL SCIENCES 2024; 6:100234. [PMID: 38646593 PMCID: PMC11033152 DOI: 10.1016/j.crmicr.2024.100234] [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: 04/23/2024] Open
Abstract
Two recently published randomized trials of doxycycline post exposure prophylaxis (PEP) have concluded that this intervention is highly effective at reducing the incidence of bacterial sexually transmitted infections (STIs) and has little or no risk of promoting the spread of antimicrobial resistance (AMR). In this perspective piece, we review four types of evidence that suggest that the risk of promoting AMR has been inadequately assessed in these studies. 1) The studies have all used proportion resistant as the outcome measure. This is a less sensitive measure of resistogenicity than MIC distribution. 2) These RCTs have not considered population-level pathways of AMR selection. 3) In populations with very high antimicrobial consumption such as PrEP cohorts, the relationship between antimicrobial consumption and resistance may be saturated. 4) Genetic linkage of AMR means that increased tetracycline use may select for AMR to not only tetracyclines but also other antimicrobials in STIs and other bacterial species. We recommend novel study designs to more adequately assess the AMR-inducing risk of doxycycline PEP.
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Affiliation(s)
- Thibaut Vanbaelen
- STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | | | - Chris Kenyon
- STI Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, 7700, South Africa
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Aguilar AG, Canals PC, Tian M, Miller KA, Piper BJ. Decreases and Pronounced Geographic Variability in Antibiotic Prescribing in Medicaid. PHARMACY 2024; 12:46. [PMID: 38525726 PMCID: PMC10961814 DOI: 10.3390/pharmacy12020046] [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: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Antibiotic resistance is a persistent and growing concern. Our objective was to analyze antibiotic prescribing in the United States (US) in the Medical Expenditure Panel System (MEPS) and to Medicaid patients. We obtained MEPS prescriptions for eight antibiotics from 2013 to 2020. We extracted prescribing rates per 1000 Medicaid enrollees for two years, 2018 and 2019, for four broad-spectrum (azithromycin, ciprofloxacin, levofloxacin, and moxifloxacin) and four narrow-spectrum (amoxicillin, cephalexin, doxycycline, and trimethoprim-sulfamethoxazole) antibiotics. Antibiotic prescriptions in MEPS decreased from 2013 to 2020 by 38.7%, with a larger decline for the broad (-53.7%) than narrow (-23.5%) spectrum antibiotics. Antibiotic prescriptions in Medicaid decreased by 6.7%. Amoxicillin was the predominant antibiotic, followed by azithromycin, cephalexin, trimethoprim-sulfamethoxazole, doxycycline, ciprofloxacin, levofloxacin, and moxifloxacin. Substantial geographic variation in prescribing existed, with a 2.8-fold difference between the highest (Kentucky = 855/1000) and lowest (Oregon = 299) states. The South prescribed 52.2% more antibiotics (580/1000) than the West (381/1000). There were significant correlations across states (r = 0.81 for azithromycin and amoxicillin). This study identified sizable disparities by geography in the prescribing rates of eight antibiotics with over three-fold state-level differences. Areas with high prescribing rates, particularly for outpatients, may benefit from stewardship programs to reduce potentially unnecessary prescribing.
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Affiliation(s)
- Alexia G. Aguilar
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 17822, USA; (A.G.A.); (P.C.C.); (M.T.); (K.A.M.)
| | - Priscilla C. Canals
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 17822, USA; (A.G.A.); (P.C.C.); (M.T.); (K.A.M.)
| | - Maria Tian
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 17822, USA; (A.G.A.); (P.C.C.); (M.T.); (K.A.M.)
| | - Kimberly A. Miller
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 17822, USA; (A.G.A.); (P.C.C.); (M.T.); (K.A.M.)
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 17822, USA; (A.G.A.); (P.C.C.); (M.T.); (K.A.M.)
- Center for Pharmacy Innovation and Outcomes, Danville, PA 17822, USA
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Reduction strategies for inpatient oral third-generation cephalosporins at a cancer center: An interrupted time-series analysis. PLoS One 2023; 18:e0281518. [PMID: 36758108 PMCID: PMC9910666 DOI: 10.1371/journal.pone.0281518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Oral third-generation cephalosporins (3GCs) are not recommended for use owing to their low bioavailability and the risk of emergence of resistant microorganisms with overuse. A standardized and effective method for reducing their use is lacking. Here, in a 60-month, single-institution, interrupted time-series analysis, which was retrospectively conducted between April 1, 2017, and March 31, 2022, we evaluated the effectiveness of a four-phase intervention to reduce the use of 3GCs in patients at a cancer center: Phase 1 (pre-intervention), Phase 2 (review of clinical pathways), Phase 3 (establishment of infectious disease consultation service and implementation of antimicrobial stewardship program), and Phase 4 (educational lecture and pop-up displays for oral antimicrobials at the time of ordering). Although no significant changes were observed in Phases 3 and 4, the first intervention resulted in a significant decrease in the trend and level of days of therapy (DOT) for 3GCs. The level for cephalexin DOT and the trend for sulfamethoxazole-trimethoprim DOT increased in Phase 4, and the trend for amoxicillin and amoxicillin-clavulanate DOT increased in Phase 3. Macrolide DOT showed a decreasing trend in Phases 2 and 4 and decreasing and increased levels in Phases 3 and 4, respectively; no change was observed for quinolones. Actual and adjusted purchase costs of 3GCs decreased significantly during all study periods, while those for oral antimicrobials decreased in Phase 2, and actual purchase costs increased in Phases 3 and 4. No significant reduction in resistant organisms, length of hospital stay, or mortality was observed. This is the first study on the effects of oral 3GC reduction strategies in patients with cancer. We conclude that even facilities that substantially use antimicrobials can efficiently reduce the use of 3GCs.
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Bukhari A, Fatima Z, Atta M, Nazir A, Alshawwa SZ, Alotaibi HF, Iqbal M. Poly Lactic-Co-Glycolic Acid Nano-Carriers for Encapsulation and Controlled Release of Hydrophobic Drug to Enhance the Bioavailability and Antimicrobial Properties. Dose Response 2023; 21:15593258231152117. [PMID: 36743194 PMCID: PMC9893093 DOI: 10.1177/15593258231152117] [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: 11/11/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
This study focusses on the fabrication of nano-carriers for delivery of ciprofloxacin through the nanoprecipitation process. This was done to examine the release of drug at the pH of stomach to find out the antibacterial action of ciprofloxacin loaded nanoparticles (NPs). Prepared NPs were characterized by Fourier Transform Infra-Red (FTIR) spectroscopy, Scanning Electron Microscopy (SEM), and particle size analyzer (PSA) techniques. Drug yield, loading, and sustained release was studied as function of time (up to 8 h). Antibacterial activity of ciprofloxacin loaded NPs were also determined against different gram-positive and gram-negative bacteria. Results revealed that nanoprecipitation is a suitable method for encapsulation of ciprofloxacin in poly(lactic-co-glycolic acid) PLGA NPs. The drug yield and drug loading were found to be 60%. The size range of NPs observed by PSA was in the range of 5.03-6.60 nm. It can be concluded that nanoformulation of ciprofloxacin loaded PLGA NPs can be used in stomach for longer period of time to enhance the bioavailability of the drug.
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Affiliation(s)
| | - Zuha Fatima
- Department of Chemistry, The University of Lahore, Lahore, Pakistan
| | - Madiha Atta
- Department of Biochemistry, The University of Lahore, Lahore, Pakistan
| | - Arif Nazir
- Department of Chemistry, The University of Lahore, Lahore, Pakistan
| | - Samar Z. Alshawwa
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Hadil F. Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Munawar Iqbal
- Department of Chemistry, Division of Science and Technology, University of Education, Lahore, Pakistan,Munawar Iqbal, Department of Chemistry, Division of Science and Technology, University of Education, Lahore 54770, Pakistan.
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Hou J, Long X, Wang X, Li L, Mao D, Luo Y, Ren H. Global trend of antimicrobial resistance in common bacterial pathogens in response to antibiotic consumption. JOURNAL OF HAZARDOUS MATERIALS 2023; 442:130042. [PMID: 36182890 DOI: 10.1016/j.jhazmat.2022.130042] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
The emergence of antimicrobial resistance (AMR) is a growing public health threat worldwide and antibiotic consumption is being increasingly recognized as the main selective pressure driving this resistance. However, global trend in antibiotic resistance in response to antibiotic consumption is not fully understood. In this study, we collected national resistance data on specific resistant pathogens considered by the World Health Organization (WHO) as priority and antibiotic consumption data for 61 countries to assess the global trends in antibiotic resistance of those common bacterial pathogens and their association with antibiotic consumption. The low- and middle-income countries (LMICs) represented the largest hotspots of resistance, which presented relatively higher resistance rates in common bacterial pathogens but lower antibiotic consumption rates compared to high-income countries (HICs). Specifically, we developed the Normalized Antibiotic Resistance/Consumption Index (NARCI) and produced global maps of NARCI to roughly assess the appropriateness of antibiotic consumption across countries and to indicate the potentially inappropriate antibiotic consumption in LMICs compared with HICs. Additionally, we linked antibiotic consumption rates and resistance rates of target pathogens, in conjunction with NARCI and the correlation analysis between antibiotic use and resistance, to inform strategies to alleviate the threat of antibiotic resistance worldwide.
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Affiliation(s)
- Jie Hou
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiang Long
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiaolong Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Linyun Li
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Daqing Mao
- School of Medicine, Nankai University, Tianjin 300071, China.
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China.
| | - Hongqiang Ren
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China
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Okubo Y, Nishi A, Uda K, Miyairi I, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yasunaga H. Financial incentives for infection prevention and antimicrobial stewardship to reduce antibiotic use: Japan's nationwide observational study. J Hosp Infect 2023; 131:89-98. [PMID: 36424696 DOI: 10.1016/j.jhin.2022.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Japanese government introduced financial incentives to reduce nationwide antibiotic use in hospital settings. AIM This study aimed to determine whether the nationwide financial incentives for creating infection prevention and control (IPC) teams introduced in 2012 and antimicrobial stewardship (ASP) teams introduced in 2018 were associated with changes in antibiotic use and health resource utilization at a national level. METHODS We conducted time-series analyses and a difference-in-differences study consisting of 3,057,517 inpatients with infectious diseases from 472 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. The primary outcome was the days of therapy (DOT) of antibiotic use per 100 patient-days (PDs). The secondary outcomes consisted of types of antibiotic used, health resource utilization, and mortality. RESULTS A total of 5,201,304 financial incentives were observed during 2012-2018, which resulted in a total of 12.1 billion JPY (≈110 million USD). Time-series analyses found decreasing trends in total antibiotic use (79.3-72.5 DOTs/100 PDs (8.6% reduction)) and carbapenem use (9.0-7.0 DOTs/100 PDs (7.8% reduction)) from 2011 to 2018 without adversely affecting other healthcare outcomes (e.g., mortality). In the difference-in-differences analyses, we did not observe meaningful changes in total antibiotic use between the incentivized and unincentivized hospitals for ASP teams, except for the northern part of Japan. No dose-response relationships were observed between the amount of financial incentives and reductions in antibiotic use during 2011-2019. CONCLUSIONS Further research and efforts are needed to accelerate antimicrobial stewardship in hospital settings in Japan.
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Affiliation(s)
- Y Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - A Nishi
- Department of Epidemiology, UCLA Fielding School of Public Health, CA, USA
| | - K Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - I Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA; Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - R Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Arun S, Xin L, Gaonkar O, Neppolian B, Zhang G, Chakraborty P. Antibiotics in sewage treatment plants, receiving water bodies and groundwater of Chennai city and the suburb, South India: Occurrence, removal efficiencies, and risk assessment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158195. [PMID: 35995170 DOI: 10.1016/j.scitotenv.2022.158195] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
The presence of antibiotics in the aqueous environment can alter the water microbiome, inducing antimicrobial resistance genes. Hence, the occurrence of 18 antibiotics belonging to sulfonamides, fluoroquinolones, tetracyclines, phenicols, and macrolides classes were investigated in surface water, groundwater, and sewage treatment plants in Chennai city and the suburbs. Fluoroquinolones had the maximum detection frequency in both influent and effluent samples of urban and suburban STPs, with ofloxacin and ciprofloxacin showing the highest influent concentrations. Erythromycin was the predominant antibiotic in surface water samples with an average concentration of 194.4 ng/L. All the detected antibiotic concentrations were higher in the Buckingham Canal compared to those in Adyar and Cooum rivers, possibly due to direct sewer outfalls in the canal. In groundwater samples, ciprofloxacin showed the highest levels with an average of 20.48 ng/L and the concentrations were comparable to those of surface water. The average sulfamethazine concentration in groundwater (5.2 ng/L) was found to be slightly higher than that of the surface water and much higher than the STP influent concentrations. High levels of ciprofloxacin and sulfamethazine in groundwater may be because of their high solubility and wide use. Moreover, erythromycin was completely removed after treatment in urban STPs; FQs showed relatively lesser removal efficiency (2.4-54%) in urban STPs and (8-44%) in suburban STP. Tetracyclines and phenicols were not detected in any of the samples. Ciprofloxacin and azithromycin in surface water pose a high risk in terms of estimated antibiotic resistance. This study revealed that the measured surface water concentration of antibiotics were 500 times higher for some compounds than the predicted calculated concentrations from STP effluents. Therefore, we suspect the direct sewage outlets or open drains might play an important role in contaminating surface water bodies in Chennai city.
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Affiliation(s)
- Sija Arun
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India
| | - Liu Xin
- Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | | | - B Neppolian
- Department of Chemistry, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India
| | - Gan Zhang
- Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou 510640, China
| | - Paromita Chakraborty
- Environmental Science and Technology Laboratory, Department of Chemical Engineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Tamil Nadu, India.
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Okubo Y, Nishi A, Michels KB, Nariai H, Kim-Farley RJ, Arah OA, Uda K, Kinoshita N, Miyairi I. The consequence of financial incentives for not prescribing antibiotics: a Japan's nationwide quasi-experiment. Int J Epidemiol 2022; 51:1645-1655. [PMID: 35353127 PMCID: PMC10233477 DOI: 10.1093/ije/dyac057] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For addressing antibiotic overuse, Japan designed a health care policy in which eligible medical facilities could claim a financial reward when antibiotics were not prescribed for early-stage respiratory and gastrointestinal infections. The policy was introduced in a pilot manner in paediatric clinics in April 2018. METHODS We conducted a quasi-experimental, propensity score-matched, difference-in-differences (DID) design to determine whether the nationwide financial incentives for appropriate non-prescribing of antibiotics as antimicrobial stewardship [800 JPY (≈7.3 US D) per case] were associated with changes in prescription patterns, including antibiotics, and health care use in routine paediatric health care settings at a national level. Data consisted of 9 253 261 cases of infectious diseases in 553 138 patients treated at 10 180 eligible or ineligible facilities. RESULTS A total of 2959 eligible facilities claimed 316 770 cases for financial incentives and earned 253 million JPY (≈2.29 million USD). Compared with ineligible facilities, the introduction of financial incentives in the eligible facilities was associated with an excess reduction in antibiotic prescriptions [DID estimate, -228.6 days of therapy (DOTs) per 1000 cases (95% CI, -272.4 to -184.9), which corresponded to a relative reduction of 17.8% (95% CI, 14.8 to 20.7)]. The introduction was also associated with excess reductions in drugs for respiratory symptoms [DID estimates, -256.9 DOTs per 1000 cases (95% CI, -379.3 to -134.5)] and antihistamines [DID estimate, -198.5 DOTs per 1000 cases (95% CI, -282.1 to -114.9)]. There was no excess in out-of-hour visits [DID estimate, -4.43 events per 1000 cases (95% CI, -12.8 to 3.97)] or hospitalizations [DID estimate, -0.08 events per 1000 cases (95% CI, -0.48 to 0.31)]. CONCLUSIONS Our findings suggest that financial incentives to medical facilities for not prescribing antibiotics were associated with reductions in prescriptions for antibiotics without adverse health care consequences. Japan's new health policy provided us with policy options for immediately reducing inappropriate antibiotic prescriptions by relatively small financial incentives.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Akihiro Nishi
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Hiroki Nariai
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert J Kim-Farley
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Kinoshita
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Infectious Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Knoxville, Tennessee, USA
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Yamaguchi R, Okamoto K, Yamamoto T, Harada S, Tanaka T, Suzuki H, Moriya K. Impact of targeted intervention using a collaborative approach for oral third-generation cephalosporins: An interrupted time-series analysis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e115. [PMID: 36483396 PMCID: PMC9726576 DOI: 10.1017/ash.2022.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To assess the effectiveness of a targeted intervention using a collaborative approach, added to a comprehensive educational intervention, to facilitate the appropriate use of oral third-generation cephalosporins (3GCs). DESIGN Quasi-experimental study. SETTING The University of Tokyo Hospital, a tertiary-care teaching hospital. PARTICIPANTS Approximately 2,000,000 outpatients and 80,000 inpatients at the hospital between April 2017 and March 2020. INTERVENTION The targeted intervention using the collaborative approach was implemented in the departments with the highest use of oral 3GCs (ophthalmology and dermatology departments). Interrupted time-series analysis was applied to assess the change in days of therapy (DOT) of oral 3GCs between the preintervention period (April 2017-April 2019) and the postintervention period (May 2019-March 2020) for both inpatients and outpatients. RESULTS After the introduction of the targeted intervention with oral 3GCs, a significant immediate reduction of 13.48 DOT per 1,000 patient days was detected in inpatients (P < .001). However, no significant change in slope was observed before and after the intervention (-0.02 DOT per 1,000 patient days per month; P = .94). Although a temporary increase was observed after the targeted intervention in outpatients, the slope significantly decreased (-0.69 DOT per 1,000 outpatient visits per month; P = .044). No differences were observed in the use of other oral antibiotics after the intervention. CONCLUSIONS The targeted intervention contributed to a reduction in DOT of oral 3GCs in both inpatients and outpatients. Targeted interventions using a collaborative approach might be helpful in further decreasing the inappropriate use of antibiotics.
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Affiliation(s)
- Ryo Yamaguchi
- Department of Pharmacy, the University of Tokyo Hospital, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, the University of Tokyo Hospital, Tokyo, Japan
| | - Takehito Yamamoto
- Department of Pharmacy, the University of Tokyo Hospital, Tokyo, Japan
- The Education Center for Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, the University of Tokyo, Tokyo, Japan
| | - Sohei Harada
- Department of Infection Control and Prevention, Faculty of Medicine, the University of Tokyo Hospital, Tokyo, Japan
| | - Takehiro Tanaka
- Department of Pharmacy, the University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Suzuki
- Department of Pharmacy, the University of Tokyo Hospital, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, the University of Tokyo Hospital, Tokyo, Japan
- Department of Infection Control and Prevention, Faculty of Medicine, the University of Tokyo Hospital, Tokyo, Japan
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10
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Psaltis AJ, Mackenzie BW, Cope EK, Ramakrishnan VR. Unravelling the role of the microbiome in chronic rhinosinusitis. J Allergy Clin Immunol 2022; 149:1513-1521. [PMID: 35300985 DOI: 10.1016/j.jaci.2022.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex, heterogenous condition with likely infectious and inflammatory causative factors. Renewed interest in the role that microbes play in this condition has stemmed from advancements in microbe identification and parallel research that has implicated the role of the microbiome in other chronic inflammatory conditions. This clinical commentary provides a review of the current literature relevant to chronic rhinosinusitis. Particular focus is paid to factors specific to the investigation of the sinonasal microbiome, evidence for the role of dysbiosis in the disease state and influences that may impact the microbiome. Possible mechanisms of disease and therapeutic implications through microbial manipulation are also reviewed, as are deficiencies and limitations of the current body of research.
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Affiliation(s)
- Alkis J Psaltis
- Department of Surgery-Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, Australia.
| | | | - Emily K Cope
- Center for Applied Microbiome Sciences, the Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Ariz
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Ind
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Howe AC, Soupir ML. Antimicrobial resistance in integrated agroecosystems: State of the science and future opportunities. JOURNAL OF ENVIRONMENTAL QUALITY 2021; 50:1255-1265. [PMID: 34528726 DOI: 10.1002/jeq2.20289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
As the Journal of Environmental Quality (JEQ) celebrates 50 years of publication, the division of environmental microbiology is one of the newest additions to the journal. During this time, significant advances in understanding of the interconnected microbial community and impact of the microbiome on natural and designed environmental systems have occurred. In this review, we highlight the intractable challenge of antimicrobial resistance (AMR) on humans, animals, and the environment, with particular emphasis on the role of integrated agroecosystems and by highlighting contributions published in JEQ. From early studies of phenotypic resistance of indicator organisms in waters systems to current calls for integrating AMR assessment across "One Health," publications in JEQ have advanced our understanding of AMR. As we reflect on the state of the science, we emphasize future opportunities. First, integration of phenotypic and molecular tools for assessing environmental spread of AMR and human health risk continues to be an urgent research need for a one health approach to AMR. Second, monitoring AMR levels in manure is recommended to understand inputs and potential spread through agroecosystems. Third, baseline knowledge of AMR levels is important to realize the impact of manure inputs on water quality and public health risk; this can be achieved through background monitoring or identifying the source-related genes or organisms. And finally, conservation practices designed to meet nutrient reduction goals should be explored for AMR reduction potential.
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Affiliation(s)
- Adina C Howe
- Dep. of Agricultural and Biosystems Engineering, Iowa State Univ., Ames, IA, 50011, USA
| | - Michelle L Soupir
- Dep. of Agricultural and Biosystems Engineering, Iowa State Univ., Ames, IA, 50011, USA
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Polymeri A, Loos BG, Aronovich S, Steigmann L, Inglehart MR. Risk factors, diagnosis and treatment of peri-implantitis: A cross-cultural comparison of U.S. and European periodontists' considerations. J Periodontol 2021; 93:481-492. [PMID: 34390497 PMCID: PMC10138758 DOI: 10.1002/jper.21-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peri-implantitis (PI) is a growing concern in the dental community worldwide. The study aimed to compare U.S. vs. European periodontists' considerations of risk factors, diagnostic criteria, and management of PI. MATERIALS AND METHODS 393 periodontists from the U.S. and 100 periodontists from Europe (Germany, Greece, Netherlands) responded to anonymous surveys electronically or by mail. RESULTS Compared to U.S. periodontists, European respondents were younger, more likely to be female and placed fewer implants per month (9.12 vs. 13.90;p = 0.003). Poor oral hygiene, history of periodontitis, and smoking were considered as very important risk factors by both groups (rated >4 on 5-point scale). European periodontists rated poor oral hygiene (4.64 vs. 4.45;p = 0.005) and history of periodontitis (4.36 vs. 4.10;p = 0.006) as more important and implant surface (2.91 vs. 3.18;p = 0.023), occlusion (2.80 vs. 3.75;p<0.001) and presence of keratinized tissue (3.27 vs. 3.77;p<0.001) as less important than did U.S. periodontists. Both groups rated clinical probing, radiographic bone loss, and presence of bleeding and suppuration as rather important diagnostic criteria. They rated implant exposure/mucosal recession as relatively less important with U.S. periodontists giving higher importance ratings than European periodontists (3.99 vs. 3.54;p = 0.001). Both groups nearly always used patient education, plaque control and mechanical debridement when treating PI. U.S. periodontists were more likely to use antibiotics (3.88 vs. 3.07;p<0.001), lasers (2.11 vs. 1.68;p = 0.005), allograft (3.39 vs. 2.14;p<0.001) and regenerative approaches (3.57 vs. 2.56;p<0.001), but less likely to use resective surgery (3.09 vs. 3.53;p<0.001) than European periodontists. CONCLUSIONS U.S. and European periodontists' considerations concerning risk factors, diagnosis and management of PI were evidence-based. Identified differences between the two groups can inform future educational efforts. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angeliki Polymeri
- Department of Periodontology, University of Amsterdam and Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Bruno G Loos
- Department of Periodontology, University of Amsterdam and Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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Adriaenssens N, Bruyndonckx R, Versporten A, Hens N, Monnet DL, Molenberghs G, Goossens H, Weist K, Coenen S. Consumption of macrolides, lincosamides and streptogramins in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother 2021; 76:ii30-ii36. [PMID: 34312653 PMCID: PMC8314107 DOI: 10.1093/jac/dkab175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Data on the consumption of macrolides, lincosamides and streptogramins (MLS) in the community were collected from 30 EU/European Economic Area (EEA) countries over two decades. This article reviews temporal trends, seasonal variation, presence of change-points and changes in composition of the main subgroups of MLS. METHODS For the period 1997-2017, data on consumption of MLS, i.e. ATC group J01F, in the community and aggregated at the level of the active substance, were collected using the WHO ATC/DDD methodology (ATC/DDD index 2019). Consumption was expressed in DDD per 1000 inhabitants per day and in packages per 1000 inhabitants per day. Consumption of MLS was analysed and presented as trends, seasonal variation, presence of change-points and compositional changes, using a classification based on mean plasma elimination half-life for macrolides. RESULTS In 2017, consumption of MLS in the community expressed in DDD per 1000 inhabitants per day varied by a factor of 13 between countries with the highest (Greece) and the lowest (Sweden) consumption. Consumption of MLS did not change significantly up to 2003, after which it significantly increased up to 2007. No significant change was observed after 2007. Consumption of MLS showed high seasonal variation. The proportional consumption of long-acting macrolides significantly increased over time compared with that of intermediate-acting macrolides, and proportional consumption of the latter increased compared with that of short-acting macrolides. CONCLUSIONS Consumption of MLS did not change significantly over time during 2007-2017, while the proportional consumption of long-acting macrolides increased. Seasonal variation remained high, which suggests that MLS are still prescribed inappropriately in many countries.
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Affiliation(s)
- Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Robin Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Dominique L Monnet
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Data Science Institute, Hasselt University, Hasselt, Belgium.,Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Catholic University of Leuven, Leuven, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Klaus Weist
- Disease Programmes Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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14
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Okubo Y, Nariai H, Michels KB, Kim-Farley RJ, Nishi A, Arah OA, Kinoshita N, Uda K, Miyairi I. Change in clinical practice variations for antibiotic prescriptions across different pediatric clinics: A Japan's nationwide observational study. J Infect Chemother 2021; 27:1621-1625. [PMID: 34376349 DOI: 10.1016/j.jiac.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2016, the Japanese government set the National Action Plan on antimicrobial resistance to reduce antibiotic prescriptions. However, the trends and variations of antibiotic prescription patterns in a routine healthcare setting during the fiscal year 2013-2018 across different clinics at a national level are unclear. METHODS This retrospective cohort study included all clinics with >100 pediatric outpatients with infectious diseases per month during the fiscal year 2013-2018 using a national database in Japan. We investigated the trends in antibiotic prescription rates and their patterns and variations across different clinics over the six years following the 2019 World Health Organization Access, Watch, Reserve antibiotic groups, and Amoxicillin Index. RESULTS A total of 2278 clinics with 94,414,170 infectious disease-related visits were eligible for the study. Most clinics showed higher Watch percentages (median 85.4%; IQR, 68.5-95.1) than Access percentages (median, 13.8%; IQR, 4.2-30.7) and Amoxicillin Index (median, 13.3%; IQR, 3.9-30.4). The introduction of the Action Plan changed annual absolute reductions in the antibiotic prescription rates from -16.0 DOTs/1000 visitors (95%CI, -16.4-15.6) to -239.3 per 1000 visitors (95%CI, -240.0-238.6). However, these impacts were heterogeneous across clinics. From 2013 to 2018, 41.4% reduced the antibiotic prescription rates by >33.3% (median, -1035.5 DOTs/1000 visitors; IQR, -1519.4-680.2), 18.7% did not change the rates (median, -40.3 DOTs/1000 visitors; IQR, -168.4-68.6), and 7.3% increased the rates by >10% (499.5 DOTs per 1000 visitors; IQR, 232.6-837.5). CONCLUSIONS We observed the National Action Plan's impacts and extensive prescription variations across different pediatric clinics. However, one-fourth of clinics did not improve antibiotic prescription patterns even after introducing the Action Plan.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
| | - Hiroki Nariai
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | - Karin B Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | - Robert J Kim-Farley
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | - Akihiro Nishi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | - Noriko Kinoshita
- Department of Infectious Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuhiro Uda
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, USA
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Taher MK, Crispo JAG, Fortin Y, Moog R, McNair D, Bjerre LM, Momoli F, Mattison D, Krewski D. Systemic quinolones and risk of acute liver failure III: A nested case-control study using a US electronic health records database. J Gastroenterol Hepatol 2021; 36:2307-2314. [PMID: 33755266 PMCID: PMC8451826 DOI: 10.1111/jgh.15504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Quinolones are globally popular antibiotics with proven potency, broad coverage, and reasonable safety. However, some concerns were raised as to their possible association with acute liver failure (ALF). The aim of this study is to assess ALF risk within 30 days of receiving a systemically administered quinolone antibiotic, in individuals with no history of liver/diseases. METHODS We conducted a nested case-control study using electronic health records from the Cerner Health Facts. The initial cohort (n = 35 349 943) included all patients who were admitted between 2000 and 2016, with no history of liver diseases, and had a minimum medical history of one year. Eligible cases were inpatients who were first diagnosed with ALF between 2010 and 2015. Using incidence density sampling, each case was matched with up to five unique controls by sex, race, age at index encounter, and period-at-risk. We used conditional logistic regression to calculate the odds ratio and 95% confidence interval for ALF risk, upon adjusting for exposure to other medications, and major confounders (diabetes mellitus and alcohol abuse). We used the STROBE Statement for reporting on our study. RESULTS We identified 3151 cases and 15 657 controls. Our primary analysis did not reveal an association between quinolones and ALF risk. However, some risk was identified among those with no or few comorbidities, those ≤ 60 years of age, women, men, African Americans, and Caucasians. CONCLUSION Although our study does not suggest an overall association between quinolones and ALF, elevated risks seen in some subgroups warrant further investigation.
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Affiliation(s)
- Mohamed Kadry Taher
- McLaughlin Centre for Population Health Risk Assessment, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Risk Sciences InternationalOttawaOntarioCanada
| | - James A G Crispo
- McLaughlin Centre for Population Health Risk Assessment, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA,Human Sciences DivisionNorthern Ontario School of MedicineSudburyOntarioCanada
| | - Yannick Fortin
- McLaughlin Centre for Population Health Risk Assessment, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Statistics CanadaOttawaOntarioCanada
| | - Ryan Moog
- Cerner CorporationKansas CityMissouriUSA
| | | | - Lise M Bjerre
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Department of Family MedicineUniversity of OttawaOttawaOntarioCanada,Institut du Savoir MontfortOttawaOntarioCanada
| | - Franco Momoli
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Risk Sciences InternationalOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Donald Mattison
- McLaughlin Centre for Population Health Risk Assessment, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Risk Sciences InternationalOttawaOntarioCanada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Risk Sciences InternationalOttawaOntarioCanada
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Larsson M, Nguyen HQ, Olson L, Tran TK, Nguyen TV, Nguyen CTK. Multi-drug resistance in Streptococcus pneumoniae among children in rural Vietnam more than doubled from 1999 to 2014. Acta Paediatr 2021; 110:1916-1923. [PMID: 33544434 DOI: 10.1111/apa.15795] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 12/27/2020] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
AIM This study assessed the Streptococcus pneumoniae colonisation rate and susceptibility to antibiotics among preschool children in rural Vietnam. METHOD Nasopharyngeal samples were collected from 546 preschool children aged 6-59 months living in 460 households in the rural BaVi District of Hanoi and their main caregivers completed questionnaires. The samples were cultured, and the Streptococcus pneumoniae colonisation rate and antibiotic susceptibility were investigated. Resistance data from this 2014 study were compared with studies in 1999 and 2007, to identify 15-year trends, together with clinical isolates from a national surveillance system of 16 Vietnamese hospital laboratories established in 2013. RESULTS We found that 221/546 (40%) of the cultures were positive for Streptococcus pneumoniae. The susceptibility rates were trimethoprim-sulphamethoxazole (5%), erythromycin (8%), ciprofloxacin (12%), benzyl-penicillin (35%), tetracycline (49%), cefotaxime (55%), moxifloxacin (99%) and vancomycin (99%). All the susceptibility rates were lower in 2014 than 1999 and 2007, except tetracycline. Multi-drug resistance was 80% in 2014, compared to 60% in 2007 and 31% in 1999. Antibiotics was reported used by 191 (35%) within one month, mainly cephalosporins 86 (45%), amoxycillin/ampicillin 69 (36%) and macrolides 30 (16%). CONCLUSION Streptococcus pneumoniae showed remarkable high resistance to commonly used antibiotics, including cephalosporins. Multi-drug resistance rose from 31% to 80% during the 15-year study period.
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Affiliation(s)
- Mattias Larsson
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Training and Research Academic Collaboration (TRAC) Sweden–Vietnam Hanoi Vietnam
| | | | - Linus Olson
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Training and Research Academic Collaboration (TRAC) Sweden–Vietnam Hanoi Vietnam
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | | | | | - Chuc Thi Kim Nguyen
- Training and Research Academic Collaboration (TRAC) Sweden–Vietnam Hanoi Vietnam
- Hanoi Medical University Hanoi Vietnam
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Tomas A, Pavlović N, Stilinović N, Horvat O, Paut-Kusturica M, Dugandžija T, Tomić Z, Sabo A. Increase and Change in the Pattern of Antibiotic Use in Serbia (2010-2019). Antibiotics (Basel) 2021; 10:397. [PMID: 33916896 PMCID: PMC8067575 DOI: 10.3390/antibiotics10040397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010-2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.
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Affiliation(s)
- Ana Tomas
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Nebojša Pavlović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Nebojša Stilinović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Olga Horvat
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Milica Paut-Kusturica
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Tihomir Dugandžija
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Oncology Institute of Vojvodina, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Zdenko Tomić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Ana Sabo
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
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Kagoya HR, Mitonga H, Kibuule D, Rennie T. National standard treatment guidelines: their impact on medicine use indicators in a resource-limited setting. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objectives
Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treatment guidelines on medicine use indicators at the population-level in Namibia.
Methods
An interrupted time-series modeling of the impact of national standard treatment guidelines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, generic and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was reflected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation.
Key findings
Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not significantly improve after the intervention at national and in all regions, except for generic prescribing in Oshikoto region, 4.5% (95% CI: 2.6 – 6.3%, P < 0.001).
Conclusion
Whilst national standard treatment guidelines immediately improved medicine use indicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines.
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Affiliation(s)
- Harriet Rachel Kagoya
- School of Public Health, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Honoré Mitonga
- School of Public Health, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Timothy Rennie
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
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Kusumoto J, Uda A, Kimura T, Furudoi S, Yoshii R, Matsumura M, Miyara T, Akashi M. Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis. BMC Oral Health 2021; 21:20. [PMID: 33413262 PMCID: PMC7791648 DOI: 10.1186/s12903-020-01367-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. METHODS The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. RESULTS After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). CONCLUSIONS This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.
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Affiliation(s)
- Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan.
| | - Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Kimura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
- Department of Oral Surgery, Konan Medical Center, Kobe, Hyogo, 658-0064, Japan
| | - Ryosuke Yoshii
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Megumi Matsumura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Paramasivan S, Bassiouni A, Shiffer A, Dillon MR, Cope EK, Cooksley C, Ramezanpour M, Moraitis S, Ali MJ, Bleier B, Callejas C, Cornet ME, Douglas RG, Dutra D, Georgalas C, Harvey RJ, Hwang PH, Luong AU, Schlosser RJ, Tantilipikorn P, Tewfik MA, Vreugde S, Wormald P, Caporaso JG, Psaltis AJ. The international sinonasal microbiome study: A multicentre, multinational characterization of sinonasal bacterial ecology. Allergy 2020; 75:2037-2049. [PMID: 32167574 DOI: 10.1111/all.14276] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The sinonasal microbiome remains poorly defined, with our current knowledge based on a few cohort studies whose findings are inconsistent. Furthermore, the variability of the sinus microbiome across geographical divides remains unexplored. We characterize the sinonasal microbiome and its geographical variations in both health and disease using 16S rRNA gene sequencing of 410 individuals from across the world. Although the sinus microbial ecology is highly variable between individuals, we identify a core microbiome comprised of Corynebacterium, Staphylococcus, Streptococcus, Haemophilus and Moraxella species in both healthy and chronic rhinosinusitis (CRS) cohorts. Corynebacterium (mean relative abundance = 44.02%) and Staphylococcus (mean relative abundance = 27.34%) appear particularly dominant in the majority of patients sampled. Amongst patients suffering from CRS with nasal polyps, a statistically significant reduction in relative abundance of Corynebacterium (40.29% vs 50.43%; P = .02) was identified. Despite some measured differences in microbiome composition and diversity between some of the participating centres in our cohort, these differences would not alter the general pattern of core organisms described. Nevertheless, atypical or unusual organisms reported in short-read amplicon sequencing studies and that are not part of the core microbiome should be interpreted with caution. The delineation of the sinonasal microbiome and standardized methodology described within our study will enable further characterization and translational application of the sinus microbiota.
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Affiliation(s)
- Sathish Paramasivan
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - Ahmed Bassiouni
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - Arron Shiffer
- Pathogen and Microbiome Institute Northern Arizona University Flagstaff AZ USA
| | - Matthew R. Dillon
- Pathogen and Microbiome Institute Northern Arizona University Flagstaff AZ USA
| | - Emily K. Cope
- Pathogen and Microbiome Institute Northern Arizona University Flagstaff AZ USA
| | - Clare Cooksley
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - Mahnaz Ramezanpour
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - Sophia Moraitis
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | | | - Benjamin Bleier
- Department of Otolaryngology Massachusetts Eye and Ear Infirmary Harvard Medical School Boston MA USA
| | - Claudio Callejas
- Department of Otolaryngology Pontificia Universidad Catolica de Chile Santiago Chile
| | | | | | - Daniel Dutra
- Department of Otorhinolaryngology University of Sao Paulo Sao Paulo Brazil
| | - Christos Georgalas
- Department of Otorhinolaryngology Amsterdam UMC Amsterdam The Netherlands
| | - Richard J. Harvey
- Department of Otolaryngology, Rhinology and Skull base University of New South Wales Sydney NSW Australia
- Faculty of Medicine and Health sciences Macquarie University Sydney NSW Australia
| | - Peter H. Hwang
- Department of Otolaryngology ‐Head and Neck Surgery Stanford University Stanford CA USA
| | - Amber U. Luong
- Department of Otolaryngology ‐Head and Neck Surgery University of Texas Austin TX USA
| | - Rodney J. Schlosser
- Department of Otolaryngology Medical University of South Carolina Charleston SC USA
| | - Pongsakorn Tantilipikorn
- Department of Otorhinolaryngology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Marc A. Tewfik
- Department of Otolaryngology ‐ Head and Neck Surgery McGill University Montreal QC Canada
| | - Sarah Vreugde
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - Peter‐John Wormald
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
| | - J. Gregory Caporaso
- Pathogen and Microbiome Institute Northern Arizona University Flagstaff AZ USA
| | - Alkis J. Psaltis
- Department of Otolaryngology, Head and Neck Surgery University of Adelaide Adelaide SA Australia
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21
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Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000-15: an analysis of pharmaceutical sales data. THE LANCET. INFECTIOUS DISEASES 2020; 21:107-115. [PMID: 32717205 DOI: 10.1016/s1473-3099(20)30332-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The WHO Access, Watch, and Reserve (AWaRe) antibiotic classification framework aims to balance appropriate access to antibiotics and stewardship. We aimed to identify how patterns of antibiotic consumption in each of the AWaRe categories changed across countries over 15 years. METHODS Antibiotic consumption was classified into Access, Watch, and Reserve categories for 76 countries between 2000, and 2015, using quarterly national sample survey data obtained from IQVIA. We measured the proportion of antibiotic use in each category, and calculated the ratio of Access antibiotics to Watch antibiotics (access-to-watch index), for each country. FINDINGS Between 2000, and 2015, global per-capita consumption of Watch antibiotics increased by 90·9% (from 3·3 to 6·3 defined daily doses per 1000 inhabitants per day [DIDs]) compared with an increase of 26·2% (from 8·4 to 10·6 DIDs) in Access antibiotics. The increase in Watch antibiotic consumption was greater in low-income and middle-income countries (LMICs; 165·0%; from 2·0 to 5·3 DIDs) than in high-income countries (HICs; 27·9%; from 6·1 to 7·8 DIDs). The access-to-watch index decreased by 38·5% over the study period globally (from 2·6 to 1·6); 46·7% decrease in LMICs (from 3·0 to 1·6) and 16·7% decrease in HICs (from 1·8 to 1·5), and 37 (90%) of 41 LMICs had a decrease in their relative access-to-watch consumption. The proportion of countries in which Access antibiotics represented at least 60% of their total antibiotic consumption (the WHO national-level target) decreased from 50 (76%) of 66 countries in 2000, to 42 (55%) of 76 countries in 2015. INTERPRETATION Rapid increases in Watch antibiotic consumption, particularly in LMICs, reflect challenges in antibiotic stewardship. Without policy changes, the WHO national-level target of at least 60% of total antibiotic consumption being in the Access category by 2023, will be difficult to achieve. The AWaRe framework is an important measure of the effort to combat antimicrobial resistance and to ensure equal access to effective antibiotics between countries. FUNDING US Centers for Disease Control and Prevention.
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Machado-Alba JE, Valladales-Restrepo LF, Gaviria-Mendoza A, Machado-Duque ME, Figueras A. Patterns of Antibiotic Prescription in Colombia: Are There Differences between Capital Cities and Municipalities? Antibiotics (Basel) 2020; 9:antibiotics9070389. [PMID: 32650491 PMCID: PMC7400600 DOI: 10.3390/antibiotics9070389] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
The use of antibiotics is the most important modifiable risk factor for the development of microorganism resistance. A cross-sectional study of outpatients receiving antibiotic prescriptions registered in a population database in Colombia was conducted. The characteristics of the consumption in capital cities and small municipalities was studied and the AWaRe classification was used. AWaRe classifies antibiotics into three stewardship groups: Access, Watch and Reserve, to emphasize the importance of their optimal use and potential harms of antimicrobial resistance. A total of 182,397 patients were prescribed an antibiotic; the most common were penicillins (38.6%), cephalosporins (30.2%) and fluoroquinolones (10.9%). ‘Access’ antibiotics (86.4%) were the most frequently prescribed, followed by ‘Watch’ antibiotics (17.0%). Being 18 or older, being male, living in a municipality, having one or more comorbidities and urinary, respiratory or gastrointestinal disorders increased the probability of receiving ‘Watch’ or ‘Reserve’ antibiotics. Penicillin and urinary antiseptic prescriptions predominated in cities, while cephalosporin and fluoroquinolone prescriptions predominated in municipalities. This analysis showed that the goal set by the WHO Access of mainly using Access antibiotics is being met, although the high use of Watch antibiotics in municipalities should be carefully studied to determine if it is necessary to design specific campaigns to improve antibiotics use.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, 660003 Pereira, Colombia; (L.F.V.-R.); (A.G.-M.); (M.E.M.-D.)
- Correspondence:
| | - Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, 660003 Pereira, Colombia; (L.F.V.-R.); (A.G.-M.); (M.E.M.-D.)
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, 660003 Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, 660003 Pereira, Colombia; (L.F.V.-R.); (A.G.-M.); (M.E.M.-D.)
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, 660003 Pereira, Colombia
| | - Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, 660003 Pereira, Colombia; (L.F.V.-R.); (A.G.-M.); (M.E.M.-D.)
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, 660003 Pereira, Colombia
| | - Albert Figueras
- Departament de Farmacologia, Terapèutica i Toxicología, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
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Thiebault T. Sulfamethoxazole/Trimethoprim ratio as a new marker in raw wastewaters: A critical review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 715:136916. [PMID: 32041046 DOI: 10.1016/j.scitotenv.2020.136916] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 05/23/2023]
Abstract
Global Trimethoprim (TMP) and Sulfamethoxazole (SMX) occurrences in raw wastewaters were systematically collected from the literature (n = 140 articles) in order to assess the relevance of using the SMX/TMP ratio as a marker of the main origin of wastewaters. These two antibiotics were selected due to their frequent use in association (i.e. co-trimoxazole) in a 5:1 ratio (SMX:TMP) for medication purposes, generating a unique opportunity to globally evaluate the validity of this ratio based on concentration values. Several parameters (e.g. sorption, biodegradation) may affect the theoretical SMX/TMP ratio. However, the collected data highlighted the good agreement between the theoretical ratio and the experimental one, especially in wastewater treatment plant influents and hospital effluents. Only livestock effluents displayed a very high SMX/TMP ratio, indicative of the very significant use of sulfonamide alone in this industry. Conversely, several countries displayed low SMX/TMP ratio values, highlighting local features in the human pharmacopoeia. This review provides new insights in order to develop an easy to handle and sound marker of wastewater origins (i.e. human/livestock), beyond atypical local customs.
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Affiliation(s)
- Thomas Thiebault
- EPHE, PSL University, UMR 7619 METIS, Sorbonne University, CNRS, F-75005, Paris, France.
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24
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Chen HH, Stringer A, Eguale T, Rao GG, Ozawa S. Impact of Antibiotic Resistance on Treatment of Pneumococcal Disease in Ethiopia: An Agent-Based Modeling Simulation. Am J Trop Med Hyg 2020; 101:1042-1053. [PMID: 31516111 DOI: 10.4269/ajtmh.18-0930] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Antimicrobial resistance (AMR) is a growing threat to global health. Although AMR endangers continued effectiveness of antibiotics, the impact of AMR has been poorly estimated in low-income countries. This study sought to quantify the effect of AMR on treatments for pediatric pneumococcal disease in Ethiopia. We developed the DREAMR (Dynamic Representation of the Economics of AMR) model that simulate children younger than 5 years who acquire pneumococcal disease (pneumonia, meningitis, and acute otitis media) and seek treatment from various health facilities in Ethiopia over a year. We examined the AMR levels of three antibiotics (penicillin, amoxicillin, and ceftriaxone), treatment failures, and attributable deaths. We used the cost-of-illness method to assess the resulting economic impact of AMR from a societal perspective by estimating the direct and indirect treatment costs and productivity losses. Findings showed that AMR against antibiotics that were used to treat pneumococcal disease led to 195,763 treatment failures per year, which contributed to 2,925 child deaths annually in Ethiopia. Antimicrobial resistance resulted in a first-line treatment failure rate of 29.4%. In 1 year, the proportion of nonsusceptible Streptococcus pneumoniae bacteria increased by 2.1% and 0.5% for amoxicillin and penicillin, and reduced by 0.3% for less commonly used ceftriaxone. Annual costs of AMR to treat pneumococcal disease were around US$15.8 million, including US$3.3 million for ineffective first-line treatments, US$3.7 million for second-line treatments, and US$8.9 million for long-term productivity losses. Antibiotic stewardship to reduce misuse and overuse of antibiotics is essential to maintain the effectiveness of antibiotics, and lessen the health and economic burden of AMR.
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Affiliation(s)
- Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Stringer
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gauri G Rao
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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25
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Fischer MA, Mahesri M, Lii J, Linder JA. Non-Infection-Related And Non-Visit-Based Antibiotic Prescribing Is Common Among Medicaid Patients. Health Aff (Millwood) 2020; 39:280-288. [DOI: 10.1377/hlthaff.2019.00545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael A. Fischer
- Michael A. Fischer is an associate professor of medicine at Harvard Medical School and an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, both in Boston, Massachusetts
| | - Mufaddal Mahesri
- Mufaddal Mahesri is a research specialist in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital
| | - Joyce Lii
- Joyce Lii is a programmer in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital
| | - Jeffrey A. Linder
- Jeffrey A. Linder is the Michael A. Gertz Professor of Medicine in the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, in Chicago, Illinois
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins. Infection 2019; 47:1037-1045. [PMID: 31605309 DOI: 10.1007/s15010-019-01362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/30/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes. METHODS A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of β-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality. RESULTS The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. CONCLUSION Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.
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Grammatico-Guillon L, Abdurrahim L, Shea K, Astagneau P, Pelton S. Scope of Antibiotic Stewardship Programs in Pediatrics. Clin Pediatr (Phila) 2019; 58:1291-1301. [PMID: 31179745 DOI: 10.1177/0009922819852985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review of pediatric antibiotic stewardship programs (ASPs) summarized the antibiotic prescribing interventions and their impact on antibiotic use and antimicrobial resistance. We reviewed studies of pediatric ASP, including the search terms "antimicrobial stewardship," "antibiotic stewardship," "children," and "pediatric." The articles' selection and review were performed independently by 2 investigators, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-one studies were included, from the past 15 years, increasing after the 2007 IDSA (Infectious Diseases Society of America) guidelines for ASP with a large variability of the programs, and the virtual exclusive focus on inpatient settings (90%): 16 formalized ASP and 5 non-ASP actions. A reduction in antibiotic prescribing in ASP has been demonstrated in the studies reporting pediatric ASP, but only one ASP showed a significant impact on antimicrobial resistance. However, the impact on antibiotic consumption in pediatrics demonstrated the important contribution of these strategies to improve antibiotic use in children, without complications or negative issues.
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Affiliation(s)
| | | | | | - Pascal Astagneau
- APHP University Hospital, Paris, France.,Sorbonne University, Paris France
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29
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Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older. PLoS One 2019; 14:e0223097. [PMID: 31557249 PMCID: PMC6762161 DOI: 10.1371/journal.pone.0223097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Many jurisdictions lack comprehensive population-based antibiotic use data and rely on third party companies, most commonly IQVIA. Our objective was to validate the accuracy of the IQVIA Xponent antibiotic database in identifying high prescribing physicians compared to the reference standard of a highly accurate population-wide database of outpatient antimicrobial dispensing for patients ≥65 years. Methods We conducted this study between 1 March 2016 and 28 February 2017 in Ontario, Canada. We evaluated the agreement and correlation between the databases using kappa statistics and Bland-Altman plots. We also assessed performance characteristics for Xponent to accurately identify high prescribing physicians with sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Results We included 9,272 physicians. The Xponent database has a specificity of 92.4% (95%CI 92.0%-92.8%) and PPV of 77.2% (95%CI 76.0%-78.4%) for correctly identifying the top 25th percentile of physicians by antibiotic volume. In the sensitivity analysis, 94% of the top 25th percentile physicians in Xponent were within the top 40th percentile in the reference database. The mean number of antibiotic prescriptions per physician were similar with a relative difference of -0.4% and 2.7% for female and male patients, respectively. The error was greater in rural areas with a relative difference of -8.4% and -5.6% per physician for female and male patients, respectively. The weighted kappa for quartile agreement was 0.68 (95%CI 0.67–0.69). Conclusion We validated the IQVIA Xponent antibiotic database to identify high prescribing physicians for patients ≥65 years, and identified some important limitations. Collecting accurate population-based antibiotic use data will remain vital to global antimicrobial stewardship efforts.
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Abstract
Antimicrobial resistance (AMR) has been declared a global public health emergency, necessitating the involvement of the whole of society to address this increasingly serious threat. AMR causes prolonged illness, greater risk of infection spread, increased morbidity, and higher mortality rates, which result in increased expenses to the government, healthcare services, and individuals. Inappropriate use of antimicrobials has been indicated as the primary cause for the global expansion of AMR. Under these circumstances, various countries have formulated suitable national action plans to curb AMR. In Japan, the national action plan on AMR was announced in April 2016. Our previous study clarified that orally administered antimicrobials accounted for approximately 90% of total consumption: oral third-generation cephalosporins, macrolides, and fluoroquinolones accounted for approximately 77% of oral consumption. Therefore pharmacists must extend their support for the appropriate use of antimicrobials prescribed by attending physicians to not only hospitalized patients but also outpatients. "Choosing wisely," a US-based health education campaign, warns against unnecessary use of antimicrobials. Pharmacists should strive to disseminate the concept of "choosing wisely" in relation to other medicines, implement further interventions, and evaluate them. In this article, we present data on use of antimicrobials in Japan, and mention how pharmacists should be involved in enabling physicians choose antimicrobials wisely.
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Affiliation(s)
- Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University
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31
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Patel M, Kumar R, Kishor K, Mlsna T, Pittman CU, Mohan D. Pharmaceuticals of Emerging Concern in Aquatic Systems: Chemistry, Occurrence, Effects, and Removal Methods. Chem Rev 2019; 119:3510-3673. [DOI: 10.1021/acs.chemrev.8b00299] [Citation(s) in RCA: 827] [Impact Index Per Article: 165.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Manvendra Patel
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Rahul Kumar
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Kamal Kishor
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Todd Mlsna
- Department of Chemistry, Mississippi State University, Mississippi State, Mississippi 39762, United States
| | - Charles U. Pittman
- Department of Chemistry, Mississippi State University, Mississippi State, Mississippi 39762, United States
| | - Dinesh Mohan
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi 110067, India
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32
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Yi X, Lin C, Ong EJL, Wang M, Zhou Z. Occurrence and distribution of trace levels of antibiotics in surface waters and soils driven by non-point source pollution and anthropogenic pressure. CHEMOSPHERE 2019; 216:213-223. [PMID: 30368086 DOI: 10.1016/j.chemosphere.2018.10.087] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/09/2018] [Accepted: 10/14/2018] [Indexed: 06/08/2023]
Abstract
Antibiotics in surface waters and soils are growing public health concerns and treated wastewater has often been identified as the main source of antibiotics. However, few studies have been conducted to evaluate the occurrence and concentrations of antibiotics in coastal cities without direct impact of wastewater discharge. In this study, the occurrence of 14 antibiotics including four macrolides, three sulfonamides, three β-lactams, lincomycin, chloramphenicol, furazolidon, and monensin in surface waters and soils in Singapore were analyzed with SPE-LC-ESI-MS/MS. The detected concentrations of antibiotics were all below 82.5 ng/L in surface waters and below 80.6 ng/g dry wt in soils. These concentrations were significantly lower than other cities that were under the impact of treated wastewater discharge, suggesting that reduction of treated wastewater discharge reduces occurrence of antibiotics in the environment. However, the wide occurrence of trace levels of antibiotics suggest that other factors may have contributed to detected environmental antibiotics. Population density was positively correlated with concentrations of clarithromycin, lincomycin, azithromycin, and sulfamethoxazole in surface waters, suggesting that non-point source pollution due to anthropogenic pressure may contribute to the wide detection of trace levels of antibiotics. The potential impact of antibiotic use, natural production, and half-lives of antibiotics were further discussed. Further studies are needed to evaluate how anthropogenic activities other than wastewater discharge may contribute to the occurrence of trace level antibiotics and their associated health risks in urban environments.
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Affiliation(s)
- Xinzhu Yi
- School of Life Sciences, South China Normal University, Guangzhou, Guangdong, 510631, China
| | - Chenghui Lin
- Department of Civil and Environmental Engineering, National University of Singapore, 117411, Singapore
| | - Eugene Jie Li Ong
- Department of Civil and Environmental Engineering, National University of Singapore, 117411, Singapore
| | - Mian Wang
- Lyles School of Civil Engineering and Division of Environmental and Ecological Engineering, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN, 47907, United States
| | - Zhi Zhou
- Lyles School of Civil Engineering and Division of Environmental and Ecological Engineering, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN, 47907, United States.
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Kenyon C. Prevalence of macrolide resistance in Treponema pallidum is associated with macrolide consumption. J Med Microbiol 2018; 68:119-123. [PMID: 30520715 DOI: 10.1099/jmm.0.000885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We hypothesized that the large global variations in the prevalence of macrolide resistance in Treponema pallidum are related to differences in population-level macrolide consumption. The hypothesis was tested by, at a country-level, regressing the peak prevalence of macrolide resistance against the national macrolide consumption in the year prior to this, controlling for the year of the resistance prevalence estimate. A strong association was found between the per capita consumption of macrolides and macrolide resistance (coefficient 0.7, 95 % confidence interval 0.2-0.12, P=0.009).
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Affiliation(s)
- Chris Kenyon
- 1HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
- 2Division of Infectious Diseases and HIV Medicine, University of Cape Town, Anzio Road, Observatory 7700, South Africa
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Kenyon C, Buyze J, Wi T. Antimicrobial Consumption and Susceptibility of Neisseria gonorrhoeae: A Global Ecological Analysis. Front Med (Lausanne) 2018; 5:329. [PMID: 30538989 PMCID: PMC6277557 DOI: 10.3389/fmed.2018.00329] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
Aims: The reasons why antimicrobial resistance in Neisseria gonorrhoeae has emerged explosively in certain populations but not others are poorly understood. We hypothesized that population level consumption of antimicrobials plays a role. Methods: Using susceptibility data from the World Health Organizations Global Gonococcal Antimicrobial Surveillance Programme and antimicrobial consumption data from the IMS Health MIDAS database we built linear regression models with country-level cephalosporin, macrolide, and fluoroquinolone consumption (standard doses/1,000 population/year) as the explanatory variable and 1-year lagged ceftriaxone, azithromycin, and ciprofloxacin resistance as the outcome variables. These were performed at two time points 2008/2009 and 2013/2014. Results: The association between antimicrobial resistance and consumption at the level of individual countries was positive in all six assessments. In four instances the positive associations were statistically significant (cephalosporins 2008: coefficient 0.0005 [95% confidence interval (CI) 0.0002–0.0007] and 2013: coefficient 0.0003 [95% CI 0.0002–0.0004]; macrolides 2013: coefficient 0.0005 [95% CI 0.00002–0.001]; fluoroquinolones 2013: coefficient 0.02 [95% CI 0.006–0.031]). Conclusions: Differences in population level consumption of particular antimicrobials may play a role in explaining the variations in the emergence of antimicrobial resistance in N. gonorrhoeae.
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Affiliation(s)
- Chris Kenyon
- Sexually Transmitted Infections HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Jozefien Buyze
- Clinical Trials Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teodora Wi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Curr Probl Pediatr Adolesc Health Care 2018; 48:272-288. [PMID: 30337150 DOI: 10.1016/j.cppeds.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions.
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Affiliation(s)
- Alexandra B Yonts
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States.
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Kållberg C, Årdal C, Salvesen Blix H, Klein E, M. Martinez E, Lindbæk M, Outterson K, Røttingen JA, Laxminarayan R. Introduction and geographic availability of new antibiotics approved between 1999 and 2014. PLoS One 2018; 13:e0205166. [PMID: 30325963 PMCID: PMC6191083 DOI: 10.1371/journal.pone.0205166] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 09/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the urgent need for new, effective antibiotics, few antibiotics of value have entered the market during the past decades. Therefore, incentives have been developed to stimulate antibiotic R&D. For these incentives to be effective, geographic availability for recently approved antibiotics needs to be better understood. In this study, we analyze geographic availability and market introduction of antibiotics approved between 1999 and 2014. MATERIAL AND METHOD We identified antibiotics, considered new chemical entities (NCEs) for systemic use approved globally between 1999 and 2014, from national medicine agencies' lists of approved drugs, and data from the WHO Collaborating Center for Drug Statistics. Geographic availability was mapped using sales data from IQVIA, and analyzed with regards to class, indication, safety, and origin. RESULTS Of the 25 identified NCEs, only 12 had registered sales in more than 10 countries. NCEs with the widest geographic availability had registered sales in more than 70 countries within a ten-year timeframe and 30 countries within a three-year timeframe, spreading across five different geographic regions and three country income classes. Half (52%) of the NCEs had an indication for infections caused by antibiotic- resistant bacteria, little diversity was seen regarding target pathogen and indication. Antibiotics originated from and/or marketed by companies from the US or Europe had greater geographic availability compared to Japanese antibiotics, which seldom reached outside of Asia. For 20 NCEs developers chose to fully or partially sublicense marketing rights to a number of companies of different sizes. CONCLUSION Our findings show great variation in geographic availability of antibiotics, indicating that availability in multiple regions and country income classes is possible, but rarely seen within a few years of market authorization. Sublicensing agreements between multiple companies was common practice. Moreover, differences were seen between countries regarding benefit/risk evaluations and company behavior. These findings could be a potential source of uncertainties, and create barriers to assure that working antibiotics are developed and made available according to public health needs.
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Affiliation(s)
- Cecilia Kållberg
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Hege Salvesen Blix
- Norwegian Institute of Public Health, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Eili Klein
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, United States of America
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elena M. Martinez
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, United States of America
| | - Morten Lindbæk
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kevin Outterson
- School of Law, Boston University, Boston, Massachusetts, United States of America
- CARB-X, Boston, Massachusetts, United States of America
| | - John-Arne Røttingen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, United States of America
- Princeton Environmental Institute, Princeton, New Jersey, United States of America
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Dekker ARJ, de Groot E, Sebalj T, Yardley L, Cals JWL, Verheij TJM, van der Velden AW. Parents' attitudes and views regarding antibiotics in the management of respiratory tract infections in children: a qualitative study of the influence of an information booklet. BJGP Open 2018; 2:bjgpopen18X101553. [PMID: 30564719 PMCID: PMC6184094 DOI: 10.3399/bjgpopen18x101553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Respiratory tract infection (RTI) is the most common reason to consult a GP during childhood, and often results in unnecessary prescribing of antibiotics. Using an information booklet during the consultation has been shown to be a promising tool to reduce antibiotic prescribing. The influence of such information on parents' views, knowledge, and expectations has not been investigated yet. AIM To explore the reported attitude and knowledge of parents towards antibiotics and management of childhood RTI, as well as the added influence of an information booklet, as perceived by parents. DESIGN & SETTING Qualitative interviews were conducted with Dutch parents who consulted the GP with their child for RTI symptoms and received an information booklet. METHOD Semi-structured interviews were audio-recorded, transcribed, coded, and analysed using framework analysis by open-axial coding and describing themes. RESULTS Eighteen parents were interviewed. Four themes were identified: prior reticence towards antibiotics; expectations of the consultation and trust in the GPs' treatment decision; confirmation and reassurance by the booklet; self-management and future consultation intentions. Dutch parents felt reassured and more confident about their pre-existing reticent attitude towards antibiotic treatment; therefore, they thought their opinion and attitude had not really been changed by the booklet. CONCLUSION In a low-prescribing country like the Netherlands, information should focus on enhancing self-efficacy and providing concrete safety-netting advice. For other countries with less reticence towards antibiotics, it is recommended that the knowledge, attitude, and perceptions of the population is studied, in order to be able to tailor interventions.
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Affiliation(s)
- Anne RJ Dekker
- GP Trainee and PhD Candidate, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Esther de Groot
- Postdoctoral Researcher, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom Sebalj
- Psychology Student, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lucy Yardley
- Professor of Health Psychology, Academic Unit of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Jochen WL Cals
- GP and Postdoctoral Researcher, Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Theo JM Verheij
- Professor of Primary Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alike W van der Velden
- Postdoctoral Researcher, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Zanichelli V, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Pulcini C, Le Maréchal M, Tebano G, Vlahović-Palčevski V, Stanić Benić M, Milanič R, Harbarth S, Hulscher ME, Huttner B. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother 2018; 73:vi17-vi29. [PMID: 29878219 PMCID: PMC5989604 DOI: 10.1093/jac/dky115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Affiliation(s)
- Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Cobey S, Baskerville EB, Colijn C, Hanage W, Fraser C, Lipsitch M. Host population structure and treatment frequency maintain balancing selection on drug resistance. J R Soc Interface 2018; 14:rsif.2017.0295. [PMID: 28835542 PMCID: PMC5582124 DOI: 10.1098/rsif.2017.0295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/28/2017] [Indexed: 11/15/2022] Open
Abstract
It is a truism that antimicrobial drugs select for resistance, but explaining pathogen- and population-specific variation in patterns of resistance remains an open problem. Like other common commensals, Streptococcus pneumoniae has demonstrated persistent coexistence of drug-sensitive and drug-resistant strains. Theoretically, this outcome is unlikely. We modelled the dynamics of competing strains of S. pneumoniae to investigate the impact of transmission dynamics and treatment-induced selective pressures on the probability of stable coexistence. We find that the outcome of competition is extremely sensitive to structure in the host population, although coexistence can arise from age-assortative transmission models with age-varying rates of antibiotic use. Moreover, we find that the selective pressure from antibiotics arises not so much from the rate of antibiotic use per se but from the frequency of treatment: frequent antibiotic therapy disproportionately impacts the fitness of sensitive strains. This same phenomenon explains why serotypes with longer durations of carriage tend to be more resistant. These dynamics may apply to other potentially pathogenic, microbial commensals and highlight how population structure, which is often omitted from models, can have a large impact.
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Affiliation(s)
- Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | | | - Caroline Colijn
- Department of Mathematics, Imperial College London, London, UK
| | - William Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christophe Fraser
- Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Long-term impact of 10-valent pneumococcal conjugate vaccination on invasive pneumococcal disease among children in Finland. Vaccine 2018. [DOI: 10.1016/j.vaccine.2018.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van der Werf ET, Duncan LJ, Flotow PV, Baars EW. Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates? Retrospective cross-sectional analysis of national primary care prescribing data in England in 2016. BMJ Open 2018; 8:e020488. [PMID: 29555793 PMCID: PMC5875618 DOI: 10.1136/bmjopen-2017-020488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine differences in antibiotic prescription rates between conventional General Practice (GP) surgeries and GP surgeries employing general practitioners (GPs) additionally trained in integrative medicine (IM) or complementary and alternative medicine (CAM) (referred to as IM GPs) working within National Health Service (NHS) England. DESIGN Retrospective study on antibiotic prescription rates per STAR-PU (Specific Therapeutic group Age-sex weighting Related Prescribing Unit) using NHS Digital data over 2016. Publicly available data were used on prevalence of relevant comorbidities, demographics of patient populations and deprivation scores. SETTING Primary Care. PARTICIPANTS 7283 NHS GP surgeries in England. PRIMARY OUTCOME MEASURE The association between IM GPs and antibiotic prescribing rates per STAR-PU with the number of antibiotic prescriptions (total, and for respiratory tract infection (RTI) and urinary tract infection (UTI) separately) as outcome. RESULTS IM GP surgeries (n=9) were comparable to conventional GP surgeries in terms of list sizes, demographics, deprivation scores and comorbidity prevalence. Negative binomial regression models showed that statistically significant fewer total antibiotics (relative risk (RR) 0.78, 95% CI 0.64 to 0.97) and RTI antibiotics (RR 0.74, 95% CI 0.59 to 0.94) were prescribed at NHS IM GP surgeries compared with conventional NHS GP surgeries. In contrast, the number of antibiotics prescribed for UTI were similar between both practices. CONCLUSION NHS England GP surgeries employing GPs additionally trained in IM/CAM have lower antibiotic prescribing rates. Accessibility of IM/CAM within NHS England primary care is limited. Main study limitation is the lack of consultation data. Future research should include the differences in consultation behaviour of patients self-selecting to consult an IM GP or conventional surgery, and its effect on antibiotic prescription. Additional treatment strategies for common primary care infections used by IM GPs should be explored to see if they could be used to assist in the fight against antimicrobial resistance.
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Affiliation(s)
- Esther T van der Werf
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna J Duncan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Erik W Baars
- Louis Bolk Institute, Bunnik, The Netherlands
- University of Applied Sciences, Leiden, The Netherlands
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Variations in Antibiotic and Azithromycin Prescribing for Children by Geography and Specialty-United States, 2013. Pediatr Infect Dis J 2018; 37:52-58. [PMID: 28746259 PMCID: PMC6622452 DOI: 10.1097/inf.0000000000001708] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Using antibiotics appropriately is critical to slow spread of antibiotic resistance, a major public health problem. Children, especially young children, receive more antibiotics than other age groups. Our objective was to describe antibiotic use in children in the United States and use of azithromycin, which is recommended infrequently for pediatric conditions. METHODS We used QuintilesIMS Xponent 2013 data to calculate the number and rate of oral antibiotic prescriptions for children by age (0-2, 3-9 and 10-19 years) and agent. We used log-binomial regression to calculate adjusted prevalence ratios and 95% confidence intervals to determine if specialty and patient age were associated with azithromycin selection when an antibiotic was prescribed. RESULTS In 2013, 66.8 million antibiotics were prescribed to US children ≤19 years of age (813 antibiotic prescriptions per 1000 children). Amoxicillin and azithromycin were the 2 most commonly prescribed agents (23.1 million courses, 35% of all antibiotics; 12.2 million, 18%, respectively). Most antibiotics for children were prescribed by pediatricians (39%) and family practitioners (15%). Family practitioners were more likely to select azithromycin when an antibiotic was prescribed in all age groups than pediatricians (for children 0-2 years of age: prevalence ratio: 1.79, 95% confidence interval: 1.78-1.80; 3-9 years: 1.40, 1.40-1.40 and 10-19 years: 1.18, 1.18-1.18). CONCLUSION Despite infrequent pediatric recommendations, variations in pediatric azithromycin use may suggest inappropriate antibiotic selection. Public health interventions focused on improving antibiotic selection in children as well as reducing antibiotic overuse are needed.
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Riaz L, Mahmood T, Khalid A, Rashid A, Ahmed Siddique MB, Kamal A, Coyne MS. Fluoroquinolones (FQs) in the environment: A review on their abundance, sorption and toxicity in soil. CHEMOSPHERE 2018; 191:704-720. [PMID: 29078193 DOI: 10.1016/j.chemosphere.2017.10.092] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 06/07/2023]
Abstract
The use of fluoroquinolones (FQs) antibiotics as therapeutic agents and growth promoters is increasing worldwide; however their extensive uses are also resulting in antibiotic resistance among world communities. FQs have also become one of the major contaminants in the waste water bodies, which are not even completely removed during the treatment processes. Furthermore, their abundance in agricultural resources, such as the irrigation water, the bio-solids and the livestock manure can also affect the soil micro-environment. These antibiotics in soil tend to interact in several different ways to affect soil flora and fauna. The current review endeavors to highlight the some critical aspects of FQs prevalence in the environment. The review presents a detailed discussion on the pathways and abundance of FQs in soil. The discussion further spans the issue of sorption and FQs transformation into the soil better understand of their behavior and their toxicity to soil flora and fauna.
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Affiliation(s)
- Luqman Riaz
- Department of Environmental Sciences, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46300, Pakistan.
| | - Tariq Mahmood
- Department of Environmental Sciences, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46300, Pakistan
| | - Azeem Khalid
- Department of Environmental Sciences, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46300, Pakistan
| | - Audil Rashid
- Department of Environmental Sciences, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46300, Pakistan
| | | | - Atif Kamal
- Department of Environmental Sciences, Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi 46300, Pakistan
| | - Mark S Coyne
- Department of Plant & Soil Sciences University of Kentucky, Lexington KY 40546-0091, USA
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Ellegård LM, Dietrichson J, Anell A. Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics? HEALTH ECONOMICS 2018; 27:e39-e54. [PMID: 28685902 PMCID: PMC5836891 DOI: 10.1002/hec.3535] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 05/05/2023]
Abstract
Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.
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Affiliation(s)
| | - Jens Dietrichson
- SFIThe Danish National Centre for Social ResearchCopenhagenDenmark
| | - Anders Anell
- Department of Business AdministrationLund UniversityLundSweden
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Abstract
Natural products have served as powerful therapeutics against pathogenic bacteria since the golden age of antibiotics of the mid-20th century. However, the increasing frequency of antibiotic-resistant infections clearly demonstrates that new antibiotics are critical for modern medicine. Because combinatorial approaches have not yielded effective drugs, we propose that the development of new antibiotics around proven natural scaffolds is the best short-term solution to the rising crisis of antibiotic resistance. We analyze herein synthetic approaches aiming to reengineer natural products into potent antibiotics. Furthermore, we discuss approaches in modulating quorum sensing and biofilm formation as a nonlethal method, as well as narrow-spectrum pathogen-specific antibiotics, which are of interest given new insights into the implications of disrupting the microbiome.
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Affiliation(s)
- Sean E. Rossiter
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, Georgia 30322, United States
| | - Madison H. Fletcher
- Department of Chemistry, Temple University, 1901 North 13th Street, Philadelphia, Pennsylvania 19122, United States
| | - William M. Wuest
- Department of Chemistry, Emory University, 1515 Dickey Drive, Atlanta, Georgia 30322, United States
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Glenn H, Friedman J, Borecki AA, Bradshaw C, Grandjean-Thomsen N, Pickup H, Yin MY, Jun C, Abdel-Latif ME. Patient Demographic and Clinician Factors in Antibiotic Prescribing for Upper Respiratory Tract Infections in the Australian Capital Territory from 2006-2015. J Clin Diagn Res 2017; 11:FC01-FC05. [PMID: 28969150 PMCID: PMC5620791 DOI: 10.7860/jcdr/2017/25539.10395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/26/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION National antibiotic stewardship programs aim to mitigate rising antimicrobial resistance and associated healthcare costs by promoting safe and appropriate antibiotic prescribing. AIM This study aimed to analyse patient and clinician demographic factors that may influence antibiotic prescribing for Upper Respiratory Tract Infections (URTIs). Trends in antibiotic prescribing patterns were also analysed over the study period. MATERIALS AND METHODS This retrospective cross-sectional study analysed data from the Australian National University Medical School Clinical Audit Project database, comprising data collected by students during patient encounters over a two week period each April-May between 2006 and 2015 (excluding 2013). Data was collected via standardised survey in multiple healthcare settings and locations in the Australian Capital Territory (ACT) and Southeast New South Wales. (NSW) URTI diagnosis and symptomatology were defined using the International Classification of Disease (ICD-10) and International Classification of Primary Care, version 2 PLUS (ICPC-2+) criteria. RESULTS URTI accounted for 5.6% (n=698) of total patient encounters (n=12,468), and of these, 42.7% (n=289) were prescribed an antibiotic intervention. Antibiotics were significantly more likely to be prescribed in the hospital setting (44.2%; n=237) compared to community GP (32.1%; n=52; p<0.05) and for patients presenting with localised symptoms (65.9%; n=109) compared to generalised symptoms (33.7%; n=122; p<0.01). No significant association was observed for age, rurality, patient gender, clinical gender or Indigenous status. The most frequently prescribed antibiotic was penicillin (67.8%; n=196). Over the decade of study, antibiotic prescribing for URTIs showed decreasing trend both overall (R2=0.204) and with respect to all demographic factors assessed. CONCLUSION This study supports the effectiveness to-date of antibiotic stewardship programs in Australia. While continued efforts are required to further mitigate antibiotic resistance, this study suggests target areas may include improving clinician resistance to patient demand for antibiotics and increasing confidence in prescribing for special populations such as Indigenous peoples and the extremes of age.
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Affiliation(s)
- Hannah Glenn
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Justin Friedman
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Alexander A. Borecki
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Camilla Bradshaw
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Nicolas Grandjean-Thomsen
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Harrison Pickup
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Michelle Yue Yin
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Catherine Jun
- Medical School, College of Medicine, Biology and Environment, Australian National University, Acton, Australia
| | - Mohamed E. Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, ACT, Australia
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Su T, Broekhuizen BDL, Verheij TJM, Rockmann H. The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study. Clin Transl Allergy 2017; 7:18. [PMID: 28593040 PMCID: PMC5461748 DOI: 10.1186/s13601-017-0154-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suspected penicillin allergy (Pen-A) is often not verified by diagnostic testing. In third line penicillin allergy labels were associated with prescription of broad spectrum antibiotics, hospital stay duration and readmission. OBJECTIVE Assess the impact of Pen-A labels on antibiotic and health care use in primary care. METHODS A retrospective cohort study was conducted in primary care in the Utrecht area, the Netherlands. All patients registered with a penicillin allergy on 31 December 2013 were selected from the General Practitioner Network database. Each patient with a Pen-A label was matched for age, gender, follow-up period with three patients without Pen-A label. Risk (OR) of receiving a reserve and second choice antibiotic, number and type of antibiotics prescribed during follow-up and number of GP contacts were compared between the two cohorts. RESULTS Of 196,440 patients, 1254 patients (0.6%) with a Pen-A label were identified and matched with 3756 patients without Pen-A label. Pen-A labels resulted in higher risk of receiving ≥1 antibiotic prescription per year (OR 2.56, 95% CI 2.05-3.20), ≥1 s choice antibiotic prescription per year (OR 2.21 95% CI 1.11-4.40), and ≥4 GP contacts per year (OR 1.71 95% CI 1.46-2.00). The chance of receiving tetracyclins (OR 2.24, 95% CI 1.29-3.89), macrolides/lincosamides/streptogamins (OR 8.69, 95% CI 4.26-17.73) and quinolones (OR 2.59, 95% CI 1.22-5.48) was higher in Pen-A patients. CONCLUSIONS In primary health care Pen-A labels are associated with increased antibiotic use, including second choice antibiotics, and more health care use.
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Affiliation(s)
- Tanly Su
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heike Rockmann
- Department of Dermatology and Allergology, University Medical Center Utrecht, G02.129, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Natali Sora I, Fumagalli D. Fast photocatalytic degradation of pharmaceutical micropollutants and ecotoxicological effects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:12556-12561. [PMID: 27640060 DOI: 10.1007/s11356-016-7640-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/07/2016] [Indexed: 05/25/2023]
Abstract
Aqueous solutions of ciprofloxacin (CP) and ibuprofen (IBP) in the presence of LaFeO3 photocatalyst, of H2O2, and of both LaFeO3 and H2O2 were irradiated under visible light. The degradation rate in the presence of both LaFeO3 and H2O2 after 5 h irradiation was more than 90 % for CP and 40 % for IBP, much higher than that with only H2O2 under visible light. For the sake of comparison, the experiments were also carried out in the dark, and both CP and IBP were not significantly converted. The degradation rate was enhanced by the simultaneous presence of small concentration of LaFeO3 (130 mg L-1) and H2O2 (0.003 M). However, tests on the aquatic acute toxicity indicate that the degradation products of CP and IBP induce toxic effects on aquatic organisms, consequently indicating incomplete detoxification after 5 h irradiation. The main degradation product of IBP was 4-isobutylacetophenone (4-IBAP), detected in the irradiated solutions by using UV/vis spectrophotometry. 4-IBAP was more toxic and showed a slower photocatalytic degradation than the parent compound. On the contrary, the toxicity of CP degradation products, although not negligible, was comparable to that of CP itself.
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Affiliation(s)
- Isabella Natali Sora
- Department of Engineering and Applied Sciences, University of Bergamo, Viale Marconi 5, 24044, Dalmine, Italy.
- INSTM R.U. Bergamo, University of Bergamo, 24044, Dalmine, BG, Italy.
| | - Davide Fumagalli
- Department of Engineering and Applied Sciences, University of Bergamo, Viale Marconi 5, 24044, Dalmine, Italy
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Pitiriga V, Vrioni G, Saroglou G, Tsakris A. The Impact of Antibiotic Stewardship Programs in Combating Quinolone Resistance: A Systematic Review and Recommendations for More Efficient Interventions. Adv Ther 2017; 34:854-865. [PMID: 28303388 DOI: 10.1007/s12325-017-0514-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Indexed: 12/16/2022]
Abstract
Quinolones are among the most commonly prescribed antibiotics worldwide. A clear relationship has been demonstrated between excessive quinolone use and the steady increase in the incidence of quinolone-resistant bacterial pathogens, both in hospital and community sites. In addition, exposure to quinolones has been associated with colonization and infection with healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus and Clostridium difficile in hospitalized patients. Therefore, the management of quinolone prescribing in hospitals through antibiotic stewardship programs is considered crucial. Although suggestions have been made by previous studies on the positive impact of stewardship programs concerning the emergence and spread of multidrug-resistant bacteria at hospital level, the association of quinolone-targeted interventions with reduction of quinolone resistance is vague. The purpose of this article was to evaluate the impact of stewardship interventions on quinolone resistance rates and healthcare-associated infections, through a literature review using systematic methods to identify and select the appropriate studies. Recommendations for improvements in quinolone-targeted stewardship programs are also proposed. Efforts in battling quinolone resistance should combine various interventions such as restriction formulary policies, prospective audits with feedback to prescribers, infection prevention and control measures, prompt detection of low-level resistance, educational programs, and guidelines for optimal quinolone usage. However, the effectiveness of such strategies should be assessed by properly designed and conducted clinical trials. Finally, novel approaches in diagnostic stewardship for rapidly detecting bacterial resistance, including PCR-based techniques, mass spectrometry, microarrays, and whole-genome sequencing as well as the prompt investigation on the clonality of quinolone-resistant strains, will strengthen our ability to personalize quinolone prescribing to individual patients.
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Youngster I, Avorn J, Belleudi V, Cantarutti A, Díez-Domingo J, Kirchmayer U, Park BJ, Peiró S, Sanfélix-Gimeno G, Schröder H, Schüssel K, Shin JY, Shin SM, Simonsen GS, Blix HS, Tong A, Trifirò G, Ziv-Baran T, Kim SC. Antibiotic Use in Children - A Cross-National Analysis of 6 Countries. J Pediatr 2017; 182:239-244.e1. [PMID: 28012694 DOI: 10.1016/j.jpeds.2016.11.027] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe the rates of pediatric antibiotic use across 6 countries on 3 continents. STUDY DESIGN Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries. RESULTS A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway, 64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population. CONCLUSIONS We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents.
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Affiliation(s)
- Ilan Youngster
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Javier Díez-Domingo
- Health Services Research Unit, Center for Public Health Research, Valencia, Spain
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Salvador Peiró
- Health Services Research Unit, Center for Public Health Research, Valencia, Spain
| | | | - Helmut Schröder
- Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany
| | - Katrin Schüssel
- Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany
| | - Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Sun Mi Shin
- Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Hege Salvesen Blix
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gianluca Trifirò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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