Search Results (282)

Background/Objectives: Antibiotic use is common among hospitalized pediatric patients. However, inappropriate use, including excessive use of Watch antibiotics, can contribute to antimicrobial resistance, adverse events, and increased healthcare costs. Consequently, there is a need to continually assess their usage among this vulnerable population. This was the objective behind this study. Methods: The medical records of all pediatric patients (under 12 years) admitted and treated with antibiotics at a Ghanaian Teaching Hospital between January 2022 and March 2022 were extracted from the hospital’s electronic database. The prevalence and appropriateness of antibiotic use were based on antibiotic choices compared with current guidelines. Influencing factors were also assessed. Results: Of the 410 admitted patients, 319 (77.80%) received at least one antibiotic. The majority (68.65%; n = 219/319) were between 0 and 2 years, and males (54.55%; n = 174/319). Ceftriaxone was the most commonly prescribed antibiotic (20.69%; n = 66/319), and most of the systemic antibiotics used belonged to the WHO Access and Watch groups, including a combination of Access and Watch groups (42.90%; n = 136/319). Neonatal sepsis (24.14%; n = 77/319) and pneumonia (14.42%; n = 46/319) were the most common diagnoses treated with antibiotics. Antibiotic appropriateness was 42.32% (n = 135/319). Multivariate analysis revealed ceftriaxone prescriptions (aOR = 0.12; CI = 0.02–0.95; p-value = 0.044) and surgical prophylaxis (aOR = 0.07; CI = 0.01–0.42; p-value = 0.004) were associated with reduced antibiotic appropriateness, while a pneumonia diagnosis appreciably increased this (aOR = 15.38; CI = 3.30–71.62; p-value < 0.001). Conclusions: There was high and suboptimal usage of antibiotics among hospitalized pediatric patients in this leading hospital. Antibiotic appropriateness was influenced by antibiotic type, diagnosis, and surgical prophylaxis. Targeted interventions, including education, are needed to improve antibiotic utilization in this setting in Ghana and, subsequently, in ambulatory care. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Background and Objectives: This study aimed to assess the prevalence of colistin prescriptions among patients with multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) infections admitted to a tertiary teaching hospital in Jordan. Additionally, the study evaluated the appropriateness of colistin prescriptions and assessed resistance levels of this strain. Materials and Methods: In this retrospective study, adult patients who were infected with MDR P. aeruginosa and were admitted to Jordan University Hospital between January 2018 and March 2024 were included. Data on demographics, clinical characteristics, sources of infection, antibiotic therapy, and clinical outcomes were collected. Results: Out of the 85 patients who met the inclusion criteria for having MDR P. aeruginosa, colistin was administered to 16 patients (18.8%). Notably, approximately two-thirds (68.7%) of the isolates from patients who received colistin were classified as extensively drug-resistant (XDR). Among the isolates, 15 out of 16 (93.8%) were resistant to both ciprofloxacin and imipenem. Among the patients requiring colistin, five (31.3%) discontinued therapy, while two (12.5%) remained on colistin despite the availability of safer alternatives. No significant difference was observed in 30-day all-cause mortality between patients treated with colistin (0%) and those who were not (4.3%, p = 1.00). Similarly, the incidence of acute kidney injury did not differ significantly between the colistin group (0%) and the non-colistin group (p = 1.00). No significant difference was found in the hospital stay between colistin-treated patients (median 10.5 days, IQR [5.0–14.0]) and those not treated with colistin (median 13.0 days, IQR [7.0–21.0]), (p = 0.22). Conclusions: This study demonstrated that colistin was selectively initiated in high-risk patients, particularly those with XDR P. aeruginosa. However, its inappropriate continuation despite safer alternatives, as well as its discontinuation when no other options existed, raise concerns about antibiotic de-escalation practices. Interestingly, no significant differences in mortality or acute kidney injury were observed between patients who were treated with colistin and those who were not. These findings emphasize the need for antimicrobial stewardship programs and highlight the importance of large-scale trials to evaluate colistin’s efficacy and safety in MDR infections. Full article

Background: There is limited published evidence on the prevalence of potentially inappropriate prescribing of medicines in relation to kidney function in older Australians, particularly those with dementia. Objectives: To examine the prevalence, temporal trends and factors associated with potentially inappropriate prescribing of renally-dependent medicines in patients with dementia, using Australian general practice data. Methods: This comparative study was reported in accordance with the STROBE guidelines for cohort studies. Retrospective analyses of the National Prescribing Service (NPS) MedicineInsight dataset were performed to determine the proportion of patients aged ≥ 65 years with a recorded diagnosis of dementia, along with matched controls, who had potentially inappropriate prescribing based on their estimated glomerular filtration rate (eGFR) during the study period (2011–2020). Each patient was included only once throughout the study. Potentially inappropriate prescribing was evaluated for 33 commonly used medicines, using the Cockcroft-Gault equation for estimated creatinine clearance or eGFR, in accordance with the guidelines from the Australian Medicines Handbook (AMH). Each patient’s medicines were included if they were prescribed within 180 days after the most recent recorded lowest eGFR value for the patient. Medicines having prescribed doses exceeding those recommended for an individual’s renal function were classified as ‘inappropriate dosage’, while those whose use was advised against were labelled ‘contraindicated’. Both categories were regarded as inappropriate prescriptions. Descriptive statistics were used to summarise patient characteristics and medication use. Temporal trends were displayed in graphs, with statistical significance determined using the Cochran-Armitage test. Binary logistic regression models were used to examine the associations between sociodemographic and clinical factors and the prescribing of medicines inconsistent with AMH guidelines. Results: The unmatched cohorts included 33,101 patients, comprising 4092 with dementia and 29,009 without. Among them, 58.4% were female, and the overall median age was 82 years [interquartile range (IQR): 77–87]. After propensity score matching, there were 4041 patients with dementia and 8031 without dementia. Over the study period, potentially inappropriate prescribing increased slightly, but insignificantly, in both groups of patients; the prevalence of inappropriate use of at least one of the 33 drugs of interest rose from 6.5% (95% CI 4.5–9.1%) in 2011 to 8.9% (95% CI 6.0–12.7%; p for trend: 0.966) in 2020 in the dementia group, and 9.2% (95% CI 8.0–10.5%) to 11.1% (95% CI 10.3–12.0%; p for trend: 0.224) in the matched controls. Over the ten-year period, approximately 9.3% (377) of patients with dementia in the matched cohort received at least one potentially inappropriate prescription. Among these, 154 (40.8%) were for contraindicated medicines, and 223 (59.1%) were for inappropriate doses based on renal function. Among patients with dementia in the matched cohort, fenofibrate, nitrofurantoin, and moxonidine were the most frequently prescribed medicines at doses inconsistent with AMH guidelines. In the unmatched dementia cohort, potentially inappropriate prescribing was not significantly associated with demographic characteristics or most comorbidities; however, it occurred more frequently in patients with an eGFR below 30 mL/min/1.73 m² or those with concomitant diabetes. Conclusions: Positively, the prevalence of potentially inappropriate prescribing of renally-dependent medicines in primary care patients with dementia in Australia was similar to their matched controls. However, there was room for improvement in the prescribing of these drugs in both patients with and without dementia. Full article

Background/Objectives: Up to 25–70% of proton-pump inhibitor (PPI) prescriptions worldwide lack an evidence-based indication, exposing patients to avoidable adverse events and unnecessary costs. Community pharmacists (CPs) are well-equipped to curb the misuse of PPIs. This study aimed to quantify CPs’ knowledge, attitudes, and practices (KAPs) regarding PPIs in two high-use Middle-Eastern markets and determine how demographic and professional factors influence guideline-adherent PPI use. Bridging this gap is crucial to ensure pharmacists can promote rational PPI use, provide accurate patient counseling, and reduce the likelihood of adverse outcomes. Methods: An online cross-sectional survey was undertaken between May 2024 and July 2024 to investigate the KAPs of CPs in Egypt and Iraq toward PPI use. The self-developed thirty-item questionnaire (17 knowledge, 11 attitude, and 6 practice items) was piloted with 30 CPs. A sample size of 385 CPs was required based on an estimated 93,000 community pharmacists in Egypt and 22,120 in Iraq; however, to improve statistical power, we aimed to include >500 CPs. Results: A total of 527 CPs from Egypt and Iraq completed the survey. The total median scores for knowledge, attitude, and practice were 11 out of 17 (IQR: 9–16), 9 out of 11 (IQR: 6–12), and 5 out of 6 (IQR: 3–8), respectively. CPs with >20 years of experience and those who relied on clinical guidelines as a primary information source demonstrated a median knowledge score significantly higher than those with fewer years of experience (p = 0.001 and 0.028, respectively). There was a significant positive association between knowledge and attitude, knowledge and practice, and attitude and practice scores (coefficients: 0.832, 0.701, and 0.445, respectively). Conclusions: Although their attitudes and practices regarding PPI use were satisfactory, the knowledge of CPs about the judicious use of PPIs requires improvement. Thus, a call for action targeting their tailored education and training is necessary to address these knowledge gaps regarding PPIs identified, including PPI adverse-effect profiles, evidence-based indications, and deprescribing criteria, and to foster informed medication attitudes and practices. Such education and training can reinforce guideline adherence, enhance patient counseling skills, and ultimately reduce inappropriate PPI use. Full article

Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions, hospitalizations, and worsened health outcomes in older adults, particularly those with cognitive impairment (CI) or dementia. This study was designed to compare the Beers Criteria^® 2023 and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria 2023 to determine which identifies a higher prevalence of PIMs in older adults with CI or dementia attending primary care-based memory clinics. PIMs were identified with the use of the updated Beers Criteria^® 2023 and STOPP Criteria 2023, from electronic medical records of study participants from January to August 2023. The study identified PIMs and analyzed associated risk factors using bivariate logistic regression. Of 44 older adults, 47.7% (n = 21) were detected with one PIM based on Beers Criteria^® 2023, and 27.2% (n = 12) were identified with at least one PIM using STOPP criteria. Using the updated Beers Criteria^® 2023 and STOPP Criteria 2023, the study identified 50 PIMs (averaging 0.9 PIMs per participant) based on Beers Criteria^® and 31 PIMs (averaging 0.6 PIMs per participant) based on STOPP Criteria, respectively. Bivariate logistic regression revealed a significant association between having nine or more comorbidities and PIMs according to Beers Criteria^® (odds ratio (OR) = 8.4, 95% confidence interval (CIn) = 1.27–55.39, p = 0.027). This study highlights the high prevalence of PIMs among older adults with CI or dementia, emphasizing the need for regular medication reviews. Implementing both criteria can enhance medication management and improve patient safety in this vulnerable population. Full article

Background/Objectives: In 2022, over 200 million outpatient antibiotic prescriptions were written in the U.S., with 30% deemed unnecessary. Previous studies have shown that demographic factors, such as age, gender, and race, influence antibiotic prescribing patterns. However, few studies have examined how social determinants of health contribute to health inequities in antibiotic prescribing. This study aims to explore these disparities in Tennessee using IQVIA data. Methods: The Tennessee Department of Health conducted a cross-sectional study using the IQVIA LRx and Dx databases, linking prescription data to diagnoses from 2022. Antibiotic prescriptions were categorized into three tiers based on appropriateness. A multivariable logistic regression model assessed factors such as age, gender, insurance type, and social vulnerability index (SVI) on antibiotic prescribing patterns. Results: Of 2,874,505 prescriptions analyzed, 59.3% were classified as inappropriate (Tier 3). Female patients and children were less likely to receive inappropriate antibiotics. Patients in lower SVI areas, indicating less social disadvantage, had lower odds of receiving unnecessary prescriptions. Medicaid and Medicare Part D beneficiaries had higher odds of receiving inappropriate antibiotics compared to those with private insurance. Conclusions: This study highlights significant health disparities in outpatient antibiotic prescribing in Tennessee. Male patients, older adults, and individuals in socioeconomically vulnerable areas are more likely to receive inappropriate prescriptions. These findings stress the need for targeted public health interventions to reduce unnecessary antibiotic use and address underlying health inequities, ultimately improving healthcare outcomes and reducing antimicrobial resistance. Full article

Introduction: The consumption of systemic antifungals is on the rise. However, a significant proportion of systemic antifungal prescriptions is inappropriate. Inappropriately prescribed antifungals are problematic, but there has been minimal emphasis on ensuring the appropriate prescription of systemic antifungals. Local studies regarding the patterns and appropriateness of antifungal prescriptions are also lacking. Materials and Methods: In this retrospective, single-centre, observational study, every in-patient prescription order of systemic antifungals in a regional hospital in Hong Kong between 1 May and 31 July 2023 was reviewed via electronic patient records. The appropriateness of a systemic antifungal prescription was assessed by its indication, dosage, duration and antifungal–concomitant drug interactions by a single reviewer. Results: A total of 177 prescriptions orders were collected. Itraconazole, micafungin and fluconazole were the most prescribed systemic antifungals. The haematology team, infectious disease team and ICU were the major systemic antifungal prescribers in this study. The overall appropriateness of systemic antifungal prescriptions was 27.7% (49/177), with an appropriateness of 72.9% (129/177) for indications, 57.1% (101/177) for dosage, 91.5% (162/177) for duration and 71.6% (127/177) for antifungal–concomitant drug interactions. Triazole antifungals had an overall prescription appropriateness of only 15% and were more likely to be prescribed inappropriately than non-triazole antifungals (p < 0.001). Common prescription pitfalls include (i) starting a systemic antifungal for sputum culture that grew Candida spp., (ii) debatable prophylaxis with itraconazole capsules, (iii) overlooking potentially serious antifungal–drug interactions. Conclusions: Inappropriate systemic antifungal prescription is not uncommon in Hong Kong. Establishing an antifungal stewardship programme in public hospitals may be beneficial. Full article

Bacterial urinary tract infections (UTIs) are common in small animal practice and their inappropriate treatment contributes to the antimicrobial resistance (AMR) spreading. This study assessed bacterial prevalence, non-susceptibility percentages, antimicrobial prescription and the impact of the application of international guidelines redacted by the International Society for Companion Animals Infectious Disease (ISCAID) in dogs and cats with UTIs evaluated at a European veterinary university hospital, over a 30-month period. A total of 729 bacterial isolates were included. The most frequently isolated bacterial species was Escherichia coli in both dogs (52.8%) and cats (45.7%). Following ISCAID guidelines, almost half of the cases were classified as upper UTIs (24.9%) or recurrent cystitis (24.8%). Multidrug resistance (MDR) percentage was 37.3% (n = 272). Over five semesters, MDR significantly decreased (p = 0.001). Additionally, a significant decrease was recorded for specimens from patients previously treated (p = 0.018) and under treatment at sampling (p < 0.001). Previous treatment with amoxicillin-clavulanate (p = 0.001), marbofloxacin (p < 0.001), enrofloxacin (p < 0.001) and piperacillin-tazobactam (p = 0.016) was linked with higher MDR rates. This study highlighted that companion animals are potential reservoirs for AMR; moreover, international guidelines applied in the daily practice guiding antimicrobial stewardship can lead to a reduction in AMR over time. Full article

Background: The validated Screening Tool of Older People’s Prescriptions (STOPP) identifies potentially inappropriate prescribing (PIP)—treatments where potential risk outweighs potential benefit. STOPP is particularly important for people aging with HIV and comorbidities, since PIP may exacerbate symptoms and decrease adherence. Methods: We analyzed data from the DC Cohort, a longitudinal cohort of people with HIV (PWH). We applied STOPP criteria to identify PIP among DC Cohort participants aged ≥ 50 years who completed a Patient Reported Outcomes (PROs) survey. All medications prescribed in the 2 years prior to PROs survey completion were considered. Negative binomial models were used to evaluate factors associated with PIP and structural equation modeling was used to evaluate whether symptom burden mediates the relationship between PIP and quality of life. Results: Of 1048 eligible DC Cohort participants, 486 (46%) had at least one PIP. The most common systems implicated were musculoskeletal (23%), analgesic drugs (16%), and the central nervous system (13%). Age, race/ethnicity, HIV transmission factor, social determinants of health, and type of HIV care site were significantly associated with number of PIP in the crude models. In the multivariable model with just demographic variables, the association between age (aIRR: 1.03 (95% CI: 1.02, 1.04)), intravenous drug use (aIRR: 1.68 (95% CI: 1.20, 2.35)), White, non-Hispanic race (aIRR: 0.67 (95% CI: 0.50, 0.92)), site type (aIRR: 0.75 (95% CI: 0.62, 0.92)), and the expected number of PIPs remained significant. In the fully adjusted multivariable model with demographics and SDOH, the association between age, intravenous drug use, White, non-Hispanic race, and expected number of PIPs remained significant. Statistical evidence that symptom burden mediates the relationship between PIP and each of the QOL dimensions was present. Conclusions: Future interventions should work to decrease PIP among these high-risk groups, especially for PIP associated with increased symptom burden. Full article

Inappropriate prescription patterns and polypharmacy are critical challenges facing the optimal management of schizophrenia patients, especially in regard to patient safety. Background/Objectives: The purpose of this study was to examine the relationship between patient safety and the existence of incorrect prescription patterns and/or polypharmacy in the medications prescribed to individuals with schizophrenia. This issue is addressed in a broad context, highlighting the purpose of this study. Methods: A cross-sectional study was adopted, involving a prospective analysis of the prescriptions of schizophrenia patients receiving treatment. Prescription patterns deemed inappropriate were evaluated based on evidence-based guidelines. Antipsychotic maximum allowable daily doses were calculated using the British National Formulary Maximum Daily Dose (BNFmax), an online tool. Patient safety outcomes were assessed using the Glasgow Antipsychotic Side-effect Scale (GASS). Results: A total of 198 patients diagnosed with schizophrenia and receiving treatment consented to participate in the GASS survey. A total of 116 (58.6%) males participated. The mean age of patients was 40.1 (±12.7). Thirty-one (66.2%) reported mild side effects, while 67 (33.8%) reported moderate side effects. Polypharmacy was detected in 103 (52%) patients’ prescriptions. The correlation between GASS and BNFmax was positive and statistically significant (p < 0.001). The elevation in GASS score was associated with polypharmacy prescriptions (OR 3.21; 95% CI 1.64–6.29), the presence of first-generation antipsychotics (FGAP) (OR 2.79; 95% CI 0.236–5.951), any combination of antipsychotics containing haloperidol (OR 3.22; 95% CI 1.11–9.32), and olanzapine (OR 3.46; 95% CI 1.36–8.79). Conclusions: The safety of patients with schizophrenia has been proven to be impacted by the improper use of psychotropic drugs. Following evidence-based guidelines is a cornerstone to ensuring optimal, effective, and safe patient treatment plans. Full article

Background: Potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) have been widely explored, but few studies focused on patients aged 75 years and over. This study was planned to explore the demographic and clinical characteristics of the older patients admitted to Units for Integrated Continuous Care, and to assess the prevalence and potential predictors of PIMs and PPOs. Methods: An observational, retrospective, and multicenter study was performed on 135 patients aged 75 years or older (i.e., 75–84 years and ≥85 years). PIMs and PPOs were investigated by applying the Screening Tool of Older People’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria. Results: The oldest-old patients (≥85 years) were less likely to come from a hospital, had fewer daily medications and a lower number of oral doses, but they presented a higher Charlson Comorbidity Index, were more dependent on activities of daily living, and were less obese than those aged 75–84 years. Results showed a high prevalence of PIMs and PPOs in both age groups. The more common PIMs and PPOs were the same in both age groups. The oldest-old patients who suffered falls were more likely to have a prescription omission of vitamin D supplements. The PIM index was not significantly different between age groups but was higher in the oldest-old group. Conclusions: Patients with a higher number of prescriptions had a higher risk of PIMs. Regarding PPOs, male gender and fall risk were predictors in the youngest group, while the number of comorbidities was significantly associated with PPOs in the oldest group. This study supports the usefulness of the STOPP/START criteria to identify PIMs and PPOs in these patients, but more research is required to determine the potential adverse outcomes of PIMs and PPOs and their clinical and economic consequences. Full article

Background/Objectives: Length of hospital stay (LOS) is a critical measure of healthcare efficiency. This study investigated factors contributing to prolonged LOS in adult patients with urinary tract infections (UTIs) in Lebanon and assessed microbial susceptibility patterns of causative pathogens. Methods: A retrospective cohort study was conducted across five Lebanese university hospitals (March 2022–December 2023), analyzing 401 patients. Data on microbiological findings and the LOS were extracted from medical records. Statistical analyses, including descriptive statistics, bivariate tests (t-tests, ANOVA, and Pearson’s correlation), and multiple linear regression (significance: p ≤ 0.05), were performed using IBM SPSS^® 27. Results: The mean LOS was 5.85 ± 2.41 days. Prolonged hospitalization was associated with patient-related factors (age, comorbidities, UTI type, specific symptoms, and multidrug-resistant infections) and treatment-related factors. Empirical use of carbapenems (β = 0.783, p = 0.004) and fluoroquinolones (β = 1.360, p = 0.014), along with inappropriate antibiotic prescriptions (β = 0.609, p = 0.022), significantly extended the LOS. Conversely, antibiotic de-escalation based on culture results reduced the LOS (β = −0.567, p = 0.029). Escherichia coli (61.8%) was the predominant pathogen, followed by Klebsiella pneumoniae (11.9%), Proteus mirabilis (7.8%), and Pseudomonas aeruginosa (7.5%). Notably, susceptibility to antibiotics showed a concerning decline. Conclusions: Inappropriate antibiotic prescriptions were linked to a prolonged LOS, emphasizing the need for judicious antimicrobial use. The positive impact of de-escalation supports culture-guided therapy. Declining antibiotic susceptibility highlights the urgency for robust antimicrobial stewardship programs (ASPs) and a national microbial resistance database to combat antimicrobial resistance (AMR) in Lebanon. Full article

Background: Dried ivy leaf extract EA 575^® (Prospan^®) is commonly used to treat coughs and may help reduce inappropriate antibiotic use for the common cold. This retrospective study investigated whether prescribing EA 575 is associated with reduced subsequent antibiotic use in children and adolescents with the common cold. Repeated EA 575 prescriptions were also analyzed to estimate treatment satisfaction. Methods: Data were sourced from the IQVIA Disease Analyzer database, including patients under 18 diagnosed with a common cold and prescribed either EA 575 or antibiotics between 2017 and 2020 (index date). Propensity score matching controlled for confounding factors. Antibiotic prescriptions were assessed 4–30 and 31–365 days after the index date, along with bacterial infections 4–40 days post-index. Repeated EA 575 prescriptions 2–5 years post-index were analyzed as a proxy for treatment satisfaction. Results: Overall, 10,390 children and adolescents were included in each matched cohort. Compared to antibiotics, EA 575 prescriptions were associated with significantly lower odds of antibiotic use 4–30 days (OR: 0.56; 95% CI: 0.49–0.64; p < 0.001) and 31–365 days (OR: 0.58; 95% CI: 0.54–0.62; p < 0.001) after the index date. The odds of bacterial infection 4–30 days after EA 575 prescription were also lower (OR: 0.67; 95% CI: 0.45–0.99; p = 0.047). Of the 42,677 patients in the EA 575 analysis, 50.5% had at least one repeated prescription, with the highest rates among children aged 0–2 years (54.7%) and the lowest in those aged 13–17 years (19.9%). Conclusions: EA 575 prescription was associated with reduced subsequent antibiotic use in children and adolescents with common colds. Frequent repeated prescription rates emphasize the therapeutic value of EA 575 as a treatment option for cold symptoms, especially in younger children. Full article

Very few studies, all employing surveys, have investigated the perceptions of community pharmacists regarding antimicrobial stewardship (AMS). A qualitative inquiry exploring factors affecting community pharmacists’ participation in AMS may assist in the implementation of AMS in the primary care setting. This study aimed to explore the perceived barriers and enablers of community pharmacists’ participation in AMS. One-on-one semi-structured telephone interviews were conducted with a sample of community pharmacists from across Australia. Interviews were transcribed verbatim and analysed using the Framework Analysis method. Twenty community pharmacists (70% female), representing urban, regional, and remote areas of Australia participated in the study. Pharmacists identified a discord between clinical needs of patients and practice policies as the primary source of excessive prescribing and dispensing of antibiotics. The fragmented nature of the primary healthcare system in Australia was seen as limiting information exchange between community pharmacists and general practitioners about antibiotic use, that was encouraging inappropriate and, at times, unsupervised use of antibiotics. The existing community pharmacy funding model in Australia, where individual pharmacists do not benefit from any financial incentives associated with clinical interventions, was also discouraging their participation in AMS. Pharmacists suggested restricting default antibiotic repeat supplies, reducing legal validity of antibiotic prescriptions to less than the current 12 months, and adopting a treatment duration-based approach to antibiotic prescribing instead of the ‘quantity-based’ approach, where the quantity prescribed is linked to the available pack size of the antibiotic. Structural changes in the way antibiotics are prescribed, dispensed, and funded in the Australian primary care setting are urgently needed to discourage their misuse by the public. Modifications to the current funding model for pharmacist-led cognitive services are needed to motivate pharmacists to participate in AMS initiatives. Full article