scholarly journals Trends in the use of antibiotics for pharyngitis in Saudi Arabia

2021 ◽  
Vol 15 (03) ◽  
pp. 415-421
Author(s):  
Rawaa Ibrahim Olwi ◽  
Duaa Ibrahim Olwi
Keyword(s):  
Primary Care ◽  
Saudi Arabia ◽  
Broad Spectrum ◽  
Odds Ratio ◽  
Diagnostic Tools ◽  
Diagnosis And Management ◽  
Adequate Knowledge ◽  
Broad Spectrum Antibiotics ◽  
Stewardship Program ◽  
Centor Score

Introduction: Pharyngitis is one of the most common diagnoses for antibiotic prescriptions worldwide. Antibiotics should be prescribed for bacterial pharyngitis to reduce its complications. The aims of this study were to assess antibiotic prescriptions for pharyngitis cases, and their relationship with physicians’ knowledge regarding its diagnosis and management. Methodology: A cross-sectional study was conducted. First, prescriptions for pharyngitis cases using the modified Centor criteria was evaluated at primary care centers in Saudi Arabia. Second, physicians’ knowledge of the modified Centor score and the diagnosis and management of pharyngitis was assessed using a self-administered questionnaire. Results: Out of 104 pharyngitis cases, 79% (n = 82) were prescribed antibiotics, of which 28% were evidence-based prescriptions. First-line antibiotics were prescribed in 34% of patients, and second-line (broad-spectrum) antibiotics such as amoxicillin/clavulanate were prescribed in half of the patients. The main significant predictors of antibiotic prescriptions were age < 3 years (odds ratio, 0.13; 95% CI, 0.02 to 0.97), tonsillar exudate (odds ratio, 21.14; 95% CI, 2.88 to 155.09), and throat erythema (odds ratio, 9.30; 95% CI, 1.18 to 73.41). Overall, physicians (n = 29) had adequate knowledge about the modified Centor score and the management of pharyngitis. Conclusions: Most prescribed antibiotics for pharyngitis were unnecessarily prescribed; the majority being broad-spectrum antibiotics. Despite physicians’ adequate knowledge of the modified Centor score and the management of pharyngitis, their practice failed to demonstrate that. Induction of the Saudi Antimicrobial Stewardship Program in the primary care centers, accessibility to diagnostic tools, and educational programs may help in reducing unnecessary antibiotic prescriptions.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis

2018 ◽  
Vol 69 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Violeta Balinskaite ◽  
Alan P Johnson ◽  
Alison Holmes ◽  
Paul Aylin
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Segmented Regression ◽  
Broad Spectrum Antibiotic ◽  
Stewardship Program ◽  
The Impact

Abstract Background The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

scholarly journals Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

2020 ◽  
Author(s):  
Dan Wang ◽  
Chaojie Liu ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Primary Care Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Latent Profile Analyses ◽  
Broad Spectrum Antibiotics

Abstract Background Overuse of antibiotics significantly fuels the development of AMR, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants. Methods A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n=501,072) made by the participants from 1 January to 31 March 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns. Results On average, each primary care physician issued 909 (ranging from 100 to 11941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD=17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD=15.83%) contained broad-spectrum antibiotics; 71.92% (SD=21.42%) contained parenteral administered antibiotics; 23.52% (SD=19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD=20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers. Conclusion Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

scholarly journals 2032. First National Survey of Antimicrobial and Antifungal Stewardship in Japan

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S682-S683
Author(s):  
Yuki Moriyama ◽  
Masahiro Ishikane ◽  
Yoshiki Kusama ◽  
Nobuaki Matsunaga ◽  
Taichi Tajima ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Odds Ratio ◽  
Fourth Generation ◽  
Limited Data ◽  
Related Factors ◽  
Antifungal Stewardship ◽  
Cross Sectional ◽  
Hospital Epidemiology ◽  
Nationwide Study ◽  
Broad Spectrum Antibiotics

Abstract Background To manage antimicrobial resistance, both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) are needed. However, limited data show AMS and AFS practices among hospitals in Japan. Methods We conducted a cross-sectional nationwide study using a questionnaire distributed to hospitals that participated in a hospital epidemiology workshop in Japan in July 2018. The questions addressed activities of preauthorization, notification, and intervention within 7 or 28 days about broad-spectrum antibiotics (third- and fourth-generation cephalosporins and piperacillin–tazobactam, carbapenem, intravenous quinolone) and antifungals. Interventions to use broad-spectrum antibiotics and antifungals were compared between large (≥501 beds) and small/medium-sized (≤500 beds) hospitals. Results Of 240 hospitals, 39 (16%; 18 large and 21 small/medium-sized) responded. Preauthorization of using broad-spectrum antibiotics and antifungals was found in 4 (10%) and 1 (3%) hospital(s), respectively. Notification of broad-spectrum antibiotics and antifungals was found in 37 (95%) and 2 (5%) hospitals, respectively. The numbers of hospitals that intervened in the use of broad-spectrum antibiotics within 7 and 28 days were 17 (44%) and 34 (87%), respectively; those of antifungals were 3 (8%) and 10 (26%), respectively (Table 1). Interventions to use broad-spectrum antibiotics within 7 days were statistically more frequent in small-/medium-sized hospitals than in large hospitals [13 (61.9%) vs. 4 (22.2%),odds ratio = 5.7, 95% confidence interval = 1.4–23.3, p = 0.023]. All hospitals had less-frequent interventions to use antifungals within 7 days than those for antibiotics[3 (14.3%) vs. 0 (0%)] (Table 2). Conclusion Small-/middle-sized hospitals had more frequent interventions within 7 days of broad-spectrum antibiotics than those of large hospitals, possibly because small-/medium-sized hospitals are agile and have few barriers against interventions to use broad-spectrum antibiotics. Compared with broad-spectrum antibiotics, interventions of antifungals were less frequently conducted in all hospitals. We need to emphasize the importance of AFS in Japan. Further studies on related factors are needed. Disclosures All authors: No reported disclosures.

scholarly journals 1877. Evaluation of Antibiotic Utilization After Introduction of a Dedicated Infectious Diseases-Critical Care Medicine Service in Critical Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S48-S48
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Victor Chen ◽  
Gregory Weston ◽  
Kelsie Cowman ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving a high volume of empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely implemented. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a large tertiary hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide an ID consult on select patients. We sought to evaluate the impact of this dedicated ID consultation and stewardship program on antibiotic utilization in the ICU. Methods This is an IRB-approved single-site retrospective study. We analyzed antibiotic utilization in the ICU during the post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICU during the pre-intervention period from January 1, 2015 to December 31, 2015. Using Poisson regression analysis, we evaluated antibiotic utilization of each agent, expressed as days of therapy (DOT) per 1,000 patient-days, between the two groups. Results The six most commonly used broad-spectrum antibiotic agents were included in the final analysis. During the intervention period, statistically significant reductions were seen in cefepime (131 vs. 101 DOT per 1,000 patient-days, P = 0.01), piperacillin-tazobactam (268 vs. 251 DOT per 1,000 patient-days, P = 0.02) and vancomycin (265 vs. 228 DOT per 1,000 patient-days, P = 0.01). The utilization of other antibiotics including daptomycin, linezolid, and meropenem did not differ significantly (Figure 1). Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently administered broad-spectrum antibiotics. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents. Disclosures All Authors: No reported Disclosures.

scholarly journals Hour-1 Bundle Adherence Was Associated With Reduction of In-Hospital Mortality Among Patients With Sepsis In Japan

2021 ◽  
Author(s):  
Yutaka Umemura ◽  
Toshikazu Abe ◽  
Hiroshi Ogura ◽  
Seitato Fujishima ◽  
Shigeki Kushimoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Broad Spectrum ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Blood Cultures ◽  
Care Bundle ◽  
Study Cohort ◽  
Broad Spectrum Antibiotics ◽  
The Impact

Abstract Background: The updated Surviving Sepsis Campaign guidelines recommend a 1-hour window for completion of a sepsis care bundle, however, the effectiveness of the hour-1 bundle has not been fully evaluated. The present study aimed to evaluate the impact of hour-1 bundle completion on clinical outcomes in sepsis patients.Methods: This is a multicenter, prospective, observational study conducted in 17 intensive care units in tertiary hospitals in Japan. We included all adult patients who were diagnosed as having sepsis by Sepsis-3 and admitted to the ICUs from July 2019 to August 2020. Impacts of hour-1 bundle adherence and delay of adherence on risk-adjusted in-hospital mortality were estimated by multivariable logistic regression analyses.Results: The final study cohort included 178 patients with sepsis. Among them, 89 received bundle-adherent care. Completion rates of each component (measure lactate level; obtain blood cultures; administer broad-spectrum antibiotics; administer crystalloid, apply vasopressors) within 1 hour were 98.9%, 86.2%, 51.1%, 94.9%, and 69.1%, respectively. Completion rate of all components within 1 hour was 50.3%. In-hospital mortality was 18.0% in patients with and 30.3% in patients without bundle-adherent care (p=0.054) Adjusted odds ratio of non-bundle-adherent versus bundle-adherent care for in-hospital mortality was 2.32 (95% CI 1.09–4.95) using propensity score. Non-adherence to obtaining blood cultures and administering broad-spectrum antibiotics within 1 hour were related to in-hospital mortality (2.65 [95% CI 1.25–5.62] and 4.81 [95% CI 1.38–16.72], respectively). Adjusted odds ratio for 1-hour delay in achieving hour-1 bundle components for in-hospital mortality was 1.28 (95% CI 1.04–1.57) by logistic regression analysis.Conclusion: Completion of the hour-1 bundle was associated with lower in-hospital mortality. Obtaining blood cultures and administering antibiotics within 1 hour may have been the components most contributing to decreased in-hospital mortality.

scholarly journals Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: a qualitative study with primary care clinicians

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029260 ◽  
Author(s):  
Oliver van Hecke ◽  
Chris Butler ◽  
Marc Mendelson ◽  
Sarah Tonkin-Crine
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Broad Spectrum ◽  
Point Of Care ◽  
Antibiotic Prescribing ◽  
Western Cape ◽  
Publicly Funded ◽  
Broad Spectrum Antibiotics ◽  
Primary Care Clinicians ◽  
Common Infections

Broad-spectrum antibiotics are routinely prescribed empirically in the resource-poor settings for suspected acute common infections, which drive antimicrobial resistance. Point-of-care testing (POCT) might increase the appropriateness of decisions about whether and which antibiotic to prescribe, but implementation will be most effective if clinician’s perspectives are taken into account.ObjectivesTo explore the perceptions of South African primary care clinicians working in publicly funded clinics about: making antibiotic prescribing decisions for two common infection syndromes (acute cough, urinary tract infection); their experiences of existing POCTs; their perceptions of the barriers and opportunities for introducing (hypothetical) new POCTs.Design, method, participants, settingQualitative semistructured interviews with 23 primary care clinicians (nurses and doctors) at publicly funded clinics in the Western Cape Metro district, South Africa. Data were analysed using thematic analysis.ResultsClinicians reported that their antibiotic prescribing decisions were influenced by their clinical assessment, patient comorbidities, social factors (eg, access to care) and perceived patient expectations. Their experiences with currently available POCTs were largely positive, and they were optimistic about the potential for new POCTs to: support evidence-based prescribing decisions that might reduce unnecessary antibiotic prescriptions; reduce the need for further investigations; support effective communication with patients, especially when antibiotics were unlikely to be of benefit. Resources and workflow disruption were seen as the main barriers to uptake into routine care.ConclusionsClinicians working in publicly funded clinics in the Western Cape Metro of South Africa saw POCTs as potentially useful for positively addressing both clinical and social drivers of the overprescribing of broad-spectrum antibiotics, but were concerned about the resource implications and disruption of existing patient workflows.

scholarly journals 1115. Reducing Broad-Spectrum Antibiotics for Uncomplicated Urinary Tract Infections: A Multimodal Stewardship Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S397
Author(s):  
Maryrose R Laguio-Vila ◽  
Mary L Staicu ◽  
Mary Lourdes Brundige ◽  
Jose Alcantara-Contreras ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Phase I ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
Phase 1 ◽  
Phase 2 ◽  
Intervention Phase ◽  
Broad Spectrum Antibiotics ◽  
Stewardship Program ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the second most common reason for antibiotics in hospitalized patients, with most receiving broad-spectrum antibiotics (BSA) regardless of infection severity. The antimicrobial stewardship program (ASP) conducted a multimodal stewardship intervention targeting reduction in one BSA, ceftriaxone, and promoted narrow-spectrum antibiotics (NSA) such as cefazolin and cephalexin for uncomplicated UTIs. Methods Phase 1: In February 2018, the ASP created a pocket card (Figure 1) containing (1) a urinary antibiogram outlining the most common urine pathogens and their local susceptibility to NSA and (2) NSA guidelines for UTIs with 0–1 systemic inflammatory response syndrome (SIRS) criteria. ASP performed a daily prospective audit with feedback on all new orders of ceftriaxone and promoted prescription of NSA. Phase 2: In August 2018, a Best Practice Alert (BPA) in the electronic medical record (EMR) was designed to interrupt providers ordering ceftriaxone with the indication of a UTI, and prompted NSA prescription instead. Quarterly didactic sessions on UTI antibiotic use and BPA functionality were done. We compared antibiotics usage rates across the 3 study phases (pre-intervention, phase I and phase II) by computing rate ratios (RRs) using Poisson regression. Results Compared with pre-intervention, phase 1 resulted in a significant decrease in ceftriaxone DOT (RR: 1.06, CI: 1.03–1.09, P < 0.001) and ceftriaxone orders for UTI (RR: 1.14, P < 0.001) and an increase in cefazolin DOT (RR: 0.89, P = 0.029) and orders for UTI (RR; 0.12, P < 0.001). It also resulted in a significant increase in cephalexin DOT (RR: 0.92, P = 0.002) and orders for UTI (RR: 0.58, P < 0.001). In phase 2, an additional significant reduction in ceftriaxone DOT (RR: 1.04, CI: 1.01–1.08, P = 0.018) and orders for UTI (RR: 1.62, P < 0.001) and an increase in cefazolin DOT (RR: 0.96, P < 0.001) and orders for UTI (RR; 0.56, P < 0.001) occurred, when comparing phase I to phase 2. It also resulted in a decrease in cephalexin DOT (RR: 0.83, P < 0.001) and orders for UTI (RR: 0.70, P < 0.001). Conclusion A multimodal stewardship intervention using a pocket card with guidelines and urine antibiogram, and an EMR BPA successfully reduced BSA and increased NSA for treatment of uncomplicated UTIs. Disclosures All authors: No reported disclosures.

scholarly journals Identifying Antibiotic Prescribing Patterns Through Multi-Level Latent Profile Analyses: A Cross-Sectional Survey of Primary Care Physicians

2020 ◽  
Vol 11 ◽  
Author(s):  
Dan Wang ◽  
Chaojie Liu ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Primary Care Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Latent Profile Analyses ◽  
Broad Spectrum Antibiotics

Background: Overuse of antibiotics significantly fuels the development of Antimicrobial resistance, which threating the global population health. Great variations existed in antibiotic prescribing practices among physicians, indicating improvement potential for rational use of antibiotics. This study aims to identify antibiotic prescribing patterns of primary care physicians and potential determinants.Methods: A cross-sectional survey was conducted on 551 physicians from 67 primary care facilities in Hubei selected through random cluster sampling, tapping into their knowledge, attitudes and prescribing practices toward antibiotics. Prescriptions (n = 501,072) made by the participants from 1 January to March 31, 2018 were extracted from the medical records system. Seven indicators were calculated for each prescriber: average number of medicines per prescription, average number of antibiotics per prescription, percentage of prescriptions containing antibiotics, percentage of antibiotic prescriptions containing broad-spectrum antibiotics, percentage of antibiotic prescriptions containing parenteral administered antibiotics, percentage of antibiotic prescriptions containing restricted antibiotics, and percentage of antibiotic prescriptions containing antibiotics included in the WHO “Watch and Reserve” list. Two-level latent profile analyses were performed to identify the antibiotic prescribing patterns of physicians based on those indicators. Multi-nominal logistic regression models were established to identify determinants with the antibiotic prescribing patterns.Results: On average, each primary care physician issued 909 (ranging from 100 to 11,941 with a median of 474) prescriptions over the study period. The mean percentage of prescriptions containing antibiotics issued by the physicians reached 52.19% (SD = 17.20%). Of those antibiotic prescriptions, an average of 82.29% (SD = 15.83%) contained broad-spectrum antibiotics; 71.92% (SD = 21.42%) contained parenteral administered antibiotics; 23.52% (SD = 19.12%) contained antibiotics restricted by the regional government; and 67.74% (SD = 20.98%) contained antibiotics listed in the WHO “Watch and Reserve” list. About 28.49% of the prescribers were identified as low antibiotic users, compared with 51.18% medium users and 20.33% high users. Higher use of antibiotics was associated with insufficient knowledge, indifference to changes, complacency with satisfied patients, low household income and rural location of the prescribers.Conclusion: Great variation in antibiotic prescribing patterns exists among primary care physicians in Hubei of China. High use of antibiotics is not only associated with knowledge shortfalls but also low socioeconomic status of prescribers.

scholarly journals Evaluation of the Quality of Antibiotic Prescribing in Primary Care: A Multicenter Longitudinal Study From Shenzhen, China

2021 ◽  
Vol 11 ◽  
Author(s):  
Yanhong Gong ◽  
Hui Li ◽  
Heping Yang ◽  
Kun Tan ◽  
Wei Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Substantial Reduction ◽  
Guideline Recommendation ◽  
Antibiotic Prescribing ◽  
Oral Antibiotics ◽  
First Line ◽  
Broad Spectrum Antibiotics ◽  
Common Infections

Background: Currently, there is no comprehensive evaluation of the quality of antibiotic prescribing in China’s primary care facilities based on longitudinal data.Methods: We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010 to 2015. To evaluate the quality of antibiotic prescribing, we used six quality indicators for analysis, including number of antibiotics per 100 consultations, ratio between broad-spectrum and narrow-spectrum antibiotics (B/N ratio), percentage of first-line antibiotics recommended by guidelines, percentage of oral antibiotics with a duration exceeding the guideline recommendation, and new pediatric-specific indicators such as percentage of antibiotics with amoxicillin (A index) and ratio between amoxicillin and broad-spectrum antibiotics (A/B ratio).Results: During the study period, 571,362 outpatient consultations resulted in antibiotic prescriptions, which contained 706,411 antibiotics. The overall number of antibiotics per 100 consultations decreased significantly from 93.50 in 2010 to 19.98 in 2015 (p = 0.004), but the B/N ratio showed an upward trend over time (p = 0.009). In different populations and different common infections, the number of antibiotics used decreased to varying degrees, while the B/N ratio increased to varying degrees, with the most obvious change in children &lt;5 years. The percentage of first-line antibiotics for common infections was not high, ranging from 3.45 to 44.25% during 2014–2015. The percentage of oral antibiotics with an exceeded duration ranged from 0.70 to 19.39%. Moreover, the A index and A/B ratio in children remained low for a long time, which was 0.76% and 0.01 in 2015.Conclusion: A review of antibiotic prescribing in Shenzhen, China, showed a substantial reduction in antibiotic use in primary care. However, problems such as widespread use of broad-spectrum antibiotics, insufficient use of first-line antibiotics and low use of amoxicillin were prevalent. Improving and optimizing the quality of antibiotic prescribing, particularly in children prescriptions, will be the focus of future antibiotic stewardship in China.

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