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Akintan P, Oshun P, Osuagwu C, Ola-Bello O, Fajolu I, Roberts A, Temiye E, Oduyebo O. Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country-the impact of an antimicrobial stewardship program. BMC Pediatr 2024; 24:383. [PMID: 38834956 DOI: 10.1186/s12887-024-04847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. METHOD A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis ( http://www.global-pps.com ). RESULTS A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. CONCLUSION The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.
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Affiliation(s)
- Patricia Akintan
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria.
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Philip Oshun
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chioma Osuagwu
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olafoyekemi Ola-Bello
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Iretiola Fajolu
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Alero Roberts
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Edamisan Temiye
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Wushouer H, Du K, Yu J, Zhang W, Hu L, Ko W, Fu M, Zheng B, Shi L, Guan X. Outpatient Antibiotic Prescribing Patterns in Children among Primary Healthcare Institutions in China: A Nationwide Retrospective Study, 2017-2019. Antibiotics (Basel) 2024; 13:70. [PMID: 38247629 PMCID: PMC10812453 DOI: 10.3390/antibiotics13010070] [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: 11/17/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
There is scarce evidence to demonstrate the pattern of antibiotic use in children in China. We aimed to describe antibiotic prescribing practices among children in primary healthcare institutions (PHIs) in China. We described outpatient antibiotic prescriptions for children in PHIs from January 2017 to December 2019 at both the national and diagnostic levels, utilizing the antibiotic prescribing rate (APR), multi-antibiotic prescribing rate (MAPR), and broad-spectrum prescribing rate (BAPR). Generalized estimating equations were adopted to analyze the factors associated with antibiotic use. Among the total 155,262.2 weighted prescriptions for children, the APR, MAPR, and BAPR were 43.5%, 9.9%, and 84.8%. At the national level, J01DC second-generation cephalosporins were the most prescribed antibiotic category (21.0%, N = 15,313.0), followed by J01DD third-generation cephalosporins (17.4%, N = 12,695.8). Watch group antibiotics accounted for 55.0% of the total antibiotic prescriptions (N = 52,056.3). At the diagnostic level, respiratory tract infections accounted for 67.4% of antibiotic prescriptions, among which prescriptions with diagnoses classified as potentially bacterial RTIs occupied the highest APR (55.0%). For each diagnostic category, the MAPR and BAPR varied. Age, region, and diagnostic categories were associated with antibiotic use. Concerns were raised regarding the appropriateness of antibiotic use, especially for broad-spectrum antibiotics.
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Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
| | - Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Junxuan Yu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Wanmeng Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Weihsin Ko
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, China;
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (K.D.); (J.Y.); (W.Z.); (L.H.); (W.K.); (M.F.)
- International Research Center for Medicinal Administration (IRCMA), Peking University, Beijing 100191, China
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Yao L, Liu Q, Lei Z, Sun T. Development and challenges of antimicrobial peptide delivery strategies in bacterial therapy: A review. Int J Biol Macromol 2023; 253:126819. [PMID: 37709236 DOI: 10.1016/j.ijbiomac.2023.126819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
The escalating global prevalence of antimicrobial resistance poses a critical threat, prompting concerns about its impact on public health. This predicament is exacerbated by the acute shortage of novel antimicrobial agents, a scarcity attributed to the rapid surge in bacterial resistance. This review delves into the realm of antimicrobial peptides, a diverse class of compounds ubiquitously present in plants and animals across various natural organisms. Renowned for their intrinsic antibacterial activity, these peptides provide a promising avenue to tackle the intricate challenge of bacterial resistance. However, the clinical utility of peptide-based drugs is hindered by limited bioavailability and susceptibility to rapid degradation, constraining efforts to enhance the efficacy of bacterial infection treatments. The emergence of nanocarriers marks a transformative approach poised to revolutionize peptide delivery strategies. This review elucidates a promising framework involving nanocarriers within the realm of antimicrobial peptides. This paradigm enables meticulous and controlled peptide release at infection sites by detecting dynamic shifts in microenvironmental factors, including pH, ROS, GSH, and reactive enzymes. Furthermore, a glimpse into the future reveals the potential of targeted delivery mechanisms, harnessing inflammatory responses and intricate signaling pathways, including adenosine triphosphate, macrophage receptors, and pathogenic nucleic acid entities. This approach holds promise in fortifying immunity, thereby amplifying the potency of peptide-based treatments. In summary, this review spotlights peptide nanosystems as prospective solutions for combating bacterial infections. By bridging antimicrobial peptides with advanced nanomedicine, a new therapeutic era emerges, poised to confront the formidable challenge of antimicrobial resistance head-on.
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Affiliation(s)
- Longfukang Yao
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China
| | - Qianying Liu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhixin Lei
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China.
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China; Hubei Key Laboratory of Nanomedicine for Neurodegenerative Diseases, Wuhan University of Technology, 122 Luoshi Road, Wuhan 430070, China.
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Yan B, He Z, Dong S, Akezhuoli H, Xu X, Wang X, Zhou X. The moderating effect of parental skills for antibiotic identification on the link between parental skills for antibiotic use and inappropriate antibiotic use for children in China. BMC Public Health 2023; 23:156. [PMID: 36690967 PMCID: PMC9872431 DOI: 10.1186/s12889-023-15099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Inappropriate antibiotic consumption promotes antibiotic resistance. However, findings on the association between antibiotic-related knowledge and behaviors are inconsistent and contradictory, resulting in unjustified guidance of interventions. The mechanisms between the different kinds of antibiotic-related skills contained in knowledge modules in some previous studies are indistinct and rarely studied. METHODS A cross-sectional survey was conducted between June 2017 and April 2018 in three Chinese provinces, investigating 9526 parents with children aged 0-13 years old. Data from 1944 parents who self-medicated their children and 2478 respondents whose children sought care were analyzed. RESULTS Skills for antibiotic identification were found to be a moderator for the association between skills for antibiotic use and two inappropriate behaviors. Compared with parents with low levels of both skills for antibiotic identification and use, those mastering both skills at either medium (OR = 0.48, 95% CI [0.26-0.88]) or high (OR = 0.15, 95% CI [0.07-0.34]) level were less likely to self-medicate their children with antibiotics. Parents with a medium level of skills for antibiotic identification and high level of skills for antibiotic use (OR = 0.18, 95% CI [0.08-0.44]) and those with a high level of both skills (OR = 0.15, 95% CI [0.05-0.47]) were less likely to ask doctors for antibiotics when seeking care. CONCLUSION Parents' high level of skills for antibiotic identification is revealed to promote inappropriate antibiotic use when parents master a low level of skills for antibiotic use. Conversely, based on excellent skills for antibiotic use, better skill for antibiotic identification is associated with a greater reduction in inappropriate behaviors. We recommend future health education to strengthen skills for antibiotic identification along with guidance on antibiotic use.
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Affiliation(s)
- Bo Yan
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenke He
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shixin Dong
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hailati Akezhuoli
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Xu
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, Hangzhou, China.
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Bert F, Previti C, Calabrese F, Scaioli G, Siliquini R. Antibiotics Self Medication among Children: A Systematic Review. Antibiotics (Basel) 2022; 11:1583. [PMID: 36358240 PMCID: PMC9687075 DOI: 10.3390/antibiotics11111583] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 09/29/2023] Open
Abstract
The phenomenon of bacterial antimicrobial resistance (AMR) is a rapidly growing global problem. Overuse and misuse of antibiotics as well as self-prescription are among the most important causes contributing to the growth of antibiotic resistance in humans. This systematic review describes the phenomenon of antibiotics self-medication (ASM) in children. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus, and Web of Science until July 2022. Published English language studies containing information regarding parents knowledge, attitudes, and behaviors in self-administration of antibiotics in children were included. A total of 702 articles were identified, and 57 were selected. A higher prevalence of ASM among children was found in the Middle-East (34%), Africa (22%), Asia (20%) and South America (17%), while the lowest prevalence was found in Europe (8%). High distance from hospital, and low income, such as having more than one child, are related with an increased risk of ASM in children. Fever and cough can also promote the misuse of antibiotics by parents. A greater attention to the regulation of the sale of antimicrobial drugs can certainly limit the risk of self-medicating behavior.
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Affiliation(s)
- Fabrizio Bert
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
- Hygiene and Infection Control Unit, ASL TO3, 10098 Turin, Italy
| | - Christian Previti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Calabrese
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Giacomo Scaioli
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
- AOU City of Health and Science of Turin, 10126 Turin, Italy
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Zhou Y, Ji X, Liang B, Jiang B, Li Y, Yuan T, Zhu L, Liu J, Guo X, Sun Y. Antimicrobial Resistance and Prevalence of Extended Spectrum β-Lactamase-Producing Escherichia coli from Dogs and Cats in Northeastern China from 2012 to 2021. Antibiotics (Basel) 2022; 11:1506. [PMID: 36358160 PMCID: PMC9686880 DOI: 10.3390/antibiotics11111506] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
(1) Background: there has been a growing concern about pet-spread bacterial zoonosis in recent years. This study aimed to investigate the trend in drug-resistance of canine Escherichia coli isolates in northeast China between 2012-2021 and the differences in drug-resistance of E. coli of different origins in 2021. (2) Methods: E. coli were isolated from feces or anal swab samples from dogs and cats, and their antibiotic susceptibility profiles and phylogenetic grouping were identified. PCR was applied on the extended spectrum β-lactamase (ESBL) E. coli for antibiotic resistance genes. (3) Results: five hundred and fifty-four E. coli isolates were detected in 869 samples (63.75%). The multidrug resistance (MDR) rates of E. coli in pet dogs showed a decreasing trend, but working dogs showed the opposite trend. Resistance genes blaCTX-M and blaCTX-M+TEM were dominant among the ESBL producers (n = 219). The consistency between the resistance phenotypes and genes was high except for fluoroquinolone-resistant ESBL E. coli. All ESBL E. coli-carrying blaNDM were isolated from working dogs, and one of the strains carried mcr-1 and blaNDM-4. Phylogroup B2 was the dominant group in pet cats, and more than half of the isolates from companion cats were ESBL E. coli. (4) Conclusions: the measures taken to reduce resistance in China were beginning to bear fruit. Companion cats may be more susceptible to colonization by ESBL E. coli. The problem of resistant bacteria in working dogs and pet cats warrants concern.
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Affiliation(s)
- Yifan Zhou
- Engineering Research Center of Glycoconjugates, Ministry of Education, School of Life Sciences, Northeast Normal University, Changchun 130024, China
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
| | - Xue Ji
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Bing Liang
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Bowen Jiang
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Yan Li
- Engineering Research Center of Glycoconjugates, Ministry of Education, School of Life Sciences, Northeast Normal University, Changchun 130024, China
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
| | - Tingyv Yuan
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
| | - Lingwei Zhu
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Jun Liu
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Xuejun Guo
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
| | - Yang Sun
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130021, China
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun 130021, China
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Edessa D, Assefa N, Dessie Y, Asefa F, Dinsa G, Oljira L. Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis. J Pharm Policy Pract 2022; 15:57. [PMID: 36180895 PMCID: PMC9524137 DOI: 10.1186/s40545-022-00454-8] [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: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. METHODS A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. RESULTS In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. CONCLUSIONS We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. TRIAL REGISTRATION NUMBER CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
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Affiliation(s)
- Dumessa Edessa
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center-Oak Ridge National Laboratory (UTHSC-ORNL, Memphis, TN, USA
| | - Girmaye Dinsa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Cai S, Wang N, Xu L, Yan F, Jiang Q, Zhao X, Wang W, Wang H, Jiang L, Cong W, Sheppard SK, Weeks J, Kasprzyk-Hordern B, Fu C, Lambert H. Impacts of Antibiotic Residues in the Environment on Bacterial Resistance and Human Health in Eastern China: An Interdisciplinary Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138145. [PMID: 35805804 PMCID: PMC9266211 DOI: 10.3390/ijerph19138145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023]
Abstract
Antibiotic resistance is a global health challenge that threatens human and animal lives, especially among low-income and vulnerable populations in less-developed countries. Its multi-factorial nature requires integrated studies on antibiotics and resistant bacteria in humans, animals, and the environment. To achieve a comprehensive understanding of the situation and management of antibiotic use and environmental transmission, this paper describes a study protocol to document human exposure to antibiotics from major direct and indirect sources, and its potential health outcomes. Our mixed-methods approach addresses both microbiological and pathogen genomics, and epidemiological, geospatial, anthropological, and sociological aspects. Implemented in two rural residential areas in two provinces in Eastern China, linked sub-studies assess antibiotic exposure in population cohorts through household surveys, medicine diaries, and biological sampling; identify the types and frequencies of antibiotic resistance genes in humans and food-stock animals; quantify the presence of antibiotic residues and antibiotic resistance genes in the aquatic environment, including wastewater; investigate the drivers and behaviours associated with human and livestock antibiotic use; and analyse the national and local policy context, to propose strategies and systematic measurements for optimising and monitoring antibiotic use. As a multidisciplinary collaboration between institutions in the UK and China, this study will provide an in-depth understanding of the influencing factors and allow comprehensive awareness of the complexity of AMR and antibiotic use in rural Eastern China.
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Affiliation(s)
- Shenghan Cai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Na Wang
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Like Xu
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Fei Yan
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xinping Zhao
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Wei Wang
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Hexing Wang
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
| | - Lufang Jiang
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
| | - Wenjuan Cong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Samuel K Sheppard
- The Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, UK
- Department of Zoology, University of Oxford, Oxford OX1 2JD, UK
| | | | | | - Chaowei Fu
- Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory of Health Technology Assessment, Shanghai 200032, China
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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Yuan J, Du W, Li Z, Deng Q, Ma G. Prevalence and Risk Factors of Self-Medication Among the Pediatric Population in China: A National Survey. Front Public Health 2022; 9:770709. [PMID: 35223755 PMCID: PMC8863670 DOI: 10.3389/fpubh.2021.770709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Self-medication of antibiotics is common in China, whereas the self-medication of other medicines is still unknown, especially for the younger children who are vulnerable to adverse drug events. The aim of this study was to estimate the prevalence of self-medication reported by parents among children under age 12 in China. Methods A national cross-sectional survey was conducted among parents of children under age 12 in China by using a self-administered online questionnaire. Parents were asked whether they have self-medicated their children in the past 12 months. Logistic regression analysis was performed to access the risk factors of self-medication. Results Eligible questionnaires were obtained from 4,608 parents. The majority of respondents were mothers aged between 30 and 39 years old who held a college degree. A total of 1,116 (or 24.21%) respondents reported self-medication in the previous year. In the logistic regression model, parents with graduate degrees were less likely to self-medicate their children [Adjusted OR (AOR) = 0.436; 95% CI = 0.296–0.641]. The odds of self-medication were associated with being a father, living in Northern China, having a child at age 6–11, even though these did not reach statistical significance. Conclusions Our findings indicate that self-medication are common in children under age 12, highlighting the drug safety issue in China. It seems that the educational level is the risk factors of self-medication. More targeted intervention and educational program should be implemented to improve drug safety.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Wandi Du
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Zhiping Li
- Department of Clinical Pharmacy, The Children's Hospital of Fudan University, Shanghai, China
| | - Qiao Deng
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Guo Ma
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
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10
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Or PL, Ching TY. The effectiveness of raising Hong Kong parents' awareness of antimicrobial resistance through an education program with peer support on social media: a randomized, controlled pilot study. BMC Public Health 2022; 22:315. [PMID: 35168586 PMCID: PMC8845248 DOI: 10.1186/s12889-022-12697-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to address the misuse of antibiotics and test the feasibility of an education program with peer support on social media in improving parents’ knowledge on antimicrobial resistance at a regional level in Hong Kong. This pilot, if successful, will be developed into a main study. Methods A cluster randomized controlled trial with two-arms were implemented. The intervention program consisted of two weekly sessions and each session lasted for 90 min. Parents in the intervention group would join a Facebook Page of Antibiotic Use, this online platform would allow participants to build a social network. A total of 48 parents had participated in the program. Parental knowledge and attitude were measured before and after the program using the Parental Perception on Antibiotics (PAPA) scale and the General Self-Efficacy Scale (GSE) to assess differences between and within the intervention and control groups. Results All parents in the intervention group had an understanding that antibiotics could be effective at treating some infections only, as compared to 40% in the control group. All parents in the intervention group and 85% of the control group disagreed that they should reduce the dose of antibiotics when their children were recovering. The test was statistically significant (p = 0.039) at p < 0.05. There were a significant difference and a strong negative correlation between peer support on Facebook and the parents’ belief that antibiotics could be stopped when their children felt better, with Pearson coefficient of − 0.78 at p < 0.001. In general, there was no significant difference between the two groups with respect to the scale. Conclusions Based on the findings in this pilot study, a further study focused on the education program with enhancement and peer support should be implemented on a larger scale with considerations of how it might support reducing incidence of antimicrobial resistance and potentially influencing prescription expectations of patients when seeking healthcare. Trial registration Retrospectively registered Chinese Clinical Trial Registry ChiCTR2100044870. Registered on 31 March 2021.
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Affiliation(s)
- Pui-Lai Or
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China.
| | - Tai-Yin Ching
- WHO Collaboration Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China
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11
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Zhou Z, Zhao D, Zhang H, Shen C, Cao D, Liu G, Zhu L, Fang Y. Understanding parental self-medication with antibiotics among parents of different nationalities: a cross-sectional study. Glob Health Res Policy 2021; 6:42. [PMID: 34696814 PMCID: PMC8543833 DOI: 10.1186/s41256-021-00226-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/14/2021] [Indexed: 01/21/2023] Open
Abstract
Background There is an increasing trend on the practices of parental self-medication with antibiotics (PSMA) around world, accelerating the antibiotic abuse. This study aims to examine the nationality differences in the practices of PSMA and knowledge, attitudes and practices (KAP) toward antibiotic use, and understand the practices of PSMA among parents of various nationalities in China. Methods A cross-sectional study based on a structured questionnaire survey was conducted in Xi’an, Shaanxi Province, China, from September 2018 to October 2018. A total of 299 respondents participated in. The practices of PSMA (a dichotomous variable) and KAP toward antibiotic use (a continuous variable) served as dependent variables. Participant’s nationality was regarded as the independent variable. Binary logistic regression and ordinary least square regression were employed to examine the association between parent’s nationality and the practices of PSMA, and KAP toward antibiotic use, respectively. Results 121 (40.88%) Chinese, 100 (33.76%) other Asians and 75 (25.34%) Occidentals were included in final analysis, with a sample size of 296. Chinese were more likely to practice PSMA (OR = 7.070; 95% CI 1.315, 38.01), with worse knowledge (Coef. = − 0.549; 95% CI − 1.021, − 0.078), attitudes (Coef. = − 3.069; 95% CI − 4.182, − 1.956) and practices (Coef. = − 1.976; 95% CI − 3.162, − 0.790) toward antibiotic use, compared to their Occidental counterparts. The main reasons for the practices of PSMA were enough previous medication experience (80.49%) and same ailments with no need to see a doctor (39.02%), with common symptoms such as fever (60.98%) and cough (58.54%). Purchasing antibiotics at pharmacies (92.08%) and using leftover antibiotics (26.83%) were usual approaches. Conclusions The study highlights the gaps in the practices of PSMA and KAP toward antibiotic use among parents of different nationalities. The access to obtain antibiotics from pharmacies reflects the pharmacists’ unaware of laws on prescription of antibiotics, fierce competition in the pharmacy market, and the government’s lax supervision in China. It suggests the need to improve pharmacists’ training, enforce current legislations on pharmacy market regarding the sale of antibiotics, and provide practical and effective educational interventions for residents about antibiotic use. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00226-y.
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Affiliation(s)
- Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Huarui Zhang
- Xi'an Lianhu District Huoshaobei Clinic, Xi'an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Liang Zhu
- Department of Health Care Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an, China.
| | - Yu Fang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, China
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