Antimicrobial prescribing patterns of clinicians and clinical services at a large animal veterinary teaching hospital

2020 ◽  
Vol 81 (2) ◽  
pp. 103-115
Author(s):  
Laurel E. Redding ◽  
Sondra Lavigne ◽  
Helen W. Aceto ◽  
Rose D. Nolen-Walston
2007 ◽  
Vol 12 (1) ◽  
Author(s):  
Norah L Katende-Kyenda ◽  
Martie S Lubbe ◽  
Jan HP Serfontein ◽  
Ilse Truter

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. ABSTRAK Die doel met hierdie studie was om die voorskryfpatrone van antimikrobiese middels in private primêre gesondheidsorginrigtings in Suid-Afrika te ondersoek.


2021 ◽  
pp. 2941-2946
Author(s):  
Nubwa Daniel ◽  
Kefas David Malgwi ◽  
Bukar Umaru ◽  
Isaac John Omeh ◽  
Ladi Sanya

Background and Aim: Veterinary antibiotics are widely used to treat bacterial diseases in various species of animals. However, despite the importance of these chemotherapeutic agents, their indiscriminate or extensive use can pose dangers to the animals or humans that consume edible tissues from animals contaminated with antibiotic residues. Therefore, concerns regarding their appropriate and judicious use in animals are of public health significance. This is because of the tendencies of developing resistance to targeted microbes and the ability of the parent compound or its metabolites to persist as residues in the animal tissues. This study aimed to determine the frequency and pattern of antibiotic usage and ascertain the level of awareness of clinicians on the judicious use of antibiotics at the University of Maiduguri Veterinary Teaching Hospital, Maiduguri, Borno State, Nigeria. Materials and Methods: Data related to the administration of antibiotics in all species of animals presented for treatment from January 2009 to December 2018 were obtained from the hospital archives, with permission from the office of the hospital directorate. The diseases, hospital units, antibiotics used, and years were parameters that were recorded for each case. Furthermore, 47 questionnaires were administered to clinicians who render services to the hospital. Results: A total of 63.9% of all cases brought to the hospital within the 10 years under study were infectious, and as such, were treated with antibiotics. The highest recorded use of antibiotics was observed in the poultry unit (38.4%), followed by the large animal unit (24.1%), with the lowest used recorded in the ambulatory unit (9.3%). Furthermore, regarding the antibiotics used, oxytetracycline had the highest occurrence (55%), followed by penicillin-streptomycin combination (12.2%), with the lowest being metronidazole (0.30%). The highest number of cases treated with antibiotics was recorded in 2018 (22.5%), and the lowest was recorded in 2014 (1.3%). Regarding the questionnaire administered to the clinicians, 78.7% of the respondents preferred oxytetracycline as their drug of choice, whereas only 2.1%, 4.3%, 2.1%, and 4.3% preferred amoxicillin, penicillin, streptomycin, and penicillin-streptomycin, respectively. Moreover, 65.9% of the respondents used a particular antibiotic because of its availability at the hospital, 8.5% because of cost, and 27.7% because of clinician preference. Furthermore, 74.5% of the clinicians offered palliative intervention while awaiting laboratory reports, whereas 8.5% treated the animals without requesting laboratory analyses. Conclusion: In this study, oxytetracycline was found to be the most used antibiotic for treating infectious diseases at the hospital because of its availability. The observed pattern appeared in the following order of frequency: Oxytetracycline, penicillin-streptomycin combination, neomycin, erythromycin, amoxicillin, tylosin, streptomycin, and gentamicin with metronidazole being the least frequent. There might also be antibiotic resistance, which requires a change to another antibiotic because of the lack of response to the initial antibiotic. Non-judicious antibiotic use can also have a negative impact on public health because of the development of multidrug-resistant "superbugs" and the problem of drug residue.


2003 ◽  
Vol 38 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Lisa A Boothby ◽  
Lih-Jen Wang ◽  
Susan Mayhew ◽  
Lynn Chestnutt

Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pain management indications because of concerns about its safety and efficacy. Inpatient data from a 417-bed community teaching hospital revealed high use of meperidine in oral, IM, and IV forms. A multifaceted academic detailing approach was employed to change prescribing behavior and decrease meperidine use. This approach included conducting two concurrent Medication Use Evaluations; Grand Rounds presentations for pharmacy staff, nurses, and medical residents; solicitation of opinion leaders; pocket and table-top cards; newsletter articles; and provision of pharmaceutical care. Comparing the number of meperidine doses dispensed per adjusted patient day before and after the intervention, use was reduced by 0.0966 doses per patient (P < 0.05: 95% CI, 0.0955 to 0.0977). The number of patients receiving meperidine was reduced by 2.43% (P < 0.05: 95% CI, 1.97 to 2.88). This translates into a relative reduction of 29.5% in patients receiving meperidine and a relative reduction of 31% in meperidine doses dispensed per patient after academic detailing initiatives vs before. Eighty-five percent of standard orders were changed to improve therapy; these changes included converting meperidine to morphine or hydromorphone, decreasing cumulative acetaminophen daily dosages, using controlled-release and immediate-release opioids for pain management when oral therapy was tolerated, and combining modalities with different mechanisms of action for synergy and to decrease potential adverse effects from larger dosages of single entities. Academic detailing of meperidine resulted in short-term changes in prescribing patterns and decreased meperidine use at this institution. Long-term implications for pain management have not yet been assessed.


Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 235
Author(s):  
Faizah Safina Bakrin ◽  
Mohd Makmor-Bakry ◽  
Wan Hazmy Che Hon ◽  
Shafeeq Mohd Faizal ◽  
Mohamed Mansor Manan ◽  
...  

Introduction: Drug utilization of analgesics in a private healthcare setting is useful to examine their prescribing patterns, especially the newer injectable cyclooxygenase (COX)-2 inhibitors (coxibs). Objectives: To evaluate the utilization of coxibs and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) indicated for postoperative orthopaedic pain control using defined daily dose (DDD) and ratio of use density to use rate (UD/UR). Method: A retrospective drug utilization review (DUR) of nonsteroidal anti-inflammatory drugs (NSAIDs) at an inpatient department of a private teaching hospital in Seremban, Malaysia was conducted. Patients’ demographic characteristics, medications prescribed, clinical lab results, visual analogue scale (VAS) pain scores and length of hospital stay were documented. Orthopaedic surgeries, namely arthroscopy, reconstructive, and fracture fixation, were included. Stratified random sampling was used to select patients. Data were collected through patients’ medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization’s DDD as a benchmark. The inclusion criteria were patients undergoing orthopaedic surgery prescribed with coxibs (celecoxib capsules, etoricoxib tablets, parecoxib injections) and tNSAIDs (dexketoprofen injections, diclofenac sodium tablets). Data were analysed descriptively. This research was approved by the academic institution and the hospital research ethics committee. Result: A total of 195 records of patients who received NSAIDs were randomly selected among 1169 cases. In term of the types of orthopaedic surgery, the ratio of included records for arthroscopy:fracture fixation:reconstructive surgery was 55.4:35.9:8.7. Most of the inpatients had low rates of common comorbidities such as cardiovascular disease as supported by their baseline parameters. The majority were not prescribed with other concomitant prescriptions that could cause drug interaction (74.9%), or gastroprotective agents (77.4%). Overall, DDDs per 100 admissions for all NSAIDs were less than 100, except for parecoxib injections (389.23). The UD/UR for all NSAIDs were less than 100, except for etoricoxib tablets (105.75) and parecoxib injections (108.00). Discussion: As per guidelines, the majority (96.9%) received other analgesics to ensure a multimodal approach was carried out to control pain. From the UD/UR results, the arthroscopy surgery was probably the most appropriate in terms of NSAID utilization. Conclusion: The prescribing pattern of NSAIDs except parecoxib was appropriate based on adverse effect and concurrent medication profile. The findings of this DUR provide insight for a low-risk patient population at a private specialized teaching hospital on the recommended use of NSAIDs for postoperative orthopaedic pain control.


2018 ◽  
Vol 39 (12) ◽  
pp. 1400-1405 ◽  
Author(s):  
Erika M. C. D’Agata ◽  
Curt C. Lindberg ◽  
Claire M. Lindberg ◽  
Gemma Downham ◽  
Brandi Esposito ◽  
...  

AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.


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