Latest Research News on Antibiotic Prescription : April 21

[1] Antibiotic Prescription Rates Vary Markedly Between 13 European Countries

There is a lack of data on antibiotic utilization in most European countries. In this study, information about the number of antibiotic prescriptions was obtained for Austria, Belgium, Finland, France, Germany, Greece, Italy, The Netherlands, Portugal, Spain and the UK from the Institute for Medical Statistics Health Global Services in the UK. For Denmark and Sweden the information was obtained from the Danish Medicines Agency (Laegemiddelstyrelsen) and the National Corporation of Swedish Pharmacies (Apoteket AB), respectively. Between 1994 and 1997 the number of prescriptions per 1,000 inhabitants increased in France and Greece whilst Portugal, Spain and Sweden reported a decrease. In 1997, Greece (1,350), Spain (1,320) and Belgium (1,070) had the highest numbers of antibiotic prescriptions per 1,000 inhabitants in the Anatomical Therapeutic Chemical classification system for drugs group J01 while The Netherlands (390), Sweden (460) and Austria (480) had the lowest. The most common antibiotic drug was extended-spectrum penicillin in 6/13 countries, macrolides in Austria, Finland, Germany and Italy, phenoxymethylpenicillin in Denmark and Sweden and cephalosporins in Greece. The variation in the number of antibiotic prescriptions per 1,000 inhabitants between the 13 European countries was substantial in terms of both total use and use of different antibiotics.

[2] Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings

Context During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown.

Objective To assess trends in antibiotic prescriptions for ARTI.

Design, Setting, and Participants The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations.

Main Outcome Measures National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI.

Results Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased.

Conclusions Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.

Infections caused by antibiotic-resistant microorganisms are associated with increased morbidity, mortality, and substantial economic burden.1 Antibiotic use creates selective pressure for the emergence of antibiotic-resistant bacteria.2-4 During the past decade, a variety of US initiatives have promoted the judicious use of antibiotics,5,6 particularly for acute respiratory tract infection (ARTI), which is a common cause of health care encounters and antibiotic prescriptions, especially in young children. In the late 1990s, antibiotic prescription rates in both children and adults decreased,7-10 but these decreases were initially accompanied by increased prescription of broad-spectrum antibiotics.9-11

Interventions not directly targeting antibacterial use may also have reduced antibiotic prescriptions and limited the spread of antibiotic resistance. For example, routine US infant immunization with a 7-valent pneumococcal conjugate vaccine (PCV-7) resulted in decreases in rates of invasive disease due to antibiotic-resistant Streptococcus pneumoniae.12 Data from the Centers for Disease Control and Prevention’s (CDC’s) laboratory and population-based surveillance indicate that decreases in pneumococcal isolates resistant to penicillin, sulfonamides, and selected cephalosporins has been sustained, but the proportion of erythromycin-resistant pneumococcus increased after the initial decreases.13 In the late 1990s, increasing rates of macrolide-resistant invasive pneumococcal disease were temporally associated with increasing use of macrolides, especially azithromycin.14

Recent measurements of antibiotic prescription patterns in the United States are unavailable. This article assesses national trends in antibiotic prescriptions for ARTI in ambulatory settings.

[3] Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000–2005

Objective

To evaluate antibiotic paediatric consumption data in the community setting using data from studies published between 2000 and 2005 and to compare inter- and intra-country antibiotic prescribing patterns.

Methods

A literature search was performed in EMBASE and MEDLINE to identify pharmacoepidemiological studies published between 2000 and 2005.

Results

Large differences between studies were found, with significant heterogeneity in epidemiological indicators. Only 20 studies reporting comparable drug prescription data were considered in the analysis, all of which were from the USA, Canada, North-Central Europe and Italy. Pre-school children were reported as comprising the most exposed age group to antibiotic therapy (prevalence 72%; prescription rate 2.2 prescriptions/person per year). In the overall child and adolescent population (≤19 years), prevalence varied from 14 to 57% (mean 34%), and the prescription rate from 0.2 to 1.3 prescriptions/person per year. Relevant inter-country qualitative and quantitative differences in antibiotic prescribing were apparent, although these were observed in only a few countries: prevalence was higher in Italy and Canada (prevalence range 42–57%) and lower in the Netherlands and the United Kingdom (prevalence range 14–21%). Penicillins were the most prescribed antibiotics in all cases (40–70% of antibiotic prescriptions), followed by macrolides (16–45%), while cephalosporins accounted for a large proportion of the prescriptions in Italy (30–40%) and Canada, but were practically absent in North European prescriptions.

Conclusion

Comparative drug utilisation studies on antibiotic use in children are needed, as are improvements in regulatory and educational programmes aimed at limiting the number prescriptions given for antibiotics. Both approaches would address public health problems, such as bacterial resistance and safety and elevated costs, related to the use and misuse of these drugs.

[4] Irrational Use of Antibiotics and Antibiotic Resistance in Southern Rural Bangladesh: Perspectives from Both the Physicians and Patients

Aims: Antibiotic resistance is one of the widely recognized public health challenges in Bangladesh. The present study was aimed to analyze the current status of irrational use of antibiotics in rural Bangladesh and to explore the views from both physicians’ and patients’ perspective.

Study Design: Population based survey.

Place and Duration of Study: The survey was conducted among 6,000 patients and 580 physicians in the rural areas of Dhaka and Rajshahi divisions of Bangladesh from July 2012 to December 2012.

Methodology: The survey followed a face-to-face interview protocol. 24 Upazila Health Complexes and 112 Union Health Centers of Dhaka and Rajshahi divisions were conveniently surveyed by trained volunteer interviewers. Two separate survey questionnaires were developed for physician and patient survey.

Results: From the physician survey it was found that significantly more doctors prescribe antibiotics in suspected infections (P<.0001). Around forty-four (44.1) percent doctors prescribe antibiotics in cold and fever before diagnosis. A significant proportion of physicians never receive any feedback about the antibiotic they prescribe (31.9%, P<.0001) and more than 50% doctors claimed that they receive feedback occasionally, not always (P<.0001). According to the physician’s patient non-compliance is the main cause of antibiotic resistance in the country (68.8%). Though 48.6% patients think that it is important to strictly follow the doctor’s prescription, a significant percentage believe that it is not always necessary (26.7%, P<.0001) and more than 50% patient stop taking the antibiotic as soon as the symptoms disappear, while only 25.2% patient complete their full course. Only 6.3% patients consult their doctor if they miss the dose of an antibiotic and more than 50% take the next dose on time (P<.0001). When a drug does not work the patient usually consider the doctor is incompetent (25.6%) and many (24.5%) believe that the quality of the drug is not up to the mark.

Conclusion: The result of this survey indicates that the antibiotics are used among the rural people in irrational way. To overcome this situation close supervision of the relevant authority is required in order to minimize the growing antibiotic resistance in Bangladesh.

[5] The Knowledge and Attitude of Practicing Dentists towards the Antibiotic Prescription: A Regional Study

Aims: To assess dentist’s knowledge and practice in relation antibiotic prescription and to investigate if they follow the current international guidelines.

Methodology: In this cross sectional study a structured and pretested questionnaire was sent to 202 licensed dental practitioners in UAE, Iran and Jordan took place in period between December 2011 and January 2012 by e-mail and physical delivery.

Results: Of 160 responding dentists 93.1% would prescribe antibiotics for dentofacial infections with systemic signs but many prescribe antibiotics for conditions where antibiotic therapy is not required according to good practice. Amoxicillin was the most frequently prescribed antibiotics. The non-clinical factor that may affect decision of the majority of dentists to prescribe antibiotics was perception of the effectiveness of those antibiotics in previous cases they treated with same agent (61.25%). Most of the respondents (84%) prescribe prophylactic antibiotics for patients at risk of infective endocarditis.

Conclusion: This study reveals that antibiotics were still being prescribed by dental practitioners where recent guidelines suggest there is no indication.

Reference

[1] Mölstad, S., Lundborg, C.S., Karlsson, A.K. and Cars, O., 2002. Antibiotic prescription rates vary markedly between 13 European countries. Scandinavian journal of infectious diseases34(5), pp.366-371.

[2] Grijalva, C.G., Nuorti, J.P. and Griffin, M.R., 2009. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. Jama302(7), pp.758-766.

[3] Rossignoli, A., Clavenna, A. and Bonati, M., 2007. Antibiotic prescription and prevalence rate in the outpatient paediatric population: analysis of surveys published during 2000–2005. European journal of clinical pharmacology63(12), pp.1099-1106.

[4] Sutradhar, K.B., Saha, A., Huda, N.H. and Uddin, R., 2014. Irrational use of antibiotics and antibiotic resistance in southern rural Bangladesh: perspectives from both the physicians and patients. Annual Research & Review in Biology, pp.1421-1430.

[5] Gaballah, K., Bahmani, A.A., Salami, A. and Hassan, N.A., 2014. The knowledge and attitude of practicing dentists towards the antibiotic prescription: a regional study. Journal of Pharmaceutical Research International, pp.2006-2018.

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