Search Results (55)

Background: Antimicrobial resistance (AMR) is a public health challenge, exacerbated by the inappropriate use of antibiotics (ABs) and the lack of standardized surveillance in healthcare settings. Objective: The Latin American PPS aimed to provide a standardized methodology for monitoring antibiotic use, gather data on antibiotic prescription practices, and support initiatives for antimicrobial stewardship (AMS). Methodology: Using a Spanish-adapted version of the WHO PPS methodology, a point prevalence survey (PPS) was conducted between 2022 and 2023 in 67 hospitals across five Latin American countries. Results: A total of 11,094 patients were surveyed, of which 47.9% received at least one AB; surgical and intensive care units displayed the highest prevalence. Most prescribed AB were third-generation cephalosporins (3GC) (22.0%), carbapenems (12.1%), glycopeptides (9.2%), and penicillin combinations (8.6%). A substantial use of agents classified under the WHO’s “Watch” group was found, with notable variances across countries. A multilevel logistic regression model identified that patient age, ICU admission, recent hospitalization, the presence of a catheter, and intubation were significantly associated with higher odds of AB use. In contrast, patients admitted to obstetric or pediatric wards had lower odds of receiving antibiotics. The model revealed considerable heterogeneity between countries, even after adjusting clinical and demographic factors. Conclusions: This study highlights AMS opportunities through targeted interventions, such as optimizing surgical prophylaxis, reducing the use of 3GC, carbapenems, and glycopeptides, and improving adherence to CPGs. These findings provide a comprehensive framework for policymakers and healthcare facilities to develop AMS strategies tailored to the Latin American context. Full article

Background: Antimicrobial resistance (AMR) remains a critical major public health challenge, largely driven by the inappropriate use of antibiotics in the community. In Spain, the National Action Plan on AMR (PRAN) emphasizes the need for robust surveillance systems based on standardized indicators and high-quality data sources. Objective: This study aimed to evaluate the feasibility of calculating PRAN prescribing indicators using the National Electronic Database for Pharmacoepidemiological Research in Primary Care (BIFAP) and to validate BIFAP as a data source for national antimicrobial prescribing surveillance. Methods: A population-based cross-sectional study was conducted using 2018 data from 9.4 million individuals. Results: Overall, 23.3% received at least one antibiotic prescription during the year, with an average of 1.8 treatments per patient. First-line recommended antibiotics represented 26.5% of total dispensed defined daily doses. Notable age-related variability in prescribing patterns was observed: children predominantly received first-line narrow-spectrum antibiotics, whereas older adults were more frequently prescribed broad-spectrum agents. Discusion: BIFAP-based indicators closely aligned with PRAN data while allowing for the calculation of additional metrics, such as prevalence of use, treatments per patient-year, and variations by age and sex. The findings underscore the importance of patient-level monitoring to identify demographic-age-specific priorities for targeted interventions aimed at optimizing antibiotic use in Primary Care. Conclusions: This study confirms the feasibility of using BIFAP to strengthen antibiotic consumption monitoring and policy evaluation efforts in Spain. Full article

Background: A point prevalence survey conducted at Singapore General Hospital in 2021 showed 48% of inpatients on antibiotics. We hypothesize that a mobile application, transforming complex antibiotic prescribing information into a succinct and individualized resource, will empower healthcare professionals and improve antibiotic prescriptions. Hence, we developed ABxSG using the behavioral design thinking approach (BDTA) to ensure positive user experience and sustained engagement. We aim to evaluate the impact of ABxSG on the proportion of inpatients on antibiotics, antibiotic appropriateness, and the number of antibiotic-related interventions by pharmacists. Methods: ABxSG was launched in March 2023. An interrupted time series analysis was conducted to evaluate its impact on the above outcomes measured using data collected from October 2021 to September 2024. There were 18 data points pre- and post-ABxSG. Results: Following the ABxSG launch, there was an immediate reduction in the proportion of inpatients on antibiotics by 1.66% (p < 0.01), followed by a sustained reduction of 3.12% at 18 months (p < 0.01). Piperacillin-tazobactam appropriateness increased by 2.76% at 1 month (p = 0.11) and further increased by 7.09% at 18 months (p < 0.05). Similarly, ceftriaxone appropriateness increased by 5.74% (p < 0.05) at 1 month and remained above pre-ABxSG levels. There was a significant increase in the number of pharmacist-led interventions for dosing optimization, with 96 more interventions/month at 18 months (p = 0.14). Conclusion: Antimicrobial stewardship teams must remain agile, embrace innovations, and adopt digital technologies to engage and empower clinicians. ABxSG reduced the proportion of inpatients on antibiotics and improved antibiotic prescriptions. The incorporation of BDTA in ABxSG, strong hospital leader support, and strategic planning to promote adoption led to its success. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major threat to human, animal, and environmental health. To tackle AMR in the livestock sector, there is a need to understand the antimicrobial use (AMU) practices of different stakeholders in order to target the common knowledge gaps and inappropriate practices with tailored interventions. In the Western Balkans, published evidence shows the presence of AMR in both humans and animals. Since studies on AMU have mainly been conducted in humans, there is a significant knowledge gap about AMU in the livestock sector. The aim of this study was to assess the knowledge, attitudes, and practices of farmers, veterinarians, veterinary pharmacy personnel, and feed mill personnel related to AMU (focusing on antibiotics) and AMR in Albania, Bosnia and Herzegovina, Kosovo (References to Kosovo shall be understood to be in the context of Security Council resolution 1244 (1999)), Montenegro, North Macedonia, and Serbia. Methods: Field interviews were conducted in 2022 with 2815 participants in selected regions of the countries. Results: The findings showed that farmers engaged in imprudent practices, including purchasing antimicrobials without a prescription, administering antimicrobials for growth promotion, and disposing of expired antimicrobials in the garbage. Farmers’ main knowledge gaps were related to the duration of antimicrobial treatment and the differentiation between AMR and antimicrobial residues. This study also revealed poor record-keeping on animal treatments and a lack of some biosecurity measures. In terms of the attitudes and practices of veterinarians and veterinary pharmacy personnel, the belief that antimicrobial drugs are important for growth promotion, and the common use and sales of highest priority critically important antimicrobials should be targets for future interventions. Conclusions: Despite significant ongoing efforts to tackle AMR, there is still a need for training, awareness-raising, and policy interventions to address the knowledge gaps identified by this study and optimize AMU in the livestock sector in the Western Balkans. Full article

Background/Objectives: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improving outcomes and reducing resistance. This study assessed the impact of a ward-specific ASP. Methods: A pre/post quasi-experimental study was conducted in an internal medicine ward at a tertiary hospital in Padua, Italy. During the intervention year (September 2023–August 2024), a multidisciplinary team (infectious disease consultants, pharmacists, microbiologists, nurses, and hygienists) held bi-weekly ward-based audits, reviewing antimicrobial prescriptions and performing bedside assessments. Therapy adjustments followed guidelines and local epidemiology. Educational sessions and infection prevention and control (IPC) protocols were also reinforced. Outcomes were compared to the previous year, considering patient characteristics. The primary outcome was antimicrobial consumption (DDD/100 patient days, DDD/100PD); secondary outcomes included cost savings, length of stay (LOS), and mortality. Results: Fifty audits assessed 1074 patients and 1401 antimicrobial treatments. Patient characteristics were similar. Antibiotic suspension or de-escalation occurred in 37.9% and 22% of patients, respectively. AWARE ACCESS class use increased (+17.5%), while carbapenem (−54.4%) and fluoroquinolone (−42.0%) use significantly declined (p < 0.05). IPC and microbiological culture guidance were provided in 12.1% of cases. Antimicrobial consumption dropped from 107.7 to 84.4 DDD/100PD (p < 0.05). No significant changes in LOS or mortality were observed. Antimicrobial costs fell by 48.8% (with EUR 57,100 saved). Conclusions: ASP reduced antimicrobial consumption, improved prescription quality, and cut costs without compromising patient outcomes. Multidisciplinary collaboration, audits, and education proved essential. Future studies should assess long-term resistance trends and integrate rapid diagnostics for enhanced stewardship. Full article

Background: The COVID-19 pandemic led to significant disruptions in healthcare services worldwide, including dental care, resulting in increased reliance on antibiotics as a substitute for in-person dental interventions. Aim: This study aimed to examine the prescription of different classes of antibiotics at the University Dental Clinical Center of Kosovo during the COVID-19 pandemic and compare it with prescription trends from the pre-pandemic period. Methodology: This study analyzed antibiotic prescription patterns at the University Dental Clinical Center of Kosovo (UCDCK) from 2019 to 2022, focusing on dental patients. Data were collected using a standardized form and a review of electronic health records. Descriptive statistics were used to examine trends, which were compared to data from other countries facing similar healthcare disruptions. The data is organized into quartiles, allowing for a comprehensive understanding of the distribution and trends in antibiotic usage over the four-year period. Results: The study revealed a significant increase in the prescription of broad-spectrum antibiotics, including amoxicillin, clavulanic acid, clindamycin, and metronidazole, during the pandemic period. Data collected from the university dentistry center showed that the highest frequency of antibiotic prescriptions occurred in 2021 (27.6%), while the lowest was in 2022 (22.8%). Metronidazole (39.4%) and amoxicillin with clavulanic acid (38.5%) were the most frequently prescribed antibiotics, together accounting for the majority of prescriptions. Amoxicillin alone represented 18.2%, with other antibiotics prescribed at significantly lower rates. These findings highlight the reliance on these antibiotics for dental treatments and underscore the importance of monitoring prescription trends to optimize usage and minimize resistance risks. Conclusions: The study highlights the impact of the COVID-19 pandemic on dental antibiotic prescription practices in Kosovo, revealing a concerning increase in broad-spectrum antibiotic use. This underscores the need for improved antibiotic stewardship in dental settings, particularly during public health crises, to prevent the exacerbation of antimicrobial resistance. Ensuring continued access to routine dental care and developing robust protocols for antibiotic prescription during emergencies are essential to mitigate the long-term public health impacts of increased antibiotic use. Full article

Background and Objective: Irrational use and overuse of antibiotics is considered a major cause of antimicrobial resistance (AMR) among patients admitted to hospitals, especially in intensive care units (ICUs). ICUs are the most critical wards in healthcare settings, where the use of antibiotics is much higher compared to other wards. Therefore, the appropriate administration and monitoring of antibiotic usage in these units is a matter of concern. Materials and Methods: This retrospective study evaluated the types, utilization patterns, sensitivity, and resistance of various antibiotics used among patients admitted to the ICUs of different hospitals after the third wave of the coronavirus disease in 2019 (COVID-19) in Pakistan. Results: It was observed that more than 40% of the patients were given two antibiotics and 54.3% were given at least one antibiotic each day. A total of 768 antibiotics from different groups, based on the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification, were prescribed to 313 patients admitted to ICUs between April and August 2021. Among the types of antibiotics, amoxicillin/clavulanic acid was the most frequently used antibiotic (75 prescriptions). It was also observed that the majority of the bacterial isolates were more sensitive to carbapenems than the other antibiotics. The current study showed that antibiotic usage according to the AWaRe classifications was 31.8% in the Access category, 59.5% in the Watch category, and 8.7% in the Reserve category in ICUs of the studied hospitals after the third wave of COVID-19. Conclusions: The findings of the study also highlight the importance and continuous need for the implementation of antibiotic stewardship programs to optimize the appropriate utilization of antibiotics in the ICUs of the studied hospitals. Full article

Background: To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO’s AWaRe classification. Methods: We analyzed data from hospital-based influenza surveillance from January 2011 to December 2020 across nine Bangladeshi tertiary-level hospitals. Surveillance physicians collected WHO-defined SARI patient data, including demographics, clinical characteristics, and antibiotic prescriptions. Descriptive statistics and parametric and non-parametric tests were used for the analysis. Results: Of 21,566 SARI patients [median age 20 years (IQR: 1.33–45), 66% male], 91% were prescribed at least one antibiotic. A total of 25,133 antibiotics were prescribed, of which 47.0% were third-generation cephalosporins, 16.5% were macrolides, and 11.1% were beta-lactam/beta-lactamase inhibitors. According to the AWaRe classification, 28.7% were in the Access group, while 71.3% were in the Watch group, and none were from the Reserve group. A downward trend in Access group (30.4% to 25.1%; p = 0.010) and an upward trend in Watch group antibiotic prescription (69.6% to 74.9%; p = 0.010) were observed. We identified that patients aged < 5 years (aOR: 1.80; 95% CI: 1.44–2.25), who were treated in government hospitals (aOR: 1.45; 95% CI: 1.35–1.57), patients with the presence of lung diseases (aOR: 1.56; 95% CI: 1.35–1.80) had an increased likelihood of being prescribed Watch group antibiotics. Conclusions: This study reveals a concerning pattern of antibiotic overuse among SARI patients in Bangladesh, with a growing trend over the past decade towards increased Watch group antibiotic prescriptions. Only one-third of the prescribed antibiotics were from the Access group, falling short of the two-thirds threshold recommended by the WHO. Effective ASPs are crucial to optimize antibiotic prescriptions and mitigate the risk of antimicrobial resistance. Full article

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation, joint pain, and progressive cartilage and bone erosion. Despite advancements in RA management with disease-modifying antirheumatic drugs (DMARDs) and biologics, some patients remain refractory to conventional treatments. Tetracyclines, such as minocycline and doxycycline, exhibit anti-inflammatory and immunomodulatory properties, making them potential supplementary treatments. This narrative review explores their effectiveness, mechanisms of action, safety profiles, and current challenges in RA care. Tetracyclines have demonstrated significant immunomodulatory effects, including the inhibition of pro-inflammatory cytokines and matrix metalloproteinases (MMPs), which are critical in RA pathology. Clinical trials, including double-blind, placebo-controlled studies, have shown efficacy in reducing RA symptoms, particularly in early and refractory cases. However, their use remains limited by inconsistent evidence, small sample sizes, and concerns about antimicrobial resistance. Current guidelines for RA management do not explicitly recommend tetracyclines due to these limitations, although off-label use may be considered in specific cases. The use of tetracycline for RA is restricted by drug interactions causing bacterial resistance alongside unpredictable patient responses, hence the necessity for prudence in its prescription within a clinical setting. To overcome these limitations, the development of safer compounds, in-depth in silico analyses, and integration with personalized medicine approaches are needed. Overall, tetracyclines show promise as adjunct therapies in RA management due to their dual anti-inflammatory and immunomodulatory actions. This review highlights the need for further research to address gaps in evidence, including the development of modified tetracyclines with reduced antimicrobial effects and improved safety profiles, as well as the integration of personalized medicine approaches to optimize patient outcomes. Full article

Background/Objectives: Antimicrobial resistance represents a growing global health crisis, demanding innovative approaches to improve antibiotic stewardship. Artificial intelligence (AI) chatbots based on large language models have shown potential as tools to support clinicians, especially non-specialists, in optimizing antibiotic therapy. This review aims to synthesize current evidence on the capabilities, limitations, and future directions for AI chatbots in enhancing antibiotic selection and patient outcomes. Methods: A narrative review was conducted by analyzing studies published in the last five years across databases such as PubMed, SCOPUS, Web of Science, and Google Scholar. The review focused on research discussing AI-based chatbots, antibiotic stewardship, and clinical decision support systems. Studies were evaluated for methodological soundness and significance, and the findings were synthesized narratively. Results: Current evidence highlights the ability of AI chatbots to assist in guideline-based antibiotic recommendations, improve medical education, and enhance clinical decision-making. Promising results include satisfactory accuracy in preliminary diagnostic and prescriptive tasks. However, challenges such as inconsistent handling of clinical nuances, susceptibility to unsafe advice, algorithmic biases, data privacy concerns, and limited clinical validation underscore the importance of human oversight and refinement. Conclusions: AI chatbots have the potential to complement antibiotic stewardship efforts by promoting appropriate antibiotic use and improving patient outcomes. Realizing this potential will require rigorous clinical trials, interdisciplinary collaboration, regulatory clarity, and tailored algorithmic improvements to ensure their safe and effective integration into clinical practice. Full article

Background/Objectives: To face antimicrobial resistance, antimicrobial stewardship programs (ASPs) have been implemented in the pediatric age, but the area of urgency remains understudied. We aimed to assess the impact of an educational program on optimizing antibiotic appropriateness in a pediatric ED. Methods: We conducted a pre-post observational study with an audit, intervention, and feedback given to prescribers. We recorded all systemic antibiotic prescriptions for children attending our pediatric ED from January to March and from July to September 2020. The study’s team assigned a score to each prescription, regarding the appropriate molecule, dose, and duration of therapy, according to the diagnosis. From April to June 2020, we held weekly meetings focusing on different pediatric infectious diseases, with interaction between one to three ED physicians and the infectious disease (ID) specialist of the study’s team. We then distributed synthetic digital guidelines adapted to our reality to all prescribers. Results: Optimal antibiotic prescriptions increased after the intervention, with statistical significance (p < 0.001) in four main aspects (overall adequacy: 13% PRE vs. 43% POST; need of antibiotics: 53% vs. 68%; adequacy of the spectrum: 55% vs. 63%; adequacy of the chosen molecule: 54% vs. 62%). We observed an improvement in all the main infectious diseases and concerns all the ED physicians. The prescription of first-choice drugs increased in specific and common illnesses such as otitis and pharyngotonsillitis. Conclusions: An antimicrobial stewardship program is a relevant method for improving the appropriateness of antimicrobial use also in the complex setting of a pediatric ED. Full article

Background/Objectives: The rational use of medicines, in accordance with the World Health Organization (WHO) guidelines, is crucial for optimizing healthcare outcomes. This cross-sectional study aimed to evaluate drug prescribing patterns and assess prescription completeness based on the WHO core drug use criteria. A comprehensive analysis was conducted at the University Clinic in the Northern region, Kingdom of Saudi Arabia (KSA). Methods: The study assessed drug prescribing patterns and examined prescription completeness by analyzing various parameters recommended by the WHO core drug use criteria. Results: Upon analyzing the 615 prescriptions, it was observed that each prescription had a mean of 2.56 prescribed drugs. Multiple medicines per prescription were prevalent in 71.4%, whereas polypharmacy was evident in 2.9%. Analgesics were the most frequently prescribed medication, accounting for 50.4% of the prescriptions, followed by supplements (31.7%), decongestants (16.1%), cough syrup (12%), and antihypertensive and diabetes treatments at 17%. Furthermore, antimicrobials were prescribed in 21.5% of the prescriptions. During the evaluation, it was found that 19.8% of the prescriptions were incomplete, lacking important information on dosing, duration, and drugs not suited to the diagnosis. Conclusions: Most of the parameters evaluated in this study were determined to fall outside the range of recommended guidelines criticized by the WHO. As a result, the implementation of efficient intervention programs, such as education initiatives, is recommended to enhance the practice of rational drug use. Contribution: This study highlights the importance of improving prescription indicators at the national level, focusing on both medication prescribing characteristics and prescription quality as a practice. Full article

Background: Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. Methods: We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014–September 2015), post-implementation (October 2015–March 2020), and COVID-19 (April 2020–August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. Results: The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. Conclusions: The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance. Full article

Background: Helicobacter pylori (H. pylori) is a prevalent bacterial pathogen implicated in different stomach and duodenal diseases, including chronic gastritis, gastric and duodenal ulcer, and stomach cancer. The COVID-19 pandemic has significantly influenced antibiotic prescription practices, potentially exacerbating antibiotic resistance in H. pylori. Objective: This study aims to investigate antibiotic prescription during the COVID-19 pandemic in Croatia and its possible impact on H. pylori antibiotic resistance, with a focus on Croatia. Methods: An extensive literature search was conducted to identify relevant studies from March 2020 to June 2024. The search strategy included terms related to COVID-19, antibiotic prescription, and Croatia. Studies were selected based on predefined eligibility criteria, focusing on observational research addressing antibiotic use during the pandemic. Results: The COVID-19 pandemic has led to significant fluctuations in community antibiotic consumption within the European Union/European Economic Area. In Croatia, antibiotic use in 2022 surpassed 2019 levels, driven by increased consumption of macrolides and other antibiotics. This surge, influenced by early pandemic treatment claims and penicillin shortages, contributed to rising antibiotic resistance in H. pylori. Resistance rates to clarithromycin and levofloxacin were notably high, driven by mutations in the 23S rRNA, gyrA, and gyrB genes. Discussion: The increased antibiotic use during the COVID-19 pandemic has highly likely complicated H. pylori eradication efforts, highlighting the necessity of judicious antibiotic use and robust antimicrobial stewardship. The pandemic underscored the need for new therapeutic strategies, optimized eradication regimens, and advanced diagnostic methods to manage bacterial infections effectively. Conclusions: The COVID-19 pandemic has significantly affected antibiotic use and resistance patterns, posing new challenges for H. pylori eradication. Addressing these challenges requires a multifaceted approach, including the development of new drugs and advanced diagnostics, coupled with sustained efforts in antimicrobial stewardship to combat emerging resistance threats. Full article

The increase in fluoroquinolone (FQ)-resistant Escherichia coli (EC) is a serious global problem. In addition, much of acute uncomplicated cystitis (AUC) cases are caused by EC. FQs have been selected for the treatment of cystitis in outpatients, and there is concern about treatment failure. It is therefore necessary to select appropriate antimicrobials to spare FQs. However, there are few reported effective antimicrobial stewardship programs (ASPs) for outpatients. We aimed to establish the effective ASP for outpatients diagnosed with AUC caused by EC, to spare the use of FQs, and to explore optimal oral antimicrobials for AUC. The study subjects were outpatients treated for AUC caused by extended-spectrum β-lactamase-non-producing EC (non-ESBL-EC). Based on the antibiogram results, we recommended cefaclor (CCL) as the initial treatment for AUC, and educated clinical pharmacists who also worked together to advocate for CCL or cephalexin (CEX) prescriptions. FQ usages decreased, and cephalosporin (Ceph) prescriptions increased in all medical departments. The Ceph group (n = 114; CCL = 60, CEX = 54) in the non-FQ group had fewer treatment failures than the FQ group (n = 86) (12.3% vs. 31.4%). Cephs, including CCL and CEX, were effective treatments for AUC caused by non-ESBL-EC. Antimicrobial selection based on antibiogram results and the practice of an ASP in collaboration with clinical pharmacists were useful for optimizing antimicrobial therapy in outpatients. Full article