scholarly journals Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

2015 ◽  
Vol 9 (11) ◽  
pp. 1264-1271 ◽  
Author(s):  
Mun Kit Lim ◽  
Pauline Siew Mei Lai ◽  
Sasheela Sri La Sri Ponnampalavanar ◽  
Sharifah Faridah Syed Omar ◽  
Nur Aishah Taib ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Case Report Form ◽  
Inappropriate Use ◽  
Common Causes ◽  
Surgical Setting ◽  
Antibiotic Courses ◽  
Inappropriate Choice

Introduction: Studies exploring the appropriateness of therapeutic antibiotic use among surgical patients are limited, particularly in developing countries. Therefore, the aim of our study was to determine the appropriateness of antibiotics prescribed in a surgical setting in Malaysia. Methodology: A prospective observational study was conducted in two surgical wards at a tertiary hospital in Malaysia from November 2012-July 2013. Data was collected using a case report form. The appropriateness of antibiotic therapy was based on compliance with either the Malaysian National Antibiotic Guidelines 2008 or International Clinical Practice Guidelines and determined by an expert panel (consisting of two infectious disease consultants and a pharmacist). Results: Over the study period, a total of 593 antibiotic courses were prescribed for 129 patients (4.6±3.4 antibiotics/patient). Only 34 (26.4%) patients received appropriate antibiotic therapy, whilst 95 (73.6%) patients received at least one course of inappropriate antibiotic therapy. The prevalence of inappropriate antibiotic use was 214 (66.3%) and 55 (42.0%) for prophylactic and therapeutic purposes, respectively. The most common causes of inappropriate prophylactic antibiotics were inappropriate timing 20 (36.4%) and inappropriate duration of prophylaxis 19 (34.5%). In cases of inappropriate timing, 9 (45%) were administered too late while 6 (30%) were too early. . In contrast, inappropriate choice of antibiotics (42.1%) and inappropriate indication (40.7%) were the most common reasons encountered for inappropriate therapeutic antibiotics. Conclusion: Our study suggests considerable inappropriate use of both prophylactic and therapeutic antibiotics in the surgical wards; highlighting an urgent need for antibiotic stewardship initiatives in this setting.

scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

scholarly journals Responsible antibiotic therapy simplified

2020 ◽  
Vol 35 ◽  
pp. 29-38
Author(s):  
Abhay K. Shah ◽  
Aashay Abhay Shah
Keyword(s):  
Developing Countries ◽  
Antibiotic Therapy ◽  
Disease Burden ◽  
Critical Role ◽  
Antibiotic Use ◽  
Developed Countries ◽  
Bacterial Disease ◽  
Antibiotic Prescribing ◽  
Inappropriate Use ◽  
Current Article

Antimicrobial resistance is a global problem and is particularly pressing in developing countries where the infectious disease burden is very high. In developing countries, where relatively easy availability and higher consumption of medicines have led to disproportionately higher incidence of inappropriate use of antibiotics and greater levels of resistance compared to developed countries. The bacterial disease burden in India is among the highest in the world; consequently, antibiotics will play a critical role in limiting morbidity and mortality in the country. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Responsible antibiotic therapy is one of the most important components of antibiotic stewardship. The current article is an attempt to provide a set of key principles to guide efforts to improve responsible and rational antibiotic use.

scholarly journals Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tian-ming Chen ◽  
Wen-hui Li ◽  
Fang Wang ◽  
Kun Tan ◽  
Qing-xiong Zhu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Targeted Therapy ◽  
Streptococcus Pneumoniae ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Antimicrobial Use ◽  
Inappropriate Use ◽  
Resistance Patterns ◽  
The Individual ◽  
Inappropriate Choice

Abstract Background Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China. Methods A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed. Results 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid. Conclusions Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.

scholarly journals Antibiotic usage in surgical prophylaxis: a prospective surveillance of surgical wards at a tertiary hospital in Malaysia

2014 ◽  
Vol 8 (02) ◽  
pp. 193-201 ◽  
Author(s):  
Ai Ling Oh ◽  
Leh Min Goh ◽  
Nik Abdullah Nik Azim ◽  
Chee Sian Tee ◽  
Chee Wei Shehab Phung
Keyword(s):  
Healthcare Costs ◽  
Prospective Observational Study ◽  
Tertiary Hospital ◽  
Antibiotic Usage ◽  
Prophylactic Antibiotics ◽  
Adherence Rate ◽  
Prospective Surveillance ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Clean Contaminated

Introduction: The widespread and inappropriate use of broad-spectrum antibiotics in surgical prophylaxis has led to reduced treatment efficacy, increased healthcare costs, and antibiotic resistance. This study aimed to explore the adherence of antibiotic usage in surgical prophylaxis to the national antibiotic guideline and the incidences of surgical site infection (SSI). Methodology: A three-month prospective observational study has been conducted in the surgical wards of Sarawak General Hospital (SGH) using a standardized surveillance form. Each patient was reviewed for up to 30 days post-operatively to determine the occurrence of SSI. Results: A total of 87 patients were included within the study period. The majority of the cases were clean-contaminated wounds (60.9%). Most were hepatobiliary cases (37.9%), followed by colorectal cases (19.5%). The most preferred antibiotic used was cefoperazone (63.2%). The choices of antibiotics in 78.2% of the cases were consistent with the guideline. Around 80% of prophylactic antibiotics were given within one hour before operation and 27.6% were omitted from intraoperative re-dosing. Prophylactic antibiotics were discontinued within 24 hours post-operatively in 77% of the cases. Of those continued for > 24 hours, the majority (60%) were administered for unknown reasons. SSI was documented in 13.8% of the total cases studied. However, there was no significant association between choices of antibiotics and timing of surgical prophylaxis with SSI (p = 0.299 and p = 0.258 respectively). Conclusion: Overall guideline adherence rate was more than 70%. Areas of non-concordance to the guideline require further investigation..

scholarly journals EVALUASI KUALITATIF PENGGUNAAN ANTIBIOTIK PADA PASIEN ANAK DENGAN METODE GYSSENS DI RSUD KARAWANG

2019 ◽  
Vol 4 (1) ◽  
pp. 297-302
Author(s):  
Diany Astuti ◽  
Yuli Nurhayati
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Therapy ◽  
Typhoid Fever ◽  
Pediatric Patients ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotics Resistance ◽  
Data Sampling ◽  
Inappropriate Use

ABSTRAK             Peresepan antibiotik untuk pasien anak-anak paling banyak digunakan dalam terapi. Penggunaan Antibiotik untuk anak-anak harus diawasi dan dikendalikan karena penggunaan antibiotik yang tidak terkontrol dan tidak tepat dapat berdampak pada kegagalan efek terapi yang diharapkan dan kemungkinan dapat meyebabkan resistensi antimikroba.  Pemakaian antibiotik harus dianalisis untuk mengendalikan resistensi antibiotik.  Tujuan penelitian ini untuk menilai rasionalitas terapi antibiotik pada pasien anak. Penelitian ini merupakan analisis deskriptif retrospektif dengan pengambilan data purposive sampling. Subjek dari penelitian adalah rekam medis dari bangsal anak RSUD Karawang. Rasionalitas penggunaan antibiotik adalah penilaian melalui metode gyssens. 147 data dianalisis untuk penelitian ini terdiri dari anak laki-laki (54,40%) dan perempuan (45,60%) dengan kasus demam tifoid (53,10), diare (24,5%) dan bronkopneumonia (22,4%). Antibiotik yang digunakan sefotaksim (71,43%), amoksisilin (5,44%) dan kloramfenikol (4,76%). Penilaian antibiotik melalui metode Gyssens adalah skala IVA (93,20%), skala IIB (6,12%) dan skala IIIA (0,68%). Kata Kunci: Antibiotik, Rasionalitas, Metode Gyssens.   ABSTRACT             Antibiotics prescription for pediatric patients is most widely used in therapy. Antibiotic use for pediatric must be watched and controlled because uncontrolled and inappropriate use of antibiotic can impact on failure of expected therapeutic effect and can also cause the possibility of antimicrobial resistance. Antibiotic consumption is must analyzed for controlling the antibiotics resistance. The aim of study The aim of this study was to assess the rationality of antibiotic therapy in pediatric patients. This research is a retrospective descriptive analysis with purposive data sampling. Subject of study are medical record from pediatric ward in RSUD Karawang. Rationality used of antibiotic is asses through Gyssens method. 147 data was analyzed for this study consist of boys (54,40%) and girls (45,60%) with case of typhoid  fever (53,10), diarrhea (24,5%) and bronchopneumonia (22,4%). Antibiotic was use Cefotaxime (71,43%), Amoxicillin (5,44%), Chloramphenicol (4,76%)etc.  Assessment  antibiotic through Gyssens method are IVA scale (93,20%), IIB scale ( 6,12%) and IIIA scale (0,68%). Keyword : Antibiotic, Rationality, Gyssens Method.

scholarly journals Factors Associated With Inappropriate Antibiotic Use in Hospitalized Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s233-s234
Author(s):  
Stephanie Cabral ◽  
Timileyin Adediran ◽  
Anthony Harris ◽  
Pranita Tamma ◽  
Sara Cosgrove ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Initial Therapy ◽  
Hospitalized Patients ◽  
Older Age ◽  
Factors Associated ◽  
Inappropriate Use ◽  
Inappropriate Antibiotics ◽  
Antibiotic Courses

Background: Inappropriate antibiotic prescription leads to increased Clostridiodes difficile infections, adverse effects including organ toxicity, and generation of antibiotic-resistant bacteria. Despite efforts to improve antibiotic use in acute-care settings, unnecessary and inappropriate prescription still occur in 30%–50% of patients. Objectives: We assessed factors associated with inappropriate antibiotic prescription at 2 time points: (1) initial, empiric therapy and (2) 3–5 days after therapy initiation. Methods: As part of a multicenter study investigating strategies to reduce antibiotic therapy after 3–5 days of use, antibiotic prescription data were collected from 11 adult and pediatric intensive care and general medical units at 6 hospitals in Maryland in 2014 and 2015. We performed a retrospective cohort study of all hospitalized patients who received any of 23 common antibiotics for at least 3 days. Each medical record was reviewed for demographics, admission and discharge dates, patient comorbidities, and antibiotic regimen by at least 1 infectious disease physician or pharmacist. Classification of antibiotic inappropriateness was based on each institution’s guidelines and standards. Bivariate analyses were performed using logistic regression for both initial therapy and therapy at days 3–5. Multivariable logistic regression was performed using covariates meeting the significance level of P < .05. Results: In total, 3,436 antibiotic courses were assessed at time of initial therapy, and 1541 regimens were continued and reviewed again at days 3–5 of therapy. For the initial therapy, 1,255 regimens (37%) were inappropriate; 45% of these were considered unnecessary and 41% were too broad in spectrum. In the multivariable regression, older age and antibiotic prescription during the summer were associated with the receipt of inappropriate antibiotics (Table 1). Having end-stage renal disease as a comorbid condition was protective against inappropriate use. At days 3–5 of therapy, 688 (45%) of the antibiotic courses were inappropriate. Reasons regimens were considered inappropriate included unnecessary antibiotic prescriptions (49%) and antibiotics being too broad (38%). Older age and receiving cefepime or piperacillin-tazobactam on day 3 of therapy were factors associated with inappropriate use (Table 2). Having undergone a transplant or a surgical procedure was protective of inappropriate antimicrobial use at days 3–5 of therapy. Conclusions: Older patients are more likely to receive inappropriate antibiotics at both initial regimen and 3–5 days later. Patients receiving cefepime or piperacillin-tazobactam are at greater risk of receiving inappropriate antibiotics at days 3–5 due to failure to de-escalate. Antibiotic stewardship strategies targeting these patient populations may limit inappropriate use.Funding: NoneDisclosures: None

Assessment of parental knowledge, attitude and practice towards antibiotic use in children

2020 ◽  
Vol 10 (2) ◽  
pp. 25-41
Author(s):  
Thejaswini Karanth ◽  
Someswar Deb ◽  
Lal Ruatpuii Zadeng ◽  
Rajeswari Ramasamy ◽  
Teena Nazeem ◽  
...  
Keyword(s):  
Parental Knowledge ◽  
Antibiotic Use ◽  
Case Report Form ◽  
Standard Case ◽  
Attitude And Practice ◽  
Validated Questionnaire ◽  
Antibiotics Use ◽  
The Impact ◽  
Knowledge Attitude And Practice

Objective to assess the impact of pharmacist assisted counselling in improving Parental Knowledge, Attitude and Practice [KAP] towards antibiotic use in children. A Prospective, Educational Interventional Study was conducted in 200 subjects, from the randomly chosen communities in Bangalore. The investigators did door to door visit. The primary demographics data of parents and their children were collected using standard Case Report Form (CRF), and the baseline towards antibiotic use in Children was obtained from parents using validated Questionnaire. In the presence of both parents, only one was supposed to answer the Questionnaire. Pharmacist assisted parent centred interventional counselling was provided with the help of Patient Information Leaflet1s (PIL). Follow-up and post interventional KAP assessment were done after two months from the baseline measurement. The changes in parental KAP towards antibiotics use in children were being assessed by comparing the Pretest and Posttest responses using statistical analysis. The knowledge of parents towards antibiotic use in children was medium to good in the baseline KAP assessment; however, in the majority of the participating parents it was not satisfactory in attitude and practice domains. A statistically significant improvement was seen in the KAP of parents towards antibiotic use in children after the pharmacist assisted interventional counselling. Thus, Investigators could bring excellent changes in the knowledge part; whereas the result for changes in the Attitude and Practice was good to medium respectively.

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

scholarly journals Educational Video Improves Knowledge about Outpatients’ Usage of Antibiotics in Two Public Hospitals in Indonesia

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 606
Author(s):  
Fauna Herawati ◽  
Rika Yulia ◽  
Bustanul Arifin ◽  
Ikhwan Frasetyo ◽  
Setiasih ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
General Hospital ◽  
Sampling Technique ◽  
Knowledge Score ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Educational Video ◽  
Inappropriate Use ◽  
Quasi Experimental ◽  
The Difference

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about “Responsible use of antibiotics” and “How to obtain antibiotics” is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients’ knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test—post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents’ knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous “yes” or “no” answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student’s t-test was applied. The educational videos significantly improved outpatients’ knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

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