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Abebe RB, Ayal BM, Alemu MA, Zeleke TK. Antibiotic appropriateness at outpatient settings in Ethiopia: the need for an antibiotic stewardship programme. Drugs Context 2024; 13:2023-12-2. [PMID: 38742144 PMCID: PMC11090269 DOI: 10.7573/dic.2023-12-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
Background Antibiotics are drugs of natural or synthetic origin used to treat various infections. The practice of excessive and inappropriate antibiotics use is the main global cause of bacterial resistance, which is one of the most serious global public health threats. It is estimated that about 50% of global antibiotic prescriptions are inappropriate. This study assesses the prevalence and pattern of inappropriate prescriptions of antibiotics amongst ambulatory care visits in Ethiopia. Methods A facility-based, cross-sectional study with a quantitative approach was conducted amongst randomly selected prescriptions issued for outpatients from May to June 2022 at Debre Markos Specialized Comprehensive Hospital, Northwest Ethiopia. Descriptive statistics, such as frequencies and percentages, were computed. For group comparisons, χ2 and independent sample t-tests were computed. The statistical significance of the association was considered at p<0.05. Results A total of 2640 antibiotics were prescribed for patients in the outpatient setting with various bacterial infections via 911 prescriptions, of which 49.5% were non-compliant with the national treatment guideline. Guideline non-compliant prescriptions increased remarkably amongst patients in the outpatient setting diagnosed with community-acquired pneumonia (38.8% versus 30.1%; p=0.006) and peptic ulcer disease (14.9% versus 9%; p=0.006). Moreover, inappropriate prescription was significantly higher amongst patients taking amoxicillin/clavulanic acid (33.2% versus 48.2%; p<0.001) and cephalexin (17.8% versus 24.3%; p=0.016). Conclusion Large proportions of antibiotic prescriptions for outpatients were non-compliant with the national treatment guideline, suggesting that prescribers need to give special attention to outpatients whilst ordering antibiotics such as amoxicillin/clavulanic acid and cephalexin. Antibiotic stewardship efforts to optimize outpatient antibiotic prescriptions and reduce the use of potentially inappropriate antibiotics are needed in Ethiopia.
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Affiliation(s)
- Rahel Belete Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bezawit Mulat Ayal
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Adela Alemu
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tirsit Ketsela Zeleke
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Mancuso G, De Gaetano S, Midiri A, Zummo S, Biondo C. The Challenge of Overcoming Antibiotic Resistance in Carbapenem-Resistant Gram-Negative Bacteria: "Attack on Titan". Microorganisms 2023; 11:1912. [PMID: 37630472 PMCID: PMC10456941 DOI: 10.3390/microorganisms11081912] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
The global burden of bacterial resistance remains one of the most serious public health concerns. Infections caused by multidrug-resistant (MDR) bacteria in critically ill patients require immediate empirical treatment, which may not only be ineffective due to the resistance of MDR bacteria to multiple classes of antibiotics, but may also contribute to the selection and spread of antimicrobial resistance. Both the WHO and the ECDC consider carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) to be the highest priority. The ability to form biofilm and the acquisition of multiple drug resistance genes, in particular to carbapenems, have made these pathogens particularly difficult to treat. They are a growing cause of healthcare-associated infections and a significant threat to public health, associated with a high mortality rate. Moreover, co-colonization with these pathogens in critically ill patients was found to be a significant predictor for in-hospital mortality. Importantly, they have the potential to spread resistance using mobile genetic elements. Given the current situation, it is clear that finding new ways to combat antimicrobial resistance can no longer be delayed. The aim of this review was to evaluate the literature on how these pathogens contribute to the global burden of AMR. The review also highlights the importance of the rational use of antibiotics and the need to implement antimicrobial stewardship principles to prevent the transmission of drug-resistant organisms in healthcare settings. Finally, the review discusses the advantages and limitations of alternative therapies for the treatment of infections caused by these "titans" of antibiotic resistance.
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Affiliation(s)
- Giuseppe Mancuso
- Department of Human Pathology, University of Messina, 98125 Messina, Italy; (S.D.G.); (A.M.); (S.Z.); (C.B.)
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Zhang W, Zhou CL, Hu Y, Lin L, Li J, Xu Y, Cui S. Dissemination of Multiple Drug-Resistant Shigella flexneri 2a Isolates Among Pediatric Outpatients in Urumqi, China. Foodborne Pathog Dis 2022; 19:522-528. [PMID: 35917515 DOI: 10.1089/fpd.2021.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Multiple drug-resistant (MDR) Shigella isolates have been reported worldwide. Between May 2017 and September 2018, 55 Shigella flexneri 2a isolates were collected from 3322 stool samples of 0-10-year-old outpatients with diarrhea at the Children's Hospital of Urumqi, China. All isolates were characterized using serotyping, antimicrobial susceptibility testing, and whole-genome sequencing. A total of 54 of 55 (98.2%) isolates exhibited MDR phenotypes and had accumulated multiple resistance determinants, particularly of fluoroquinolones and cephalosporins preferred for shigellosis treatment: point mutations in quinolone resistance-determining regions (QRDRs) of topoisomerases (GyrA (S83L, D87N) and ParC (S80I) [n = 9]; GyrA (S83L) and ParC (S80I) [n = 45]) and acquisition of qnrS1 (n = 3) and blaCTX-M (n = 8). Over 70% of isolates acquired two point mutations of GyrA (S83L) and ParC (S80I) in QRDRs and 11 highly resistant isolates accumulated three point mutations in QRDRs or acquired qnrS1. Four S. flexneri 2a isolates from three single-nucleotide polymorphism clusters exhibited coresistance to ciprofloxacin, cefotaxime, or azithromycin (AZM), which are used as first- and second-line shigellosis treatment antimicrobials in clinics. Our data indicated that fluoroquinolones should be terminated in shigellosis treatment for outpatients in Urumqi. The transferable antimicrobial resistance determinants have been identified for third-generation cephalosporins and AZM. Novel strategies are urgently required for developing empirical medication to reduce the antimicrobial selective pressure and prevent dissemination of MDR S. flexneri 2a isolates.
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Affiliation(s)
- Wenli Zhang
- Department of Clinical Examination, The Children's Hospital, Urumqi, Xinjiang, China
| | - Christine L Zhou
- Department of Biology, University of Maryland, College Park, Maryland, USA
| | - Ying Hu
- Department of Biological Detection, The National Institutes for Food and Drug Control, Beijing, China
| | - Lan Lin
- Department of Biological Detection, The National Institutes for Food and Drug Control, Beijing, China
| | - Jingyun Li
- Department of Biological Detection, The National Institutes for Food and Drug Control, Beijing, China
| | - Yinghua Xu
- Department of Biological Detection, The National Institutes for Food and Drug Control, Beijing, China
| | - Shenghui Cui
- Department of Biological Detection, The National Institutes for Food and Drug Control, Beijing, China
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Impact of a pilot multimodal intervention to decrease antibiotic use for respiratory infections in a geriatric clinic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e1. [PMID: 36310812 PMCID: PMC9614947 DOI: 10.1017/ash.2021.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 01/12/2023]
Abstract
Background: More than 80% of antibiotics are prescribed in the outpatient setting, of which 30% are inappropriate. The National Action Plan for Combating Antimicrobial Resistance called for a 50% decrease in outpatient antibiotic use by 2020. Inappropriate antibiotics are associated with adverse reactions and Clostridioides difficile infection, especially among older adults. Study design: Before and after study. Methods: We performed a quality improvement initiative at the University of Colorado Seniors Clinic. Providers received education on antibiotic guidelines, electronic antibiotic order sets were introduced with standardized stop dates. Antibiotic use data were collected for 6 months before and 6 months after the intervention, from December to May to avoid seasonal variation. Descriptive statistics and linear mixed-effects regression models were used for this comparison. Results: Total antibiotic prescriptions for acute respiratory conditions decreased from 137 prescriptions before the intervention (December 1, 2017, to May 31, 2018) to 112 prescriptions after the intervention (December 1, 2018, to May 31, 2019), driven primarily by decreases in antibiotic prescriptions for pneumonia, sinusitis, and bronchitis. Prescriptions for broad-spectrum antibiotics declined following the intervention including decreases in levofloxacin from 12 (9%) to 3 (3%) and amoxicillin-clavulanate from 15 (12%) to 7 (7%). We detected significant reductions in prescribed antibiotic durations (days) after the intervention for sinusitis (estimate, −2.0; 95% CI, −3.1 to −1.0; P = .0003), pharyngitis (estimate, −2.5; 95% CI, −4.6 to −0.5; P = .018), and otitis (−3.2; 95% CI, −5.2 to −1.3; P = .008). Conclusions: Low-cost interventions were initially successful in changing patterns of antibiotic use and decreasing overall antibiotic prescribing among older patients in the outpatient setting. Long-term follow-up studies are needed to determine the sustainability and clinical impact of these interventions.
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Al-Shatnawi SF, Al-Hosban SY, Altawalbeh SM, Khasawneh RA. Antibiotic prescribing patterns for childhood infections in ambulatory settings in Jordan. Int J Clin Pract 2021; 75:e14740. [PMID: 34403534 DOI: 10.1111/ijcp.14740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Antibiotics' rational prescribing is a major goal of the World Health Organization's (WHO) global action plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of paediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. METHODS A cross-sectional retrospective study was conducted by selecting a random sample of paediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age ≤18 years) receiving at least one antibiotic were included. The WHO's model of drug utilisation was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. RESULTS A total of 20 494 prescriptions, containing 45 241 prescribed drugs, were obtained. The average number of prescribed drugs per prescription was (2.21 ± 0.98). Approximately 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic names and from the essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season and facility type were significant predictors of prescribed antibiotics to overall medications ratio. CONCLUSIONS This is the first study of antibiotic prescribing patterns among outpatient paediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient paediatrics. Such findings necessitate more focussed efforts and regulations that support rational utilisation of drugs.
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Affiliation(s)
- Samah F Al-Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan
| | - Sanabil Y Al-Hosban
- Department of Pharmacy, Mafraq Gynecology and Pediatric Hospital, Ministry of Health, AlMafraq, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan
| | - Rawand A Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Science and Technology, Irbid, Jordan
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Machado-Duque ME, García DA, Emura-Velez MH, Gaviria-Mendoza A, Giraldo-Giraldo C, Machado-Alba JE. Antibiotic Prescriptions for Respiratory Tract Viral Infections in the Colombian Population. Antibiotics (Basel) 2021; 10:864. [PMID: 34356785 PMCID: PMC8300612 DOI: 10.3390/antibiotics10070864] [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: 05/26/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobials are frequently inappropriately prescribed for the management of upper respiratory tract infections (URTIs); therefore, the frequency of antibiotic prescriptions for patients with viral URTIs was assessed in this study. A cross-sectional study, including ambulatory patients diagnosed with viral URTI, was conducted, and records of antimicrobial prescriptions were obtained. Sociodemographic, clinical (diagnostic), and pharmacological (antimicrobial) variables were assessed. Through multivariate analysis, variables associated with the use of antibiotics for viral infections were identified. A total of 341,182 patients with viral URTIs were identified. The patients, who were from 26 different departments of Colombia, had a mean age of 29.7 ± 23.5 years and a female predominance of 58.7% (n = 200,195). The most frequent viral infections were as follows: acute rhinopharyngitis (common cold) (n = 206,211; 60.4%); unspecified acute tonsillitis (n = 27,432; 8.0%); and acute pharyngitis (n = 26,411; 7.7%). A total of 24.8% of the patients (n = 84,453) received a prescription for antibiotics, predominantly penicillins (n = 61,871; 18.1%) and cephalosporins (n = 10,926; 3.2%). Patients treated in Atlántico, Valle, and Risaralda departments, along with those older than 5 years, were more likely to receive antibiotics for the treatment of viral infections. Antibiotics are frequently prescribed for the management of URTIs, which is considered an inappropriate practice due to a lack of clinical benefits, increased generation of antimicrobial resistance, and a risk of adverse reactions due to the use of medications that patients do not require. Drug utilization studies are a great tool for monitoring how antibiotics are being used and planning interventions to improve their use.
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Affiliation(s)
- Manuel E. Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Diego Arturo García
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Melissa Hiromi Emura-Velez
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Claudia Giraldo-Giraldo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
| | - Jorge E. Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
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Nguyen LV, Pham LTT, Bui AL, Vi MT, Nguyen NK, Le TT, Pham ST, Nguyen PM, Nguyen TH, Taxis K, Nguyen T, Tran HD. Appropriate Antibiotic Use and Associated Factors in Vietnamese Outpatients. Healthcare (Basel) 2021; 9:healthcare9060693. [PMID: 34201175 PMCID: PMC8228789 DOI: 10.3390/healthcare9060693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Inappropriate antibiotic use among outpatients is recognized as the primary driver of antibiotic resistance. A proper understanding of appropriate antibiotic usage and associated factors helps to determine and limit inappropriateness. We aimed to identify the rate of appropriate use of antibiotics and identify factors associated with the inappropriate prescriptions. Methods: We conducted a cross-sectional descriptive study in outpatient antibiotic use at a hospital in Can Tho City, Vietnam, from August 1, 2019, to January 31, 2020. Data were extracted from all outpatient prescriptions at the Medical Examination Department and analyzed by SPSS 18 and Chi-squared tests, with 95% confidence intervals. The rationale for antibiotic use was evaluated through antibiotic selection, dose, dosing frequency, dosing time, interactions between antibiotics and other drugs, and general appropriate usage. Results: A total of 420 prescriptions were 51.7% for females, 61.7% with health insurance, and 44.0% for patients with one comorbid condition. The general appropriate antibiotic usage rate was 86.7%. Prescriptions showed that 11.0% and 9.5% had a higher dosing frequency and dose than recommended, respectively; 10.2% had an inappropriate dosing time; 3.1% had drug interactions; and only 1.7% had been prescribed inappropriate antibiotics. The risk of inappropriate antibiotic use increased in patients with comorbidities and antibiotic treatment lasting >7 days (p < 0.05). Conclusions: The study indicated a need for more consideration when prescribing antibiotics to patients with comorbidities or using more than 7 days of treatment.
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Affiliation(s)
- Lam V. Nguyen
- Department of Anatomy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
| | - Lien T. T. Pham
- Department of Medicinal Chemistry, Can Tho University of Medicine and Pharmacy, Can Tho 900000, Vietnam;
| | - Anh L. Bui
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Mai T. Vi
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Nguyet K. Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Tam T. Le
- Can Tho University of Medicine and Pharmacy Hospital, Can Tho City 900000, Vietnam;
| | - Suol T. Pham
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Phuong M. Nguyen
- Department of Pediatrics, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam;
| | - Thao H. Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands;
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam; (A.L.B.); (M.T.V.); (N.K.N.); (S.T.P.); (T.N.)
| | - Hung D. Tran
- Faculty of Nursing, Can Tho University of Medicine and Pharmacy, Can Tho City 900000, Vietnam
- Correspondence:
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