Antibiotic Prescriptions for Respiratory Tract Viral Infections in the Colombian Population

An evaluation of antibiotic prescription pattern and drug rationality analysis among outpatients at public health setting, India

BACKGROUND

Antibiotic resistance (AMR) is a significant worldwide health problem, with inappropriate antibiotic prescription being a major contributing factor. Prudent antibiotic use is essential for enhancing health outcomes and reducing AMR. This study assesses antibiotic prescribing practices and their logic in a public community health facility catering to 12,900 urban and rural populations in North India.

METHODS

Cross-sectional research was performed from August 2021 to August 2022, examining 1219 outpatient antibiotic prescriptions. The data encompassed medication kind, dose, duration, adherence to therapeutic criteria, and rationale evaluated by ID specialists and clinical pharmacologists. The evaluation was conducted in accordance with standard procedures, including those from NCDC and PGIMER. Demographics, antibiotic classifications, WHO AWaRe categories, diagnoses, and compliance with the essential drug list (EDL) were evaluated.

RESULTS

The results indicated that 45.9 % of prescriptions were for males and 54 % for females, predominantly involving individuals aged 20-40 years. Amoxicillin + clavulanic acid (27.2 %) was the most often given antibiotic, followed by metronidazole (13.4 %) and azithromycin (10.3 %). The WHO AWaRe categorization revealed that 49.7 % of antibiotics were categorized as "Access," 27.3 % as "Watch," and none as "Reserve." An examination of rationality indicated that 57 % of urinary tract infection prescriptions were justified, but just 29 % of respiratory tract infection prescriptions were deemed logical. Diarrhea and respiratory tract infections were recognized as primary targets for minimizing superfluous antibiotic consumption.

CONCLUSION

The research underscores the necessity for enhanced antibiotic prescription protocols in outpatient environments. Specialized education for healthcare professionals, improved prescription oversight, and compliance with evidence-based protocols are essential for fostering judicious antibiotic utilization and addressing AMR.

A Biosocial Perspective to Understand Antimicrobial Prescription Practices: A Retrospective Cross-Sectional Study from a Public Community Health Center in North India

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a "biosocial" perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a "biosocial" perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings.

Impact of COVID-19 on antibiotic usage in primary care: a retrospective analysis

The COVID-19 pandemic has contributed to many changes in the medical practice, including a wider access to tele-consultations. It not only influenced the type of treatment but also shed light on mistakes often made by doctors, such as the abuse of antibiotics. This study aimed to evaluate the antibiotic treatment, and the impact of the COVID-19 pandemic on antibiotic prescribing during a GP's visit. The retrospective medical history analysis involved data from a first-contact medical center (Pantamed, Olsztyn, Poland), from 1 January 2018 to 31 May 2023. Quantities of prescribed antibiotics were assessed and converted into the so-called active list for a given working day of adult patients (> 18 years of age). Statistical analysis based on collective data was performed. During the COVID-19 pandemic, a decline in the number of medical consultations has been observed, both remotely via tele-medicine and in personal appointments, compared to the data from before the pandemic: n = 95,251 versus n = 79,619. Also, during the COVID-19 pandemic, there was a decrease in the total amount of prescribed antibiotics relative to the data before the pandemic (2.44 vs. 4.54; p > 0.001). The decrease in the quantities of prescribed antibiotics did not depend on the way doctor consultations were provided. The COVID-19 pandemic has contributed to changing the family doctors' management of respiratory infections. The ability to identify the etiological agent-the SARS-COV2 virus-contributed to the reduction of the antibiotics use.

Interventions to Improve Antibiotic Use in Hospitals with Different Levels of Complexity in Colombia: Findings from a Before-and-After Study and Suggestions for the Future

BACKGROUND

In the collaborative efforts to control bacterial antimicrobial resistance (AMR), the challenge for many low- and middle-income countries currently lies in the adequate design and successful implementation and operation of different strategies aimed at improving antibiotic use during hospital care. This study aims to provide data on these different strategies in three hospitals with different levels of complexity and geographic locations in Colombia.

METHODS

This before-and-after study describes and analyzes the development and implementation of clinical practice guidelines (CPGs), continuing education courses, quick consultation tools, and antimicrobial stewardship programs (ASPs) with the use of telemedicine. This includes measuring indicators in the ASP framework such as adherence to CPGs and antibiotic consumption.

RESULTS

We used five CPGs developed in the Colombian context. We designed and developed a Massive Open Online Course (MOOC) and a mobile application (app) as strategies for dissemination and implementation. The ASP was designed and implemented according to each institution's level of complexity. In the three hospitals, a progressive increase in adherence to the antibiotic recommendations proposed in the CPGs was observed, and there was a lower use of antibiotics with the ASPs, both in the general wards and ICUs.

CONCLUSIONS

We concluded that in medium-complexity hospitals located in small rural cities, successful development of ASPs is possible when they are well-planned, implemented, and supported by the organization. It is necessary that Colombia and other Latin American countries continue activities that reduce AMR by designing, implementing, and improving these interventions throughout the national territory.