A Questionnaire-based Survey on Treatments and Practices of Antibiotics in URTI and Fever of Unknown Origin in India

India is the largest consumer of antibiotics in the world. High antibiotic consumption is linked to the emergence and community spread of multidrug-resistant bacteria. It is well-established that antibiotic overuse is one of the leading causes of antibiotic resistance, which is a major global public health challenge. Optimizing antibiotic usage is, thus, an essential issue. Before promoting and defining judicious antibiotic prescribing, it is crucial to analyze practitioners' diagnostic and prescribing practices. Hence, a nationwide retrospective questionnaire-based survey was conducted among 950 Indian doctors. This survey aimed to describe the approaches and practices of Indian doctors towards antibiotic use in upper respiratory tract infections (URTIs) and pyrexia of unknown origin (PUO) and compare practices with national guidelines. These are the most common reasons for primary health care consultations and significantly contribute to the overuse of antibiotics. According to the survey, amoxicillin-clavulanic acid remains the first-line antibiotic for URTI treatment. Third-generation cephalosporins were found to be the most prescribed antibiotics for PUO, uncomplicated typhoid and infections during pregnancy. Our survey results show that most of the clinicians in our study were well aware of the guidelines for antimicrobial use issued by Indian Council of Medical Research (ICMR) and the nationwide problem of antimicrobial resistance. This study provides an important insight into the prescribing practices of antibiotics among Indian doctors.

Antimicrobial usage and its quantification for neonatal sepsis at a tertiary care hospital neonatal intensive care unit

Background: Antimicrobial therapy for neonatal sepsis is challenging as its judicious use can save neonates while its inappropriate use can lead to rapid emergence of resistant strains. Quantification of consumption of antimicrobial agents (AMA) has not been undertaken in Indian neonatal intensive care units (NICU) setting. This prospective observational study evaluated the antimicrobial prescribing pattern and quantified its consumption in clinically suspected neonatal sepsis (NS) cases.Methods: Clinically suspected NS cases admitted over study period of 18 months in a tertiary care level III NICU were enrolled. Data of antimicrobials prescribed, its consumption, culture sensitivity profile of organisms isolated were collected.Consumption was quantified by computing the days of therapy (DOT) per 1000 patient-days (PD).Results: 150 clinically suspected NS cases were enrolled; 37.33% were culture positive. The most common AMA prescribed were netilmicin (94.67%), piperacillin-tazobactam (88.67%). Only 0.67% cases received reserve antimicrobials like colistin, vancomycin and linezolid. 58% received 2 AMA, 39.33% received ?3 agents. Total antimicrobial consumption was 614.86 DOT/1000 PD and 21.68 DOT/ neonate. Statistically significant difference in total AMA consumption amongst culture positive versus negative cases (p <0.001) was observed but difference was not significant in EOS versus LOS (p=0.95).Conclusion: Usage of antimicrobials for neonatal sepsis was guided by sensitivity pattern of local prevalent flora and clinical response. Usage of reserve antimicrobials were restricted. However, consumption of AB was higher compared to developed countries and we intend to use the study outcome data for antibiotic stewardship program to reduce antibiotic consumption and modify prescribing trends at the study setting.

Pattern of management of febrile neutropenia among breast cancer patients treated with different chemotherapeutic regimens

Background: Breast cancer is one of the common malignancies in females. Chemotherapy with Adriamycin and Cyclophosphamide (AC) followed by the Docetaxel (AC-T, Regimen-I), AC followed by Docetaxel and Carboplatin (AC-T+Cr, Regimen-II) and AC followed by Docetaxel and Trastuzumab (AC-T+Tr, Regimen-III) are commonly given for treatment. These cause myelosuppression and febrile neutropenia and need necessary interventions.Methods: This is a prospective open labelled observational comparative study to evaluate the antibiotic usage needed to treat sepsis following febrile neutropenia among breast cancer patients undergoing chemotherapy with regimen I, II and III. All patients received prophylactic Pegfilgrastim / Filgrastim. Antibiotics used and days in intensive care unit (ICU) in all the 8 cycles of chemotherapy were recorded. 38 patients in Regimen I, 40 patients in Regimen II and 46 patients in Regimen III completed the study and were included in the statistical analysis.Results: In regimen II, following cycle 2 of chemotherapy, none of the patients needed antibiotic therapy. Antibiotic use was maximum, following cycle 1of chemotherapy in regimen I and III, maximum number of antibiotics prescribed were 7. Number of days of ICU care needed for regimen II patients following 3rd cycle of chemotherapy was 3.5±3.5 days. No ICU care was needed for regimen III patients, following cycles 2, 3 and for regimen II following cycle 7.Conclusions: Febrile neutropenia produced by chemotherapy were effectively treated with intravenous antibiotics in ICU for an average of 2-3 days. No mortality was associated with febrile neutropenia and all patients were recovered.

Evaluation of the therapeutic use of antibiotics in Aegean Region hospitals of Turkey: A multicentric study.

Purpose: The antibiotic restriction policy has been validated nationwide since February 2003 by the Ministry of Health because the excessive consumption of antimicrobials causes a high cost. The aim of this study was to evaluate the therapeutic use of antibiotics in Aegean Region hospitals and to assess the impact of this nationwide antibiotic restriction policy. This new policy is based on justification that the infectious disease (ID) physicians should be primarily responsible for the prescription of antimicrobials. Materials and Methods: Eight university and government hospitals were included in the study. The criteria of the Council for Appropriate and Rational Antibiotic Therapy (CARAT) were considered. Both patient-based and antibiotic-based analyses were performed. For the analysis of inappropriate use, logistic regression was modeled. Results: Therapeutic use was determined in 540 patients by a total of 29 ID physicians.In the study, 30.2% of the patients were given antimicrobials and empirically started antibiotics accounted for 79% cases of therapeutic antibiotic use, and 60% of those were inappropriate (P = 0.001). The appropriate use of ID level antibiotics (P = 0.000) were very compatible with other antimicrobial groups. Conclusion: The study shows that the Turkish government's new intervention policy on antimicrobial prescribing has been effective.

Evaluation of Positive Rate of Aerobic BacT/Alert Blood Culture Bottles by Antibiotic Usage and Inoculated Blood Volume / 대한임상병리학회지

BACKGROUND: Inoculated blood volume and residual antibiotic effects are the key variables that influence successful blood cultures especially in patients receiving antibiotics. In our hospital we have inoculated BacT/Alert blood culture bottles with 5 mL of blood, but recent reports about the BacT/Alert system recommend an inoculation of up to 10 mL of blood. METHODS: We studied about 931 paired aerobic blood culture sets and each set was inoculated with 3 mL (3 mL bottle) and 7 mL (7 mL bottle) of blood. The positive rates, the yield and speed of detecting microorganisms in the culture bottles were compared to the specimen information of antibiotic usage. We also analyzed the antibiotic effect on each set of blood cultures by inoculation with standard microorganisms (E. coli ATCC 25922 and S. aureus ATCC 25923) in the used bottle sets. RESULTS: Positive cultures were obtained from 98 sets (10.5%) and 161 organisms grew. Of 931 blood culture bottle sets, 744 (79.9%) were obtained from patients on antibiotic therapy. The positive rate of blood culture bottles from patients receiving antibiotic therapy was significantly lower than those from patients who were not receiving antibiotic therapy (P0.05). When culture bottles with no growth (from patients receiving antibiotic therapy) were used, no differences were found in detection time and positive rates between 3 mL and 7 mL blood culture bottles that were artificially seeded with standard E. coli or S. aureus strains. CONCLUSIONS: Although antibiotic usage rate before using the blood cultures was high in our hospital, the 7 mL bottle showed a better yield and speed of detecting microorganisms than did the 3 mL bottle irrespective of antibiotic usage before using the blood cultures. This data suggests that blood volume elevation (from 5 mL up to 10 mL) can be recommended for BacT/Alert Blood culture systems.