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OBJECTIVES@#This study evaluated the antibiotic prescribing patterns in pediatric patients in the Out Patient Department (OPD) of the Philippine Children’s Medical Center (PCMC) where it may encourage drug monitoring and improvement in the utilization of antibiotics in the department.@*MATERIALS AND METHODS@#A descriptive, cross-sectional study involving patient encounters selected using convenience sampling was conducted at the outpatient department of PCMC. All previously healthy pediatric patients aged 3 months to 18 years diagnosed with pediatric community- acquired pneumonia (PCAP) with no known acute and chronic comorbidities were included. The observed values of the antibiotic prescribing indicators were compared with the optimal values recommended by the World Health Organization (WHO), and the Index of Rational Drug Prescribing (IRDP) was calculated.@*RESULTS@#A total of 600 patients diagnosed with PCAP were included in the study seen at the PCMC OPD from January 2020 to July 2022. Ninety-six percent of the patient encounters had at least one antibiotic prescribed (SD + 0.20). The average number of medicines prescribed per patient encounter was 2.05 (SD + 0.85). Of these, 100% were prescribed by generic name and were prescribed from the essential drug list. The most commonly prescribed medications were antibiotics (43.17%) with coamoxiclav (42.93%), amoxicillin (37.76%), and cefuroxime (7.59%) being the top three commonly prescribed antibiotics.@*CONCLUSION@#With respect to the IRDP, PCMC scores well with 3.16 where the most rational score is 4. However, this study highlights the high occurrence of prescribing antibiotics in the institution.
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Pacientes Ambulatoriais , PediatriaRESUMO
ABSTRACT@#Inappropriate antibiotic prescribing in dentistry has been widely reported but local studies are scarce. We aimed to evaluate antibiotic prescribing practices among dental officers in a public dental primary care clinic against current guidelines: specifically assessing the number, appropriateness, accuracy of prescriptions, type of antibiotics prescribed and repeated prescribing of the same type of antibiotics within a specific duration. A retrospective audit consisting of two cycles (1st cycle: July to September 2018, 2nd cycle: July to September 2019) was carried out by manually collecting relevant data of patients (aged 18 and above) who were prescribed antibiotics from carbon copies of prescription books. Between each cycle, various interventions such as education through a continuous professional development (CPD) session, presentation of preliminary findings and making guidelines more accessible to dental officers were implemented. When the 1st and 2nd cycles were compared, the number of antibiotic prescriptions issued reduced from 194 to 136 (–30.0%) whereas the percentage of appropriate prescriptions increased slightly by 4.1%. Inaccurate prescriptions in terms of dosage and duration decreased (–0.5% and –13.7%, respectively) whilst drug form and frequency of intake increased (+15.7% and +0.7%, respectively). Repeated prescribing of the same antibiotics by the same officer within a period of ≤6 weeks no longer occurred. Amoxicillin and metronidazole were most commonly prescribed in both cycles. Overall, the antibiotic prescribing practices did not closely adhere to current guidelines. However, clinical audit in conjunction with targeted interventions resulted in improvement in the antibiotic prescribing patterns. Thus, further intervention and re-audit is necessary.
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Dosagem , Clínicas Odontológicas , Auditoria ClínicaRESUMO
Background: Surgical site infection (SSI) is the most common postoperative complication and represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. Appropriate antibiotic prophylaxis helps in reducing the incidence of SSIs. Appropriate surgical prophylaxis is a multifactorial process that depends on proper case selection, antibiotic selection including dosing and route of administration and duration of therapy.Methods: A prospective observational study was conducted over 3 months on 200 operated patients in surgery ward of a tertiary hospital. Patient details like demography, type of surgery performed and antibiotics prescribed pre and post-surgical procedure was collected and analysed using Microsoft excel.Results: Out of 200 patients 32.5% (65) were females and 67.5% (135) were males. Total number of prophylactic antibiotics prescribed were 368. The most commonly prescribed group of antibiotics was cephalosporins (44.29%) followed by metronidazole (26.5%) and ofloxacin (9.48%). Among the cephalosporins the most commonly prescribed was cefuroxime in 82 patients (50.3%) and cefoperazone in 79 patients (48.46%). SSI developed in 3 out of 200 patients (1.5%).Conclusions: There is an urgent requirement to promote rational antibiotic prescribing among surgeons. The need of the hour is developing and implementing national guidelines for surgical prophylaxis by a multidisciplinary group of experts.
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Describir algunos conocimientos, actitudes y prácticas de médicos en 3 ciudades colombianas con respecto a la prescripción de antibióticos. Se realizó una encuesta sobre conocimientos, actitudes y prácticas de la prescripción de antibióticos en médicos asistentes a 3 conferencias científicas de la Asociación Colombiana de Infectología en Febrero de 2008. La encuesta fue anónima e individual. Los resultados se analizaron usando Excel 2007 y STATA 2000. Se realizaron 96 encuestas a 29 médicos generales y 67 médicos especialistas. Entre el 29,2% y el 67,42% tienen conocimientos equivocados respecto a la prescripción de antibióticos. El 97,4% de los médicos encuestados considera que la venta de antibióticos debe realizarse únicamente bajo prescripción médica. La mayoría de los encuestados reconoce limitaciones del intervalo de dosificación y de la seguridad para la prescripción de antibióticos. El 60% se mostró en desacuerdo con la aplicación de guías de otros países en nuestros medio y el 76% de los consideran que los infectólogos aportan al manejo clínico de los pacientes. El 72% de los encuestados reportó tener apoyo de un infectólogo y en su institución existen estrategias de restricción de uso de antibióticos, refieren además utilizar asilamiento de contacto frente a organismos multiresistentes. Las respuestas no son significativamente diferentes de acuerdo a los años de experiencia. Los médicos reportaron en su mayoría prácticas conservadoras y racionales del uso de antibióticos aunque algunas limitaciones en el conocimiento farmacológico de los mismos.
Describe knowledge, attittudes and, practices about antibiotic use in Colombian physicians from three different cities. We applied a voluntary survey about knowledge, attittudes and practices about antibiotic prescription at three scientific meetings of the Asociacion Colombiana de Infectología, on February 2008. The survey was anonimous and individual. The results were analyzed using Excel 2007 and STATA 2000. We analyzed 96 surveys, 29 from general practitioners and 67 medical specialists. Physicians had wrong knowledge about antibiotic use between 29,2% and 67,42%. Most physicians (97.4%) considered the antibiotics have to be sold only under medical prescription. Many physicians recognized having limited knowledge about antibiotic dosing interval and security. 60% physicians disagreed with the application of guidelines from other countries in our enviroment and 76% physician consider the infectious disease experts contribute to clinical management of patients. Physicians reported having support from an infectious disease expert on 72%, and had strategies to restrict the use of some antibiotics, likecontact isolation when multi-resistant organisms had been suspected. There were not differences between answers according to years of experience. Several physcians reported conservative practices and rational antibiotic use with limited knowledge about antibiotic pharmacokinetics and pharmacodynamics.
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Humanos , Masculino , Feminino , Inquéritos e Questionários , Antibacterianos , Médicos , Farmacocinética , Doenças Transmissíveis , Estratégias de Saúde , Colômbia , Conhecimento , Infectologia , PrescriçõesRESUMO
Background: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia. Methods: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru. Results: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002). Conclusion: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.
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Prescrições de Medicamentos , Resistência Microbiana a MedicamentosRESUMO
Background: Irrational prescribing of medicine results in serious morbidity and mortality as well as additional economic burden and also lead to reduction in the quality of treatment; thereby causing wastage of resources, increased treatment cost, increased risk for adverse drug reaction, and emergence of resistance. WHO has generated indicators in three main drug use areas; prescribing, patient care, and facility specific factors. Methods: This study was carried out with the aim of identifying prescription pattern of antibiotics and evaluates the rationality of prescriptions in accordance with WHO prescribing indicators. 300 prescriptions were examined from the inpatient department (IPD) of a tertiary care teaching hospital from the Department of Medicine, Surgery, and Orthopedics. The IPDs were visited twice a week. Each prescription was followed for the duration of 5 days. The prescribing and dispensing details from each prescription were recorded in a tabular form as mentioned in data acquisition form. The data were analyzed as per the WHO core drug use indicators. Results: This study clearly highlights the practice of polypharmacy, low uses of generic drugs, injudicious usage of antibiotic, and injection and low usage of the drug prescribed from essential drug list. Conclusions: Multi-faceted interventions are required at many levels for the benefits of the community in the form of continued medical educational programs, consumer awareness, formation of hospital formulary, and undergraduate clinical pharmacology and therapeutics teaching.
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BACKGROUND/AIMS: We evaluated the status of antibiotic stewardship programs (ASPs) for physicians. This survey was a follow-up study of data from 2006 and was performed with some new questions about ASPs. METHODS: The online survey collected information on infectious diseases from doctors in 84 hospitals. The questions included some about ASPs. The data were analyzed and compared with a previous report. RESULTS: Responses came from 40 hospitals. ASPs existed in 87.5% of these (95.5% in 2006), and a computerized preauthorization system was the most common method (85.0%, 59.1% in 2006). An antimicrobial management team existed in 33 hospitals (82.5%), and the preauthorization systems were mainly implemented by infectious disease doctors (72.5%). Incentives to set up ASPs existed in only 12.5% of hospitals (2.3% in 2006). CONCLUSIONS: Computerized preauthorization ASP systems are relatively more common. To improve the uptake of ASPs in each hospital a team approach from the medical institutions is required, along with the cooperation and willingness of those involved.
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Antibacterianos , Doenças Transmissíveis , Seguimentos , Motivação , ViperidaeRESUMO
OBJECTIVE: To identify physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies (UHWI). METHODS: A cross-sectional survey of physicians at the UHWI was conducted between September 2008 and April 2009 using a 28-item, self-administered questionnaire. Eligible physicians from several specialities were identified from departmental rotas. RESULTS: A total of 174 physicians completed the questionnaire, a response rate of 73%. Most physicians considered antibiotic resistance to be an extremely important global problem (55%) but less significant nationally (35%). Factors identified as important in producing resistance included wide-spread use of antibiotics (91%), inappropriate empiric choices (79%) and use of broad-spectrum agents (70%). Hand-washing was not considered to be important in reducing resistance. Useful interventions included access to current information on local resistance patterns (90%), institutional specific antibiotic guidelines (89%) and educational programmes (89%). Antibiotic cycling (40%) and restriction (35%) were regarded as less helpful. Knowledge of resistance-prone antibiotics and specific resistant organisms at the UHWI was poor, except for methicillin-resistant Staphylococcus aureus (MRSA). Empiric therapy for common infections was appropriate in most cases, and antibiotic choices were guided by availability of drugs (89%) and patient factors such as renal disease or allergy (80%). Only 45% of physicians would de-escalate to a narrow-spectrum antibiotic guided by a microbiology report, and consultants were more likely to de-escalate therapy than junior staff (p = 0.002). CONCLUSIONS: Although physicians were aware of the problem of resistance to antibiotics and the contributory factors, their practice did not reflect measures to reduce it. Continuing educational programmes and institution-specific antibiotic prescribing guidelines are needed.
OBJETIVO: Identificar los conocimientos y actitudes de los médicos con respecto a la resistencia antimicrobiana y la práctica de prescripción de antibióticos en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se llevó a cabo un estudio transversal en UHWI, entre septiembre del 2008 y abril del 2009 de abril, usando un cuestionario autoadministrado de 28 puntos. Los médicos elegibles de varias especialidades fueron identificados de las listas departamentales. RESULTADOS: Un total de 174 médicos completaron el cuestionario, para una tasa de respuesta del 73%. La mayor parte de los médicos consideró que la resistencia antibiótica constituye un problema sumamente importante desde un punto de vista global (55%) pero menos significativo desde una perspectiva nacional (35%). Los factores identificados como importantes en la formación de la resistencia incluyeron el uso generalizado de antibióticos (91%), las elecciones empíricas inapropiadas (79%), y el uso de agentes de amplio espectro (70%). El lavarse las manos no se consideró importante para la reducción de la resistencia. Las intervenciones útiles incluyeron el acceso a la información corriente sobre patrones de resistencia locales (90%), normas institucionales específicas sobre el uso de antibióticos (89%) y programas educativos (89%). El ciclo (40%) y la restricción (35%) de los antibióticos se consideraron menos útiles. El conocimiento de antibióticos con tendencia a la resistencia y organismos resistentes específicos en el HUWI era pobre, excepto en el caso del Staphylococcus aureus resistente a la meticilina (SARM). La terapia empírica para las infecciones comunes fue apropiada en la mayoría de los casos, y las opciones antibióticas estuvieron dictadas por la disponibilidad de medicamentos (89%) y factores relacionados con los pacientes, tales como enfermedades renales o alergias (80%). Sólo el 45% de los médicos desescalarían a un antibiótico de estrecho espectro guiado por un informe microbiológico, y los consultantes mostraron una tendencia mayor a desescalar la terapia, en comparación con la observada en el personal subalterno (p = 0.002). CONCLUSIONES: Aunque los médicos tenían conciencia del problema de la resistencia a los antibióticos y los factores contribuyentes, su práctica no reflejó las medidas para reducirla. Se necesitan programas de educación continua y normas institucionales específicas para la prescripción de antibióticos.