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Park B, Lee H, Choi H, Lee J. Age-related off-label drug prescribing in pediatric patients in South Korea and consistency of labeling compared to the United States, Europe, and Japan. Clin Transl Sci 2024; 17:e13869. [PMID: 38946123 PMCID: PMC11214956 DOI: 10.1111/cts.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024] Open
Abstract
Insufficient labeling information regarding the appropriate age for prescribing drugs to the pediatric population is challenging. This study aimed to analyze the off-label prescription of age-related drugs for pediatric patients using claims data from South Korea and to assess the consistency of the approved age in South Korea, the United States, Europe, and Japan. In 2020, 1004 unique drugs were prescribed to the pediatric population in South Korea. We found that 641 drugs (63.8%, p < 0.0001) were related to off-label prescriptions for age-related use at least once, and the total number of off-label prescriptions was 2,236,669 (62.2%, p < 0.0001). Chlorpheniramine (28%) was the most frequently prescribed drug for pediatric patients with an age-related off-label, followed by budesonide (9%) and epinephrine (9%). The degree of agreement in the approved age range for 641 off-label drugs across countries was assessed using the overall kappa coefficient. We observed slight agreement in labeling across all countries (κ: 0.16, 95% confidence interval [CI]: 0.14-0.18). The highest degree of agreement was observed between the United States and Europe (0.41, 0.37-0.45) due to pediatric-population-specific legislation. South Korea showed the lowest degree of agreement with the United States and Europe (0.10, 0.06-0.14). The United States, Europe, and Japan showed fair agreement (0.23, 0.21-0.26). However, the degree of agreement between South Korea, the United States, and Japan (0.09, 0.06-0.11) and South Korea, Europe, and Japan (0.08, 0.05-0.10) was low. This study highlights the need for South Korean regulatory agencies to consider introducing pediatric legislation to prescribe evidence-based drugs for safe and effective use.
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Affiliation(s)
- Bojung Park
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
| | - Hyesung Lee
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Hyeyoung Choi
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
| | - Jaehyun Lee
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
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Han SB, Bae KS, Choi UY, Kim JH. Antibiotics for Pediatric Patients With Laryngotracheobronchitis in Korea: A Nationwide Study Based on Administrative Data. J Korean Med Sci 2024; 39:e189. [PMID: 38915281 PMCID: PMC11196854 DOI: 10.3346/jkms.2024.39.e189] [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: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory infection (ARI) among children, most often caused by a virus, and should not be treated with antibiotics. Reducing the usage of unnecessary antibiotics in ARI using an antimicrobial stewardship program (ASP) is an effective measure against AMR in children. This study investigates the antibiotic prescription pattern in pediatric patients with laryngotracheobronchitis in Korea. Our results will be useful to improve the ASP. METHODS The data were obtained from the government agency Health Insurance Review and Assessment Service. We analyzed outpatient prescriptions issued to children ≤ 5 years of age with a first-listed diagnosis code for laryngotracheobronchitis, i.e., International Classification of Disease, 10th Revision, code J050 (croup), J040 (laryngitis), or J041 (tracheitis), during 2017-2020. For each prescription, demographic information and information about medical facilities visited (type of hospital, specialty of physician, location of hospital) were extracted. The overall antibiotic prescription rate was subsequently estimated, and multivariable analysis was conducted to determine the associated factors of antibiotic prescription. Prescribed antibiotics were described and classified into extended-spectrum penicillins, cephalosporin, and macrolides. RESULTS Of 2,358,194 prescriptions reviewed, 829,172 (35.2%) contained antibiotics. In the multivariable analysis, management in a hospital was the strongest factor associated with antibiotic prescription (adjusted odds ratio [aOR], 22.33; 95% confidence interval [CI], 20.87-23.89; P < 0.001), followed by management in a clinic (aOR, 12.66; 95% CI, 11.83-13.54; P < 0.001) and management in a general hospital (aOR, 8.96; 95% CI, 8.37-9.59; P < 0.001). Antibiotic prescription was also significantly associated with patients who were ≤ 2 years of age, managed by a pediatric specialist, and treated at a hospital located in a non-metropolitan region. Overall, extended-spectrum penicillins were the most frequently prescribed (18.6%) antibiotics, followed by cephalosporins (9.4%) and macrolides (8.5%). CONCLUSION The results of our study suggest that ASPs need to focus on physicians in hospitals, clinics, general hospitals, and pediatric specialties. Providing education programs to these groups to increase awareness of AMR and appropriate antibiotics use could be effective ASP policy and may help to reduce unnecessary prescriptions of antibiotics for laryngotracheobronchitis among pediatric patients and therefore potentially AMR in children in Korea.
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Affiliation(s)
- Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kil Seong Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ui Yoon Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim KR, Park HJ, Baek SY, Choi SH, Lee BK, Kim S, Kim JM, Kang JM, Kim SJ, Choi SR, Kim D, Choi JS, Yoon Y, Park H, Kim DR, Shin A, Kim S, Kim YJ. The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study. J Korean Med Sci 2024; 39:e172. [PMID: 38832477 PMCID: PMC11147790 DOI: 10.3346/jkms.2024.39.e172] [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: 12/12/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. METHODS A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ². RESULTS The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881). CONCLUSION The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.
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Affiliation(s)
- Kyung-Ran Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jung Park
- Department of Pharmacy, Samsung Medical Center, Seoul, Korea
- Sungkyunkwan University School of Pharmacy, Suwon, Korea
| | - Sun-Young Baek
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Soo-Han Choi
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung-Kee Lee
- Department of Pediatrics, Seoulsan Boram Hospital, Ulsan, Korea
| | - SooJin Kim
- Samsung Dream Pediatric Clinic, Suwon, Korea
| | - Jong Min Kim
- Department of Pediatrics, Myongji Hospital, Goyang, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun-Ja Kim
- Samsung Dream Pediatric Clinic, Jeju, Korea
| | | | - Dongsub Kim
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joon-Sik Choi
- Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea
| | - Yoonsun Yoon
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwanhee Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Doo Ri Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Areum Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seonwoo Kim
- Academic Research Service Headquarter, LSK Global PS, Seoul, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Korea.
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Choi UY, Han SB. Antibiotic Use in Korean Children Diagnosed With Acute Bronchiolitis: Analysis of the National Health Insurance Reimbursement Data. J Korean Med Sci 2024; 39:e141. [PMID: 38711315 DOI: 10.3346/jkms.2024.39.e141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Acute bronchiolitis, the most common lower respiratory tract infection in infants, is mostly caused by respiratory viruses. However, antibiotics are prescribed to about 25% of children with acute bronchiolitis. This inappropriate use of antibiotics for viral infections induces antibiotic resistance. This study aimed to determine the antibiotic prescription rate and the factors associated with antibiotic use in children with acute bronchiolitis in Korea, where antibiotic use and resistance rates are high. METHODS Healthcare data of children aged < 24 months who were diagnosed with acute bronchiolitis between 2016 and 2019 were acquired from the National Health Insurance system reimbursement claims data. Antibiotic prescription rates and associated factors were evaluated. RESULTS A total of 3,638,424 visits were analyzed. The antibiotic prescription rate was 51.8%, which decreased over time (P < 0.001). In the multivariate analysis, toddlers (vs. infants), non-capital areas (vs. capital areas), primary clinics and non-tertiary hospitals (vs. tertiary hospitals), inpatients (vs. outpatients), and non-pediatricians (vs. pediatricians) showed a significant association with antibiotic prescription (P < 0.001). Fourteen cities and provinces in the non-capital area exhibited a wide range of antibiotic prescription rates ranging from 41.2% to 65.4%, and five (35.7%) of them showed lower antibiotic prescription rates than that of the capital area. CONCLUSION In Korea, the high antibiotic prescription rates for acute bronchiolitis varied by patient age, region, medical facility type, clinical setting, and physician specialty. These factors should be considered when establishing strategies to promote appropriate antibiotic use.
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Affiliation(s)
- Ui Yoon Choi
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
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Wang Y, Wang G, Zhu L, Li X, Li J, Li Z. Inappropriate prescription of intravenous antibiotics at a tertiary children's hospital in China. Minerva Pediatr (Torino) 2024; 76:161-166. [PMID: 34098708 DOI: 10.23736/s2724-5276.21.05902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Antibiotics are one of the most frequently prescribed medication classes worldwide. Inappropriate prescription of antibiotics has increased the risk of drug-resistant infections and associated mortality. The aim of this study was to examine the patterns of intravenous antibiotics prescribing in emergency and outpatient departments of a tertiary children's hospital in China. METHODS Data on intravenous prescriptions dispensed by the emergency and outpatient department from January 1, 2015 to May 31, 2016 were extracted from the information system of the Children's Hospital of Fudan University. Prevalence of intravenous antibiotics use and the suitability of intravenous antibiotic prescription were evaluated on the basis of a completed microbiological examination, antibiotics susceptibility testing, and dose prescribed for patients diagnosed with pneumonia, acute bronchitis, fever, and acute upper respiratory infection (AURI) patients. The prescription rate was expressed as the number of intravenous antibiotic prescriptions per total number of prescriptions. RESULTS Overall, 94.2% of pediatric patients and 78.5% of issued intravenous prescriptions were for antibiotics. beta-lactam antibacterial (90.5%) and macrolides (18.5%) were the most commonly used categories of antibiotics, while cefuroxime (28.8%) was the most used antibiotic. Besides, pneumonia (31.3%), acute bronchitis (14.1%), fever (6.5%), and AURI (5.5%) were the most commonly recorded infections. However, in these four diseases, the rate of conducting microbiological examination was 0.3%, 0.2%, 2.1%, and 2.8%, respectively. Approximately, 52.1%, 40.0%, 40.4%, and 30.5% of intravenous antibiotic prescriptions were inappropriately used in pneumonia, acute bronchitis, fever, and AURI, respectively. Doses higher and lower than the recommended were often for each of these four diseases. CONCLUSIONS The frequency of intravenous antibiotic prescription was high in pediatric emergency and outpatient departments. Inappropriate use of intravenous antibiotics commonly occurred in pneumonia, acute bronchitis, fever, and AURI. Appropriate interventions and prevention strategies need to be developed to curtail inappropriate prescribing of antibiotics.
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Affiliation(s)
- Yan Wang
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
- Key Laboratory of Tropical Translational Medicine of Education, Hainan Provincial Key Laboratory for Research and Development of Tropical Herbs, School of Pharmacy, Hainan Medical University, Haikou, China
| | - Guangfei Wang
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Zhu
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoxia Li
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Li
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiping Li
- Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China -
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Kostev K, van den Boom L, Tanislav C, Jacob L. Changes in the Prescription of Antibiotics and Phytopharmaceuticals in Children Treated for Acute Upper and Lower Respiratory Tract Infections in Pediatric Practices in Germany in 2013, 2018, and 2022. Antibiotics (Basel) 2023; 12:1491. [PMID: 37887192 PMCID: PMC10604680 DOI: 10.3390/antibiotics12101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Background: Little is known about the recent trends in antibiotic and phytopharmaceutical prescribing for acute upper (URIs) and lower respiratory tract infections (LRIs) in children and adolescents. Therefore, this study investigated changes in the prescription of antibiotics and phytopharmaceuticals in children diagnosed with acute URIs and LRIs in pediatric practices in Germany in 2013, 2018, and 2022. Methods: The present retrospective study included children aged 2-12 years diagnosed with acute URIs or LRIs in one of 180 pediatric practices in 2013, 2018, and 2022. The URIs included nasopharyngitis, sinusitis, pharyngitis, tonsillitis, laryngitis and tracheitis, and upper respiratory infections of multiple and unspecified sites, while the LRIs corresponded to bronchitis. The primary outcomes were the proportion of children being prescribed antibiotics and the proportion of those being prescribed phytopharmaceuticals. Results: A total of 120,894 children were diagnosed with acute URIs or LRIs in 2013 compared to 116,844 in 2018 and 127,821 in 2022. The prevalence of antibiotic prescription decreased for all diagnoses between 2013 and 2022. This decrease was statistically significant for both 2013-2018 and 2018-2022 for nasopharyngitis, pharyngitis, and bronchitis. Meanwhile, there was a significant increase in the use of phytopharmaceuticals for all diagnoses between 2013 and 2018. The prevalence of phytopharmaceutical prescription decreased slightly between 2018 and 2022, but this decrease was generally not statistically significant. Conclusions: The prescription of antibiotics has decreased and that of phytopharmaceuticals has increased in children diagnosed with acute URIs and LRIs in Germany over the last decade. More data are needed to corroborate these findings in other settings.
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Affiliation(s)
- Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt, Germany
- University Clinic, Philipps-Universität Marburg, 35043 Marburg, Germany
| | - Louisa van den Boom
- Division of Pediatrics/Pediatric Diabetology, DRK Hospital, 57548 Kirchen, Germany
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children’s Hospital, University of Bonn, 53127 Bonn, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling, 57074 Siegen, Germany;
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
- AP-HP, Université Paris Cité, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 75010 Paris, France
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Ha EK, Lee SW, Kim JH, Lee E, Cha HR, Han BE, Shin J, Han MY. Associations between Delayed Introduction of Complementary Foods and Childhood Health Consequences in Exclusively Breastfed Children. Nutrients 2023; 15:3410. [PMID: 37571347 PMCID: PMC10421357 DOI: 10.3390/nu15153410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The timing of complementary food (CF) introduction is closely related to childhood health, and it may vary depending on the region, culture, feeding type, or health condition. Despite numerous studies on the benefits of breastfeeding and the optimal timing of CF introduction, there have been limited investigations regarding delayed CF introduction in exclusively breastfed children. We compared an exposed group (CF introduction ≥7 months) with a reference group (CF introduction at 4 -< 7 months) regarding hospital admission, disease burden, and growth until age 10. Data from a nationwide population-based cohort study involving children born between 2008 and 2012 in the South Korea were analyzed. The final cohort comprised 206,248 children (165,925 in the exposed group and 40,323 in the reference group). Inverse probability of treatment weighting with propensity score matching was used to balance baseline health characteristics in the comparison groups. We estimated the incident risk ratios (IRR) for outcomes using modified Poisson regression and weighted odds ratios (weighted ORs) and their 95% confidence intervals (CIs) using multinomial logistic regression. The exposed group was associated with low height-for-age z-score (HAZ) (IRR (95% CI) for -1.64 < HAZ ≤ -1.03: 1.11 (1.08 to 1.14); HAZ ≤ -1.64: 1.21 (1.14 to 1.27)) and frequent (≥6 events) hospitalizations (weighted OR 1.18 (1.09 to 1.29). The rates of hospital admission, death, and specific medical conditions did not differ between groups. However, delaying the introduction of CF until seven months in exclusively breastfed infants was associated with frequent hospitalization events and lower heights.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Seung Won Lee
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (S.W.L.); (H.R.C.)
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea;
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Hye Ryeong Cha
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (S.W.L.); (H.R.C.)
| | - Bo Eun Han
- Department of Software, Sejong University, Seoul 05006, Republic of Korea;
| | - Jeewon Shin
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
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Xue F, Xu B, Shen A, Shen K. Antibiotic prescriptions for children younger than 5 years with acute upper respiratory infections in China: a retrospective nationwide claims database study. BMC Infect Dis 2021; 21:339. [PMID: 33845771 PMCID: PMC8040226 DOI: 10.1186/s12879-021-05997-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background In China, there were few studies to estimate antibiotic use for children with upper respiratory infections at the national level. The aim of this study was to describe the antibiotic prescribing practice for children aged < 5 years old with upper respiratory infections (URIs) using a nationwide claims database. Methods This was a retrospective cross-sectional study using a sampled database from the China Health Insurance Research Association (CHIRA). Study subjects included children younger than 5 years with outpatient visits in 2015 that resulted in a diagnosis of a upper respiratory infection. We calculated the percentage of visits who received antibiotics, the proportion of injection formulations, the percentage of combined antibiotics and the proportion of each antibiotic class. The patterns of antibiotic prescription were also described by medical institution type, city level and geographical region. Results Among the 92,821 visits, 27.1% were prescribed antibiotics, of which 27.0% received injection formulations. The rate of antibiotic prescribing varied by age group (P < 0.001), with the lowest (16.0%) in infants and the highest in patients at age 3 to < 4 years (29.9%) and age 4 to < 5 years (32.5%). The Midwestern region, underdeveloped cities and low-level hospitals represented relatively higher rates of prescribing antibiotics (P < 0.001) and higher proportions of injection dosage forms (P < 0.001). The most 3 common antibiotic classes prescribed of all visits with antibiotic prescriptions were the third-generation cephalosporins (34.9%), macrolides (24.3%), and the second-generation cephalosporins (23.3%). Conclusions In mainland China, the overall rate of antibacterial prescribing and the proportion of injection formulations prescribed in children under 5 years with URIs were at a low level, but still higher in underdeveloped regions and cities. Moreover, the overuse of the second and third generation cephalosporins, macrolides, remains a serious issue. Further efforts should be focused on reducing those non-first-line antibiotic prescribing and narrowing the gaps among regions and cities.
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Affiliation(s)
- Fengxia Xue
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Baoping Xu
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Adong Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Kunling Shen
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Characteristics of prescriptions and costs for acute upper respiratory tract infections in Chinese outpatient pediatric patients: a nationwide cross-sectional study. BMC Complement Med Ther 2020; 20:346. [PMID: 33198719 PMCID: PMC7667745 DOI: 10.1186/s12906-020-03141-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infections (AURI) is important for the regulation of outpatient care and reimbursement policy. This study aims to provide evidence on these issues that was in short supply. METHODS We conducted a retrospective cross-sectional study based on data from National Engineering Laboratory of Application Technology in Medical Big Data. All outpatient pediatric patients aged 0-14 years with an uncomplicated AURI from 1 January 2015 to 31 December 2017 in 138 hospitals across the country were included. We reported characteristics of patients, the average number of medications prescribed per encounter, the categories of medication used and their percentages, the cost per visit and prescription costs of drugs. For these measurements, discrepancies among diverse groups of age, regions, insurance types, and AURI categories were compared. Kruskal-Wallis nonparametric test and Student-Newman-Keuls test were performed to identify differences among subgroups. A multinomial logistic regression was conducted to examine the independent effects of those factors on the prescribing behavior. RESULTS A total of 1,002,687 clinical records with 2,682,118 prescriptions were collected and analyzed. The average number of drugs prescribed per encounter was 2.8. The most frequently prescribed medication was Chinese traditional patent medicines (CTPM) (36.5% of overall prescriptions) followed by antibiotics (18.1%). It showed a preference of CPTM over conventional medicines. The median cost per visit was 17.91 USD. The median drug cost per visit was 13.84 USD. The expenditures of antibiotics and CTPM per visit (6.05 USD and 5.87 USD) were among the three highest categories of drugs. The percentage of out-of-pocket patients reached 65.9%. Disparities were showed among subgroups of different ages, regions, and insurance types. CONCLUSIONS The high volume of CPTM usage is the typical feature in outpatient care of AURI pediatric patients in China. The rational and cost-effective use of CPTM and antibiotics still faces challenges. The reimbursement for child AURI cases needs to be enhanced.
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Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study. Int J Antimicrob Agents 2020; 56:106193. [PMID: 33045344 DOI: 10.1016/j.ijantimicag.2020.106193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The assessment of antibiotic use for acute upper respiratory infections (AURIs) is important to promote the appropriateness of antibiotic prescribing. Evaluation of antibiotic prescriptions for AURIs at a national level is very limited in China. OBJECTIVE To investigate outpatient antibiotic prescriptions for AURIs in Chinese hospitals. METHODS This study used data from over 10 million outpatient and emergency department visits for AURIs, which contained information on drug prescription and diagnosis, from 94 cities and 28 provinces of mainland China. Antibiotic prescription rates for various subgroups and potential predictors of antibiotic use were estimated. Patterns of antibiotic prescriptions and proportions of individual antibiotics prescribed for different types of AURIs were analysed and reported. RESULTS In total, 10 770 219 outpatient visits for AURIs were included in this study. Of these, 40.8% (95% confidence interval 40.7-40.8%) resulted in antibiotic prescriptions. Patient characteristics, including age, gender, payment type, AURI type, department and season of visit, were significantly associated with antibiotic prescriptions for AURIs. In total, 4 984 744 antibiotic agents were prescribed, of which 87.9% were broad-spectrum antibiotics and only 36.8% were prescribed in line with the guideline recommendations. Azithromycin (13.2%), cefdinir (11.7%), cefixime (8.3%) and cefaclor (8.2%) were the most commonly prescribed antibiotics for AURIs in China. CONCLUSIONS Antibiotic prescribing for patients with AURIs in outpatient settings was prevalent nationwide in China. Antibiotic stewardship efforts targeting specific populations in outpatient settings are needed to reduce antibiotic use and promote appropriate antibiotic selection for AURIs in China.
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11
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Respiratory pathogens – Some altered antibiotic susceptibility after implementation of pneumococcus vaccine and antibiotic control strategies. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:682-689. [DOI: 10.1016/j.jmii.2019.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022]
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12
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Li G, Jackson C, Bielicki J, Ellis S, Hsia Y, Sharland M. Global sales of oral antibiotics formulated for children. Bull World Health Organ 2020; 98:458-466. [PMID: 32742031 PMCID: PMC7375212 DOI: 10.2471/blt.19.235309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate international consumption patterns of child-appropriate oral formulations of antibiotics by formulation type, with a focus on dispersible tablets, using data from a global sales database. Method Antibiotic sales data for 2015 covering 74 countries and regional country groups were obtained from the MIDAS® pharmaceutical sales database, which includes samples of pharmacy wholesalers and retailers. The focus was on sales of child-appropriate oral formulations of Access antibiotics in the 2017 World Health Organization's WHO Model list of essential medicines for children. Sales volumes are expressed using a standard unit (i.e. one tablet, capsule, ampoule or vial or 5 mL of liquid). Sales were analysed by antibiotic, WHO region and antibiotic formulation. Findings Globally, 17.7 billion standard units of child-appropriate oral antibiotic formulations were sold in 2015, representing 24% of total antibiotic sales of 74.4 billion units (both oral and parenteral) in the database. The top five child-appropriate Access antibiotics by sales volume were amoxicillin, amoxicillin with clavulanic acid, trimethoprim-sulfamethoxazole, cefalexin and ampicillin. The proportion of the top five sold for use as a syrup varied between 42% and 99%. Dispersible tablets represented only 22% of all child-appropriate oral formulation sales and made up only 15% of sales of 10 selected Access antibiotics on the model list for children. Conclusion Globally most child-appropriate oral antibiotics were not sold as dispersible tablets in 2015, as recommended by WHO. There is a clear need for novel solid forms of antibiotics suitable for use in children.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Charlotte Jackson
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Sally Ellis
- Global Antibiotic Research & Development Partnership, Geneva, Switzerland
| | - Yingfen Hsia
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
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13
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Song YK, Han N, Burckart GJ, Oh JM. International Coherence of Pediatric Drug Labeling for Drug Safety: Comparison of Approved Labels in Korea and the United States. Clin Pharmacol Ther 2019; 107:530-540. [PMID: 31544241 PMCID: PMC7028218 DOI: 10.1002/cpt.1640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/06/2019] [Indexed: 01/24/2023]
Abstract
The objective of this study was to analyze information on pediatric use in Korean drug product labels and compare it with that in US Food and Drug Administration (FDA) labeling information. Prescription information on pediatric use contained in the commonly used drugs’ product labels approved by Korean government was compared with that approved by the FDA. Among the top 50 commonly prescribed drugs, 20 drugs were deemed to have insufficient prescribing information in Korean drug labels. Pediatric prescribing information regarding indication, approved age, formulations, and safety was insufficient in Korean drug labels compared with those in the FDA. Most important, the adverse events frequently reported in Korean children were not sufficiently presented in drug labels. In conclusion, this study highlights the urgent need for the Korean regulatory agency to encourage and accelerate research and development to increase the extent of pediatric prescribing information to be added to drug labels to promote appropriate drug prescribing for children.
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Affiliation(s)
- Yun-Kyoung Song
- College of Pharmacy, Daegu Catholic University, Gyeongsan-si, Gyeongbuk, Korea
| | - Nayoung Han
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea
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14
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Kitano T, Nishikawa H, Suzuki R, Onaka M, Nishiyama A, Kitagawa D, Oka M, Masuo K, Yoshida S. The impact analysis of a multiplex PCR respiratory panel for hospitalized pediatric respiratory infections in Japan. J Infect Chemother 2019; 26:82-85. [PMID: 31383498 PMCID: PMC7128379 DOI: 10.1016/j.jiac.2019.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/18/2023]
Abstract
Background Rapid molecular diagnosis of infections has contributed to timely treatments and antimicrobial stewardship. However, the benefit and cost-effectiveness vary in each country or community because they have different standard practices and health care systems. In Japan, rapid antigen tests (RATs) have been frequently used for pediatric respiratory infections. We investigated the impact and cost-effectiveness of a multiplex PCR (mPCR) respiratory panel for pediatric respiratory infections in a Japanese community hospital. Methods We replaced RATs with an mPCR respiratory panel (FilmArray®) for admitted pediatric respiratory infections on March 26, 2018. We compared the days of antimicrobial therapy (DOT) and length of stay (LOS) during the mPCR period (March 2018 to April 2019) with those of the RAT period (March 2012 to March 2018). Results During the RAT and mPCR periods, 1132 and 149 patients were analyzed. The DOT/case was 12.82 vs 8.56 (p < 0.001), and the LOS was 8.18 vs 6.83 days (p = 0.032) in the RAT and mPCR groups, respectively. The total costs during admissions were ∖258,824 ($2331.7) and ∖243,841 ($2196.8)/case, respectively. Pathogen detection rates were 30.2% vs 87.2% (p < 0.001). Conclusion Compared to conventional RATs, the mPCR test contributed to a reduction in the DOT and LOS in a Japanese community hospital for admission-requiring pediatric respiratory infections. However, a proper stewardship program is essential to further reduce the unnecessary usage of antimicrobials.
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Affiliation(s)
- Taito Kitano
- Department of Pediatrics, Nara Medical University Hospital, 840 Shijo, Kashihara, Nara, 6348521, Japan.
| | - Hiroki Nishikawa
- Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Rika Suzuki
- Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Masayuki Onaka
- Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Atsuko Nishiyama
- Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Daisuke Kitagawa
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Miyako Oka
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Kazue Masuo
- Department of Microbiology, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
| | - Sayaka Yoshida
- Department of Pediatrics, Nara Prefecture General Medical Center, 2-897-5 Shichijo West, Nara, Nara, 6308581, Japan
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15
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Teratani Y, Hagiya H, Koyama T, Adachi M, Ohshima A, Zamami Y, Tanaka HY, Tatebe Y, Tasaka K, Mikami N, Shinomiya K, Kitamura Y, Kano MR, Hinotsu S, Sendo T. Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013-15: a retrospective observational study. Fam Pract 2019; 36:402-409. [PMID: 30272148 DOI: 10.1093/fampra/cmy094] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this age of antimicrobial resistance, unnecessary use of antibiotics to treat non-bacterial acute respiratory tract infections (ARTIs) and inappropriate use of antibiotics in treating bacterial ARTIs are public health concerns. PURPOSE Our aim is to identify the pattern of oral antibiotic prescriptions for outpatients with ARTIs in Japan. METHODS We analysed health insurance claims data of patients (aged ≤74 years) from 2013 to 2015, to determine the pattern of antibiotic prescriptions for outpatient ARTIs and calculated the proportion of each antibiotic. RESULTS Data on 4.6 million antibiotic prescriptions among 1559394 outpatients with ARTIs were analysed. The most commonly prescribed classes of antibiotics included cephalosporins (41.9%), macrolides (32.8%) and fluoroquinolones (14.7%). The proportion of first-, second- and third-generation cephalosporins was 1.0%, 1.7% and 97.3%, respectively. Fluoroquinolones accounted for a quarter of the prescriptions for ARTIs in patients aged >20 years. In contrast, penicillins accounted for just 8.0% of the total number of antibiotic prescriptions for ARTIs. CONCLUSIONS According to clinical guidelines, penicillins are first-line antibiotics against ARTIs. However, third-generation cephalosporins, macrolides and fluoroquinolones are more frequently prescribed in Japan. Although we could not assess the extent to which appropriate antibiotics are selected, our results support the necessity of improving antibiotic choices in the treatment of ARTIs.
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Affiliation(s)
- Yusuke Teratani
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hideharu Hagiya
- Department of Infection Control and Prevention, Osaka University Hospital, Osaka, Japan
| | - Toshihiro Koyama
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Education and Research Center for Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Mayu Adachi
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ayako Ohshima
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yoshito Zamami
- Department of Clinical Pharmacology and Therapeutics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroyoshi Y Tanaka
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasuhisa Tatebe
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Ken Tasaka
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Naoko Mikami
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Kazuaki Shinomiya
- Education and Research Center for Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Department of Toji Pharmacy, Smile Co., Ltd, Hiroshima, Japan
| | | | - Mitsunobu R Kano
- Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Department of Pharmaceutical Biomedicine, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Clinical Epidemiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
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16
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Shin JY, Jeong S, Jeon HL, Byun S, Park KH, Jeong HE, Park SJ. The risk profile of rhegmatogenous retinal detachment before and after using a fluoroquinolone: a 12 year nationwide self-controlled case series study. J Antimicrob Chemother 2018; 73:3442-3453. [PMID: 30165476 DOI: 10.1093/jac/dky336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/23/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives To determine whether or not fluoroquinolone use increases the incidence of retinal detachment. Design Self-controlled case series analysis. Participants Participants were identified using the South Korean National Health Insurance Database between 1 January 2004 and 31 December 2015. A total of 15 134 patients who experienced rhegmatogenous retinal detachment (RRD) with at least one prescription of a fluoroquinolone were included. Methods Incidence rate ratios (IRRs) and their 95% CIs were calculated using conditional Poisson regression. The main outcome measure was a recorded diagnosis of RRD (ICD-10: H33.0) with a claim for the surgical code for RRD. Results We found an increased risk of retinal detachment in the first 1-30 days following the initiation of fluoroquinolone therapy (IRR 1.85; 95% CI 1.71-1.95), which rose for the 31-60 days period (IRR 2.05; 95% CI 1.43-2.95) but remained constant after more than 60 days (IRR 1.25; 95% CI 0.75-2.10). However, the elevated risk was also found in the 1-30 day period prior to the initiation of fluoroquinolone therapy (IRR 1.58; 95% CI 1.49-1.68) and also 31-60 days before medication use (IRR 1.11; 95% CI 1.03-1.19). Conclusions Our case-based study indicated that the risk after fluoroquinolone exposure doubled; however, the risk profile before and after fluoroquinolone use means that the association between fluoroquinolone use and retinal detachment might not be a causal relationship.
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Affiliation(s)
- Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sohyun Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ha-Lim Jeon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Seongjun Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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17
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Song I, Park SJ, Byun SJ, Choe YJ, Shin JY. Increased use of third-generation cephalosporin antibiotics in the outpatient setting in Korean children and adolescents. Pediatr Int 2018; 60:803-810. [PMID: 29947452 DOI: 10.1111/ped.13651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 04/11/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antimicrobial resistance is a concern to public health, and controlling antibiotic use is therefore important. This study analyzed the trend in outpatient antibiotic prescriptions in children and adolescents in Korea. METHODS Using National Prescribing Sample data from the Korea Health Insurance Review and Assessment Service between 1 January 2010 and 31 December 2014, we analyzed outpatient systemic antibiotic (anatomical therapeutic chemical [ATC] J01) prescriptions in patients aged 2-17 years. The antibiotic rate was defined as the proportion of all outpatient prescriptions for antibiotics. We calculated absolute and relative differences with 95%CI between 2010 and 2014 in the antibiotic rate by age group (2-6, 7-11, and 12-17 years) and the percentage of antibiotic prescriptions by antibiotic class. Seven of the most commonly used antibiotic drugs were identified based on defined daily dose. RESULTS A total of 7 261 176 prescriptions were written for 1 039 756 pediatric patients between 2010 and 2014. The antibiotic rate in all patients increased from 34.8% in 2010 to 70.4% in 2014, resulting in the relative difference of 102.1% (95%CI: 101.7-102.5). Extended spectrum penicillins were the most commonly prescribed antibiotic class, accounting for 40.0-41.0% of all antibiotic prescriptions. The use of third-generation cephalosporins increased steeply with the relative difference of 55.7% (95%CI: 55.2-56.2). Amoxicillin/clavulanate, an extended spectrum antibiotic drug, was the predominately used antibiotic drug but the use of cefpodoxime, a third-generation cephalosporin, increased by 96%. CONCLUSIONS The use of outpatient antibiotics, especially third-generation cephalosporins, has increased in children and adolescents in Korea.
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Affiliation(s)
- Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jun Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-June Choe
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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18
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Song YK, Han N, Kim MG, Chang HJ, Sohn HS, Ji E, Oh JM. A national pharmacoepidemiological study of antibiotic use in Korean paediatric outpatients. Arch Dis Child 2017; 102:660-666. [PMID: 28119402 DOI: 10.1136/archdischild-2016-310981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Information on the use of antibiotics in Eastern Asian children is limited. The objectives of this study were to evaluate in Korean paediatric outpatients (1) the nationwide pattern of prescribing antibiotics according to age group and medical institution and (2) the adherence of antibiotic use for acute respiratory tract infections to both national guidelines and European antibiotic prescribing quality indicators. METHOD This population-based study used the national insurance reimbursement database for 2011. The study subjects were outpatients younger than 18 years old prescribed systemic antibiotics. Patterns of antibiotic prescription were compared according to diagnostic conditions, age group and medical institution. The disease-specific proportion of recommended antibiotic or quinolone use for acute respiratory tract infections was evaluated on the basis of clinical practice guidelines and European quality indicators. RESULTS The data consisted of 70.7 million prescription records for 7.9 million paediatric outpatients, which means that 79.3% of the whole paediatric population used antibiotics. Broad-spectrum antibiotics made up 78.5% of the prescriptions, with broad-spectrum penicillins such as amoxicillin/clavulanate being the most commonly prescribed (50.2%). They were prescribed more commonly in younger paediatric patients (∼80%) than in adolescents (66.6%). The leading diagnosis accounting for antibiotic prescription was bronchitis (35.9%). The prescription proportion of recommended antibiotics in the European quality indicators was extremely low compared with the national guidelines: <0.1% for pharyngotonsillitis and 13.4% for acute otitis media. CONCLUSIONS Antibiotic use in children in Korea is inappropriately high. In addition, broad-spectrum antibiotics are used excessively.
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Affiliation(s)
- Yun-Kyoung Song
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyeu-Jin Chang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyun Soon Sohn
- College of Pharmacy, CHA University, Gyeonggi-do, Republic of Korea
| | - Eunhee Ji
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
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Ababneh MA, Al-Azzam SI, Ababneh R, Rababa'h AM, Demour SA. Antibiotic prescribing for acute respiratory infections in children in Jordan. Int Health 2017; 9:124-130. [PMID: 28338813 DOI: 10.1093/inthealth/ihx003] [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: 10/06/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Most acute respiratory infections (ARIs) in children are due to viral etiology; however, over-prescribing of antibiotics for ARIs is common. The aim of this investigation was to identify antibiotic prescribing prevalence for children with ARIs and to identify predictors of broad-spectrum antibiotic prescribing. Methods This was a prospective cross sectional study in a sample of ambulatory care settings in Jordan. Children (<18 years) presenting with ARIs were assessed in terms of patient's demographics, antibiotic prescription and clinical diagnosis. Multivariable logistic regression analysis was used to identify predictors of broad-spectrum antibiotic prescription. Results Antibiotics were prescribed for 78.4% (4575/5829) of children with ARIs. Antibiotic prescription for ARIs for which antibiotics are not indicated was 69.2% (2688/3883). Broad-spectrum antibiotic prescription occurred in 51.1% (2337/4575) of all antibiotic-prescribed participants. Some of the predictors of broad-spectrum antibiotic prescription were: otitis media (OR 4.93 [95% CI 3.44-7.14]), tonsillitis (OR 6.03 [95% CI 4.39-8.33]), age 0-5 years (OR 1.17 [95% CI 1.02-1.38]) compared to age 6-12 years, fever (OR 2.14 [95% CI 1.78-2.59]), outpatient setting (OR 73 [95% CI 2.17-3.42]) and military sector (OR 2.29 [95% CI 1.82-2.90]). Conclusions Antibiotic prescribing is high and often inappropriate. Predictors of broad-spectrum antibiotic prescribing were identified. Health policy initiatives should involve all stakeholders to minimize inappropriate antibiotic prescription and to prevent poor outcomes associated with such practice.
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Affiliation(s)
- Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Rawan Ababneh
- Department of Clinical Pharmacy, Royal Medical Services, Amman, Jordan
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110Jordan
| | - Saddam Al Demour
- Department of Special Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
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20
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Choe YJ, Lee HJ, Lee H, Oh CE, Cho EY, Choi JH, Kang HM, Yoon IA, Jung HJ, Choi EH. Emergence of antibiotic-resistant non-vaccine serotype pneumococci in nasopharyngeal carriage in children after the use of extended-valency pneumococcal conjugate vaccines in Korea. Vaccine 2016; 34:4771-6. [DOI: 10.1016/j.vaccine.2016.08.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/15/2022]
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21
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Lee YK, Lee H, Kim JM, Kang JM, Lee ST, Lee NY, Kim YJ, Cho H. The Antibiotic Resistance Pattern of Gram-Negative Bacteria in Children Younger Than 24 Months with a Urinary Tract Infection: A Retrospective Single-Center Study over 15 Consecutive Years. ACTA ACUST UNITED AC 2015. [DOI: 10.3339/chikd.2015.19.2.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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