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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 36365

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Dr. Rabia Hussain

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Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
Interests: medicine safety; pharmacovigilance; antibiotics use
Special Issues, Collections and Topics in MDPI journals

Dr. Jaya Muneswarao

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Department of Pharmacy, Penang Hospital, Ministry of Health Malaysia, George Town, Penang, Malaysia
Interests: pharmacotherapy; respiratory diseases; antibiotics; anti-infectives

Prof. Dr. Zaheer Ud-Din Babar

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Department of Pharmacy, University of Huddersfield, Huddersfield, UK
Interests: pharmaceutical policy; access to medicines; pharmacy practice research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

COVID-19 has affected areas all over the globe, leading to secondary infections. However, there are myriad issues about access, use, and consumption of antimicrobials globally. Few innovative antibiotics are coming to the market, and the treatment options are becoming limited. The emergence of superinfections due to antibiotic misuse and overuse is also posing a serious threat to healthcare systems. In low- and middle-income countries (LMICs), a large number of antibiotics are available without a prescription, contributing to the irrational use of antibiotics. This has led to the development of antibiotic resistance coupled with the emergence of the new and large-scale spread of infections. This is becoming very challenging in terms of our ability to treat the burden of these diseases. This Special Issue will explore the access and utilization of antibiotics in primary and secondary care settings. Papers from all corners of the world are welcome. This includes original research articles, reviews, meta-analyses as well as commentaries.

Dr. Rabia Hussain
Dr. Jaya Muneswarao
Prof. Zaheer Ud-Din Babar
Guest Editors

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Keywords

access
rationale use
antibiotics
therapeutic guidelines
anti-infectives
safety

Published Papers (12 papers)

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Research

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9 pages, 253 KiB

Open AccessArticle

Pre-Visit Use of Non-Prescribed Antibiotics among Child Patients in China: Prevalence, Predictors, and Association with Physicians’ Prescribing of Antibiotics at Medical Visits

by Nan Christine Wang

Antibiotics 2022, 11(11), 1553; https://doi.org/10.3390/antibiotics11111553 - 4 Nov 2022

Cited by 2 | Viewed by 1199

Abstract

Antibiotic resistance is one of the most serious global public health crises. Inappropriate use of antibiotics is an important contributor. Using a cross-sectional survey, we recruited 3056 caregivers from 21 provinces in China to complete a questionnaire pertaining to their most recent medical visits for children’s acute respiratory tract infection (ARTI) symptoms in October 2013. The findings show that the prevalence of caregivers giving children non-prescribed antibiotics before their medical visit was as high as 38%. Caring for an older child and having lower educational attainment increased the likelihood of self-medication with antibiotics; among Chinese residential areas, caregivers living in tier 2 urban districts were most likely to administer non-prescribed antibiotics before their visit. Physicians’ prescribing of antibiotics was significantly associated with caregivers’ self-reported pre-visit use of non-prescribed antibiotics. Misuse should be addressed by regulating the sale of antibiotics and improving communication at medical consultations. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

11 pages, 1738 KiB

Open AccessArticle

Outpatient Antibiotic Use and Costs in Adults: A Nationwide Register-Based Study in Finland 2008–2019

by Elisa Pyörälä, Kati Sepponen, Anneli Lauhio and Leena Saastamoinen

Antibiotics 2022, 11(11), 1453; https://doi.org/10.3390/antibiotics11111453 - 22 Oct 2022

Cited by 2 | Viewed by 1643

Abstract

The objective of this study was to describe the prevalence of outpatient use and costs for systemic antibacterials by age and sex among adults in Finland from 2008–2019. Data from the Finnish statistical database Kelasto, containing information concerning all reimbursed medicines for 18+-year-olds during 2008–2019, were analyzed. In addition to the decreased (26%) use of systemic antibiotics, decreased use was observed in all antibiotic categories, notably including several wide-spectrum antibiotics. The use of quinolones decreased by 49% and of tetracyclines by 39%. The 10 most frequently used antibiotics covered 89% of all adult antibiotic prescriptions. Antibiotic use also decreased in every age group during the study period. Although the overall yearly costs of outpatient antibiotics during the 10-year study period decreased from EUR 36.4 million to EUR 30.7 million, the cost per prescription increased slightly. In conclusion, according to the findings of this study, concerning adults and the results of our previous study concerning children and adolescents (2008–2016), there has been a decreasing trend of outpatient antibacterial use among the whole Finnish outpatient population over the duration of nearly one decade. However, during the same time period, there has been a specific increasing trend for the Gram-negative AMR threat regarding E. coli resistance. Therefore, based on our important findings in Finland, methods other than the restriction of antibiotic use, such as new anti-infective innovations, including antibacterials, are needed as soon as possible to tackle this major global health threat—a silent pandemic. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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14 pages, 1367 KiB

Open AccessArticle

Antibiotic Prescribing Practices for Treating COVID-19 Patients in Bangladesh

by Utpal Kumar Mondal, Tahmidul Haque, Md Abdullah Al Jubayer Biswas, Syed Moinuddin Satter, Md Saiful Islam, Zahidul Alam, Mohammad Shojon, Shubroto Debnath, Mohaiminul Islam, Haroon Bin Murshid, Md Zakiul Hassan and Nusrat Homaira

Antibiotics 2022, 11(10), 1350; https://doi.org/10.3390/antibiotics11101350 - 4 Oct 2022

Cited by 3 | Viewed by 1963

Abstract

Although national and international guidelines have strongly discouraged use of antibiotics to treat COVID-19 patients with mild or moderate symptoms, antibiotics are frequently being used. This study aimed to determine antibiotics-prescribing practices among Bangladeshi physicians in treating COVID-19 patients. We conducted a cross-sectional survey among physicians involved in treating COVID-19 patients. During September–November 2021, data were collected from 511 respondents through an online Google Form and hardcopies of self-administered questionnaires. We used descriptive statistics and a regression model to identify the prevalence of prescribing antibiotics among physicians and associated factors influencing their decision making. Out of 511 enrolled physicians, 94.13% prescribed antibiotics to COVID-19 patients irrespective of disease severity. All physicians working in COVID-19–dedicated hospitals and 87% for those working in outpatient wards used antibiotics to treat COVID-19 patients. The majority (90%) of physicians reported that antibiotics should be given to COVID-19 patients with underlying respiratory conditions. The most prescribed antibiotics were meropenem, moxifloxacin, and azithromycin. Our study demonstrated high use of antibiotics for treatment of COVID-19 patients irrespective of disease severity and the duty ward of study physicians. Evidence-based interventions to promote judicious use of antibiotics for treating COVID-19 patients in Bangladesh may help in reducing an overuse of antibiotics. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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13 pages, 1917 KiB

Open AccessArticle

Antibiotic Use before, during, and after Seeking Care for Acute Febrile Illness at a Hospital Outpatient Department: A Cross-Sectional Study from Rural India

by Bronwen Holloway, Harshitha Chandrasekar, Manju Purohit, Ashish Sharma, Aditya Mathur, Ashish KC, Leticia Fernandez-Carballo, Sabine Dittrich, Helena Hildenwall and Anna Bergström

Antibiotics 2022, 11(5), 574; https://doi.org/10.3390/antibiotics11050574 - 25 Apr 2022

Cited by 1 | Viewed by 2412

Abstract

Antibiotic resistance is a naturally occurring phenomenon, but the misuse and overuse of antibiotics is accelerating the process. This study aimed to quantify and compare antibiotic use before, during, and after seeking outpatient care for acute febrile illness in Ujjain, India. Data were collected through interviews with patients/patient attendants. The prevalence and choice of antibiotics is described by the WHO AWaRe categories and Anatomical Therapeutic Chemical classes, comparing between age groups. Units of measurement include courses, encounters, and Defined Daily Doses (DDDs). The antibiotic prescription during the outpatient visit was also described in relation to the patients’ presumptive diagnosis. Of 1000 included patients, 31.1% (n = 311) received one antibiotic course, 8.1% (n = 81) two, 1.3% (n = 13) three, 0.4% (n = 4) four, 0.1% (n = 1) five, and the remaining 59.0% (n = 590) received no antibiotics. The leading contributors to the total antibiotic volume in the DDDs were macrolides (30.3%), combinations of penicillins, including β-lactamase inhibitors (18.8%), tetracyclines (14.8%), fluoroquinolones (14.6%), and third-generation cephalosporins (13.7%). ‘Watch’ antibiotics accounted for 72.3%, 52.7%, and 64.0% of encounters before, during, and after the outpatient visit, respectively. Acute viral illness accounted for almost half of the total DDDs at the outpatient visit (642.1/1425.3, 45.1%), for which the macrolide antibiotic azithromycin was the most frequently prescribed antibiotic (261.3/642.1, 40.7%). Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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19 pages, 2410 KiB

Open AccessArticle

Availability, Prices and Affordability of Antibiotics Stocked by Informal Providers in Rural India: A Cross-Sectional Survey

by Meenakshi Gautham, Rosalind Miller, Sonia Rego and Catherine Goodman

Antibiotics 2022, 11(4), 523; https://doi.org/10.3390/antibiotics11040523 - 14 Apr 2022

Cited by 5 | Viewed by 4087

Abstract

Providers without formal training deliver healthcare and antibiotics across rural India, but little is known about the antibiotics that they stock. We conducted a cross-sectional survey of such informal providers (IPs) in two districts of West Bengal, and assessed the availability of the antibiotics, as well as their sales volumes, retail prices, percentage markups for IPs and affordability. Of the 196 IPs that stocked antibiotics, 85% stocked tablets, 74% stocked syrups/suspensions/drops and 18% stocked injections. Across all the IPs, 42 antibiotic active ingredients were stocked, which comprised 278 branded generics from 74 manufacturers. The top five active ingredients that were stocked were amoxicillin potassium clavulanate (52% of the IPs), cefixime (39%), amoxicillin (33%), azithromycin (25%) and ciprofloxacin (21%). By the WHO’s AWaRe classification, 71% of the IPs stocked an ACCESS antibiotic and 84% stocked a WATCH antibiotic. The median prices were in line with the government ceiling prices, but with substantial variation between the lowest and highest priced brands. The most affordable among the top five tablets were ciprofloxacin, azithromycin, cefixime and amoxicillin (US$ 0.8, 0.9, 1.9 and 1.9 per course), and the most affordable among the syrups/suspensions/drops were azithromycin and ofloxacin (US$ 1.7 and 4.5 per course, respectively), which are mostly WATCH antibiotics. IPs are a key source of healthcare and antibiotics in rural communities; practical interventions that target IPs need to balance restricting WATCH antibiotics and expanding the basket of affordable ACCESS antibiotics. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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16 pages, 449 KiB

Open AccessArticle

Impact of Extended and Restricted Antibiotic Deescalation on Mortality

by Hwei Lin Teh, Sarimah Abdullah, Anis Kausar Ghazali, Rahela Ambaras Khan, Anitha Ramadas and Chee Loon Leong

Antibiotics 2022, 11(1), 22; https://doi.org/10.3390/antibiotics11010022 - 27 Dec 2021

Cited by 2 | Viewed by 2352

Abstract

Background: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. This study aims to compare the survival curve of patient de-escalated (early or late) against those not de-escalated on antibiotics, to determine the association of patient related, clinical related, and pressure sore/device related characteristics on all-cause 30-day mortality and determine the impact of early and late antibiotic de-escalation on 30-day all-cause mortality. Methods: This is a retrospective cohort study on patients in medical ward Hospital Kuala Lumpur, admitted between January 2016 and June 2019. A Kaplan–Meier survival curve and Fleming–Harrington test were used to compare the overall survival rates between early, late, and those not de-escalated on antibiotics while multivariable Cox proportional hazards regression was used to determine prognostic factors associated with mortality and the impact of de-escalation on 30-day all-cause mortality. Results: Overall mortality rates were not significantly different when patients were not de-escalated on extended or restricted antibiotics, compared to those de-escalated early or later (p = 0.760). Variables associated with 30-day all-cause mortality were a Sequential Organ Function Assessment (SOFA) score on the day of antimicrobial stewardship (AMS) intervention and Charlson’s comorbidity score (CCS). After controlling for confounders, early and late antibiotics were not associated with an increased risk of mortality. Conclusion: The results of this study reinforce that restricted or extended antibiotic de-escalation in patients does not significantly affect 30-day all-cause mortality compared to continuation with extended and restricted antibiotics. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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14 pages, 1154 KiB

Open AccessArticle

Point Prevalence Survey of Antimicrobial Utilization in Ghana’s Premier Hospital: Implications for Antimicrobial Stewardship

by Daniel Ankrah, Helena Owusu, Asiwome Aggor, Anthony Osei, Agneta Ampomah, Mark Harrison, Frempomaa Nelson, Grace Owusu Aboagye, Priscilla Ekpale, Jennifer Laryea, Julia Selby, Serwaa Amoah, Linda Lartey, Okaikor Addison, Elizabeth Bruce, Joyce Mahungu and Mariyam Mirfenderesky

Antibiotics 2021, 10(12), 1528; https://doi.org/10.3390/antibiotics10121528 - 14 Dec 2021

Cited by 11 | Viewed by 3125

Abstract

The first comprehensive point prevalence survey at the Korle Bu Teaching Hospital (KBTH) was performed as part of the 2019 Global Point Prevalence Survey (Global-PPS) on antimicrobials. The aim was to establish a PPS baseline for the whole hospital and to identify required stewardship interventions. The PPS was conducted over three days in June 2019 using the GLOBAL-PPS standardized method for surveillance of antimicrobial utilization in hospitals to evaluate antimicrobial prescribing. In all, 988 patients were admitted to 69 wards. Overall antimicrobial prevalence was 53.3%. More community-acquired infections (CAI) were treated empirically compared to health-care associated infections (94.0% vs. 86.1% respectively, p = 0.002). Main indications for prescribing antimicrobials were pneumonia (18.4%), skin and soft tissue infections (11.4%) and sepsis (11.1%). Among antimicrobials, systemic antibiotics accounted for 83.5%, of which amoxicillin with beta-lactam inhibitor (17.5%), metronidazole (11.8%) and ceftriaxone (11.5%) dominated. Guideline compliance was 89.0%. Stop/review dates were completed in 33.4% and documented reason was recorded in 53.0% of all prescriptions. If the findings in this PPS can be addressed antimicrobial stewardship at the KBTH stands to improve significantly. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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10 pages, 453 KiB

Open AccessArticle

Adherence to National Antimicrobial Guidelines in Hospitalized Geriatric Patients with Community-Acquired Pneumonia: A Prospective Observational study in a Malaysian Hospital

by Sadia Shakeel, Jaya Muneswarao, Azrina Abdul Aziz, Heng Yeong Le, Fatin Syazwanni Abd. Halim, Anees Ur Rehman and Rabia Hussain

Antibiotics 2021, 10(12), 1490; https://doi.org/10.3390/antibiotics10121490 - 4 Dec 2021

Cited by 1 | Viewed by 3511

Abstract

The evaluation of disease progression and onsite therapeutic care choices for community-acquired pneumonia (CAP) patients is vital for their well-being and the optimum utilization of healthcare resources. The current study was conducted to assess physicians’ adherence to clinical practice standards and antibiotic prescribing behavior for the treatment of CAP in older people. A prospective study that included 121 consecutive patients admitted for CAP was conducted at Kulim Hospital, Kedah, from March 2020 to August 2020. Medical records including demographic data, comorbidity, physical examination, laboratory or radiologic findings, and drugs used for the treatment of CAP were accessed from bed head tickets (BHT). The mean age for patients was 73.5 ± 6.2 years, 73 (60.3%) and 48 (39.6%) were males and females, respectively. Amoxicillin/clavulanate (19.8%) was the most prescribed antibiotic for non-severe pneumonia followed by ampicillin sodium/sulbactam sodium (6.6%), while in patients with severe CAP beta-lactam + beta lactamase inhibitors (BLIs) with a combination of macrolide were the most common antibiotics prescribed either in patients with (21.4%) or without co-morbidities (8.2%). The average length of stay in the hospital with severe pneumonia was 6–7 days for 23.9% of patients and < 5 days for 21.4% of patients. The duration of intravenous antibiotics in patients with severe pneumonia was 6–7 days for 32.2% of patients. The present findings revealed the adherence of antibiotic prescribing practices to the Malaysian National Antimicrobial Guideline 2019 for CAP therapy among geriatric patients and adherence to the CAP criteria for hospital admissions. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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9 pages, 2515 KiB

Open AccessArticle

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

by Zhenwei Yu, Jianping Zhu, Jiayi Jin, Lingyan Yu and Gang Han

Antibiotics 2021, 10(8), 916; https://doi.org/10.3390/antibiotics10080916 - 28 Jul 2021

Cited by 8 | Viewed by 2227

Abstract

Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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14 pages, 1101 KiB

Open AccessArticle

Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014–2019

by Gabriele Gradl, Johanna Werning, Salka Enners, Marita Kieble and Martin Schulz

Antibiotics 2021, 10(7), 831; https://doi.org/10.3390/antibiotics10070831 - 8 Jul 2021

Cited by 3 | Viewed by 4104

Abstract

Background: Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. Methods: Use of antibiotics from 2014–2019 was analyzed using dispensing data from community pharmacies claimed to the statutory health insurance (SHI) funds. Quality of regional antibiotic use in 2019 was assessed by calculating indicators based on defined daily doses per 1000 SHI-insured persons per day (DID). Oral cephalosporin and fluoroquinolone use was followed by linear regression analyses. Results: The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. In 2019, DID varied from 1.62 in Brandenburg to 3.17 in Rhineland-Palatinate for cephalosporins and from 0.47 in Brandenburg to 0.89 in Saarland for fluoroquinolones. The city-states Hamburg, Bremen, and Berlin showed highest quality with the applied indicator set. From 2014–2019, a significant decrease in utilization of oral cephalosporins was found in all federal states. During 2017–2019, all states showed a significant decline of fluoroquinolone use. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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9 pages, 1283 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on the Prescribing Patterns of First-Line Antibiotics in English Primary Care: A Longitudinal Analysis of National Prescribing Dataset

by Alisha Zubair Hussain, Vibhu Paudyal and Muhammad Abdul Hadi

Antibiotics 2021, 10(5), 591; https://doi.org/10.3390/antibiotics10050591 - 17 May 2021

Cited by 23 | Viewed by 4022

Abstract

The COVID-19 pandemic has impacted on public access to health services. This study aimed to investigate the impact of COVID-19 pandemic on commonly prescribed first-line antibiotics in English primary care. A secondary analysis of publicly available government data pertaining to primary care prescribing was conducted. A list of twenty first-line antibiotics used to treat common infections was developed following the National Institute of Clinical Excellence (NICE) guidelines. All primary care prescription and cost data pertaining to commonly prescribed first-line antibiotics in England between March and September of 2018–2020 were extracted and adjusted for inflation. Analysis suggests prescribing of antibiotics significantly reduced by 15.99% (p = 0.018) and 13.5% (p = 0.002) between March and September 2020 compared with same time period for 2018 and 2019, respectively. The most noticeable decrease in 2020 was noticed for prescribing for meningitis (−62.3%; p = 0.002) followed by respiratory tract infections (−39.13%; p = 0.035), in terms of indications. These results are suggestive of reduced transmission of infections in the community due to national lockdowns, social distancing and hygiene practices. In addition, the impact of reduced face-to-face consultations in general practices needs to be investigated as a potential reason for reduced prescribing. The pandemic also offers an opportunity to rationalize antibiotics use in the community. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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13 pages, 3320 KiB

Open AccessFeature PaperReview

Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review

by Angel-Orión Salgado-Peralvo, Juan-Francisco Peña-Cardelles, Naresh Kewalramani, María-Victoria Mateos-Moreno, Álvaro Jiménez-Guerra, Eugenio Velasco-Ortega, Andrea Uribarri, Jesús Moreno-Muñoz, Iván Ortiz-García, Enrique Núñez-Márquez and Loreto Monsalve-Guil

Antibiotics 2022, 11(1), 5; https://doi.org/10.3390/antibiotics11010005 - 22 Dec 2021

Cited by 12 | Viewed by 3883

Abstract

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA^® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2–3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted. Full article

(This article belongs to the Special Issue Access, Consumption and Use of Antimicrobials)

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