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Antibiotic prescribing principles

Priya Nori, Theresa Madaline, Iona Munjal, Shubha Bhar, Yi Guo, Susan K Seo, Andrea Porrovecchio, Elizabeth Gancher, Joshua Nosanchuk, Liise-Anne Pirofski, Belinda Ostrowsky
BACKGROUND: To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center. METHODS: We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations...
2017: Open Forum Infectious Diseases
Stefanie Jane Oliver, James Cush, Jeanette E Ward
BACKGROUND: To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. WHAT WE DID: Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing...
2017: Frontiers in Public Health
Yuan-Yuan Wang, Ping Du, Fang Huang, Dong-Jie Li, Jun Gu, Fu-Ming Shen, Yuan-Ying Jiang
Whilst the 'Principles of clinical use of antibiotics' was released by the Ministry of Health of the People's Republic of China in 2004, limited research has been conducted to evaluate the quality of antibiotic use in real-world practice. In this study, we sought to examine antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China. De-identified outpatient and emergency department pharmacy records containing antimicrobials were extracted from the hospital electronic health records system...
December 2016: International Journal of Antimicrobial Agents
Avinash S Patil, Jessica S Sheng, Sarah K Dotters-Katz, Maria S Schmoll, Mitchell L Onslow
PURPOSE: Anti-infectives are among the most commonly prescribed medications in pregnancy. However, detailed information on the pharmacokinetics and pharmacodynamics of these medications in pregnancy is limited, leading to uncertainty among clinicians regarding the tolerability and efficacy of treatments. The purposes of this review were to highlight key physiologic changes during pregnancy that influence drug behavior, and to discuss areas of active research related to anti-infective drugs in pregnancy...
September 2016: Clinical Therapeutics
Myriam Gharbi, Luke S P Moore, Enrique Castro-Sánchez, Elpiniki Spanoudaki, Charlotte Grady, Alison H Holmes, Lydia N Drumright
BACKGROUND: Appropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes...
August 30, 2016: BMC Infectious Diseases
Nicola Principi, Susanna Esposito
BACKGROUND: Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed...
August 18, 2016: BMC Infectious Diseases
Benjamin A Lipsky, Matthew Dryden, Finn Gottrup, Dilip Nathwani, Ronald Andrew Seaton, Jan Stryja
BACKGROUND: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing antibiotics. OBJECTIVES: This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds...
November 2016: Journal of Antimicrobial Chemotherapy
Charlotte I Barker, Eva Germovsek, Mike Sharland
The penicillins remain the class of antibiotics most commonly prescribed to children worldwide. In an era when the risks posed by antimicrobial resistance are growing, an understanding of antibiotic pharmacology and how to apply these principles in clinical practice is increasingly important. This paper provides an overview of the pharmacology of penicillins, focusing on those aspects of pharmacokinetics, pharmacodynamics and toxicity that are clinically relevant in paediatric prescribing. Penicillin allergy is frequently reported but a detailed history of suspected adverse reactions is essential to identify whether a clinically relevant hypersensitivity reaction is likely or not...
February 2017: Archives of Disease in Childhood. Education and Practice Edition
Adrian John Brink, Johan Van Wyk, V M Moodley, Craig Corcoran, Pieter Ekermans, Louise Nutt, Tom Boyles, Olga Perovic, Charles Feldman, Guy Richards, Marc Mendelson
Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not...
May 10, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
E V Ponomarenko, Ya S Skripnikova, O I Mangurenko
Abstract The principles of rational antibacterial therapy in children for the burn trauma were analyzed. The results of the completed treatment of 808 children for the burn trauma in a Combustiological Department of Municipal clinical hospital of City of Zaporozhye were studied. In 326 (40.3%) children antibacterial therapy was conducted, including one antibiotic--in 268 (82.2%), two and more--in 37 (11.3%). The preparations were prescribed empirically, taking into account bacteriological profile of the Department and the patients premorbidity background present...
February 2016: Klinichna Khirurhiia
James Q Del Rosso, Joshua A Zeichner
Antibiotics are commonly used by dermatologists in clinical practice, primarily because of the overall track record of favorable efficacy and safety with the most commonly used agents. During the past decade, increased attention has been given to the problems associated with antibiotic resistance. This article summarizes important principles gleaned from the continued efforts of the Scientific Panel on Antibiotic Use in Dermatology; other groups working diligently in this area, such as the Centers for Disease Control and Prevention and the Canadian Antimicrobial Resistance Alliance; and from the published literature...
April 2016: Dermatologic Clinics
Kerina J Denny, Menino O Cotta, Suzanne L Parker, Jason A Roberts, Jeffrey Lipman
INTRODUCTION: The altered pathophysiology in critically ill patients presents a unique challenge in both the diagnosis of infection and the appropriate prescription of antibiotics. In this context, the importance of effective and timely treatment needs to be weighed against the individual and community harms associated with antibiotic collateral damage and antibiotic resistance. AREAS COVERED: We evaluate the principles of antibiotic use in critically ill patients, including dose optimisation, use of combination antibiotic therapy, therapeutic drug monitoring, appropriate antibiotic therapy duration, de-escalation, and utilisation of sepsis biomarkers...
May 2016: Expert Opinion on Drug Safety
Sana Zahabiyoun, Mahasti Sahabi, Mohammad Javad Kharazi
OBJECTIVES: Cases of antimicrobial resistance are increasing, partly due to inappropriate prescribing practices by dentists. The purpose of this study was to investigate the prescribing practices and knowledge of dentists with regards to antibiotics. Moreover, this study aimed to determine whether the prescriptions comply with the recommended guidelines and whether clinical audit can alter the prescribing practices of dentists leading to better use of antibiotics in the dental service...
March 2015: Journal of Dentistry of Tehran University of Medical Sciences
S S Virdee, D Seymour, S Bhakta
Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. This can be attributed to the technical complexities of conventional techniques and the presence of pulp pathosis. Reasons for why the latter influences the ability to attain pulpal anaesthesia is not yet fully understood, but its frequent occurrence is well documented. In light of overcoming this it has become common practice to prescribe antibiotics, refer onto secondary care or to even commence treatment without appropriately anaesthetising the tooth...
October 23, 2015: British Dental Journal
A L Cremers, S Janssen, M A M Huson, G Bikene, S Bélard, R P M Gerrets, M P Grobusch
SETTING: Lambaréné, Gabon. OBJECTIVES: To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. DESIGN: Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic...
December 21, 2013: Public Health Action
Jing-Fen Jin, Ling-Ling Zhu, Meng Chen, Hui-Min Xu, Hua-Fen Wang, Xiu-Qin Feng, Xiu-Ping Zhu, Quan Zhou
BACKGROUND: Intravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration. Comparative studies of SC versus IV, IM versus IV, or IM versus SC have been sporadically conducted, and some new findings are completely different from the dosage recommendation as described in prescribing information. However, clinicians may still be ignorant of such new evidence-based findings when choosing treatment methods. METHODS: A literature search was performed using PubMed, MEDLINE, and Web of Sciences™ Core Collection to analyze the advantages and disadvantages of SC, IV, and IM administration in head-to-head comparative studies...
2015: Patient Preference and Adherence
C Pulcini, F Wencker, N Frimodt-Møller, W V Kern, D Nathwani, J Rodríguez-Baño, G S Simonsen, V Vlahović-Palčevski, I C Gyssens
We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology...
April 2015: Clinical Microbiology and Infection
Peter Davey, Claire Peden, Esmita Charani, Charis Marwick, Susan Michie
There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information...
March 2015: International Journal of Antimicrobial Agents
Salih Mollahaliloglu, Ali Alkan, Basak Donertas, Senay Ozgulcu, Ahmet Akici
OBJECTIVE: Irrational pharmacotherapy is a widespread health care problem, and knowing the prescription practices of physicians at an institutional level can present solutions. This study aimed to investigate whether physicians' prescribing patterns showed differences at the level of the health care institution. MATERIALS AND METHODS: Photocopies of 3201 prescriptions written at primary health care centers (PHCs), public hospitals, private hospitals, and university hospitals (UHs) were collected from 10 provinces in Turkey...
June 2013: Eurasian Journal of Medicine
Ingvild Vik, Marianne Bollestad, Nils Grude, Anders Bærheim, Sigvard Mölstad, Lars Bjerrum, Morten Lindbæk
BACKGROUND: Although uncomplicated cystitis is often self-limiting, most such patients will be prescribed antibiotic treatment. We are investigating whether treatment of cystitis with an NSAID is as effective as an antibiotic in achieving symptomatic resolution. METHODS/DESIGN: This is a randomized, controlled, double blind trial following the principles of Good Clinical Practice. Women between the ages of 18 to 60 presenting with symptoms of uncomplicated cystitis are screened for eligibility...
December 17, 2014: BMC Infectious Diseases
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