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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (10 July 2024) | Viewed by 21365

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Special Issue Editors

Dr. Sajal K. Saha

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Guest Editor

1. School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC, Australia
2. Menzies School of Health Research, Charles Darwin University, Darwin, ‎NT‎, Australia
3. National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
Interests: antimicrobial stewardship; antimicrobial resistance; antimicrobial prescribing; implementation science; primary care

Dr. Matthaios Papadimitriou-Olivgeris

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Guest Editor

Division of Infectious Diseases, Cantonal Hospital of Sion and Institut Central des Hôpitaux (ICH), Sion, Switzerland
Interests: endocarditis; bacteremia; candidemia; Staphylococcus aureus; carbapenemase

Special Issue Information

Dear Colleagues,

Optimizing antimicrobial use in primary care is central to addressing growing antimicrobial resistance (AMR). Worldwide, primary care faces enormous challenges in the design and implementation of antimicrobial stewardship programs. Although the national AMR action plans of several countries highlight the importance of antimicrobial stewardship in primary care, evidence is limited in the literature related to intervention strategies which are effective and feasible, implementation trials, multidisciplinary health service models supporting stewardship programs, and regulatory policies. This evidence has unique importance to guide practitioners, stakeholders, and policymakers about evidence-based prescribing practices, stewardship implementation, identifying stewardship targets, and informing policies to harness antimicrobial stewardship in primary care. This Special Issue of Antibiotics aims to accumulate evidence of both original research and reviews to present an overview of the current progress and practices in evidence-based antimicrobial prescribing and stewardship in primary care. We welcome your contributions to any of the above topics.

Dr. Sajal K. Saha
Dr. Matthaios Papadimitriou-Olivgeris
Guest Editors

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Keywords

antibiotic prescribing
antibiotic dispensing
antibiotic stewardship
regulatory policies
implementation
interprofessional stewardship models
primary care

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Published Papers (8 papers)

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Research

11 pages, 1724 KiB

Open AccessArticle

Impact of Educational Films on Antibiotic Prescription among Physicians: A Web-Based Survey in Japan

by Kosaku Komiya, Ryohei Kudoh, Norihito Kaku, Yuichiro Shindo, Tatsuya Hayashi, Kei Kasahara, Tomohiro Oishi, Naruhiko Ishiwada, Makoto Ito, Hiroshi Yotsuyanagi, Naoki Hasegawa, Kazuhiro Tateda, Muneki Hotomi and Katsunori Yanagihara

Antibiotics 2024, 13(8), 724; https://doi.org/10.3390/antibiotics13080724 - 1 Aug 2024

Cited by 1 | Viewed by 1484

Abstract

Although antibiotics are most frequently prescribed for respiratory tract infections, effective interventions for their proper use by physicians have not been fully established. We assessed the impact of educational films on the rates of antibiotic prescriptions for respiratory tract infections using fictitious scenarios. In this nationwide web-based survey prospective study, a total of 1100 physicians were included. The physicians were required to view educational short films and determine the need for prescribing antibiotics in 10 fictitious scenarios involving adults diagnosed with different acute respiratory tract infectious diseases. The antibiotic prescription rates for each scenario were compared before and after viewing the educational short film. The rates of antibiotic prescription significantly decreased after viewing the educational film, especially in cases with a narrowly defined common cold (from 51% to 15%), mild pharyngolaryngitis (from 71% to 25%), and acute bronchitis without chronic respiratory underlying diseases (from 63% to 23%). Alternatively, a slight decrease in rates was observed in cases with moderate or severe rhinosinusitis (from 94% to 79%), moderate or severe acute pharyngitis (from 88% to 69%), and acute bronchitis with chronic lung disease (from 70% to 58%), for which antibiotics are recommended. Educational short films may encourage the proper use of antibiotics for respiratory tract infections; however, the possibility of undertreatment in patients requiring antibiotics must be considered. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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10 pages, 223 KiB

Open AccessArticle

Testing Different Message Styles about Unnecessary Antibiotics Using an Online Platform

by Säde Stenlund, Kirstin C. Appelt, Matthew B. Ruby, Nick Smith, Hannah Lishman and David M. Patrick

Antibiotics 2024, 13(7), 657; https://doi.org/10.3390/antibiotics13070657 - 16 Jul 2024

Viewed by 820

Abstract

Patients’ expectations are a major contributor to the unnecessary prescribing of antibiotics, yet limited research has examined how physicians can calibrate these expectations. The studies we conducted tested how varying messages could impact patients’ expectations for antibiotics and their experience of medical appointments. All the participants read a short scenario about an appointment for mild sinusitis symptoms, with the patient’s expectation of antibiotics. In Study 1, the participants (n = 1069) were randomly assigned to read a positively framed, neutral, or negatively framed message regarding unnecessary antibiotics. In Study 2, the participants (n = 1073) read a message emphasizing either the societal or personal harms of unnecessary antibiotics, or a message without additional rationale. None of our pre-registered hypotheses were supported, but our exploratory analyses indicated that the societal message increased concern about antibiotic resistance. The participants who were more concerned about resistance were less likely to ask for antibiotics, more satisfied when the physician did not prescribe them, and more likely to recommend the physician to a friend. Discussing the consequences of the different courses of action did not appear to negatively impact physician–patient rapport. These studies demonstrate an inexpensive method with which to pre-test various messages about antibiotic consumption, and suggest that such messages are not negatively received by patients. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

13 pages, 1201 KiB

Open AccessArticle

Responding to Urinary Tract Infection Symptoms in England’s Community Pharmacies

by Sejal Parekh, Kieran Hand, Lingqian Xu, Victoria Roberts, Fionna Pursey, Diane Ashiru-Oredope and Donna M. Lecky

Antibiotics 2023, 12(9), 1383; https://doi.org/10.3390/antibiotics12091383 - 30 Aug 2023

Cited by 2 | Viewed by 4840

Abstract

Most urinary tract infections (UTIs) are self-limiting and frequently present in primary care; it is common for patients to seek symptom relief. The TARGET Treating Your Infection (TYI) leaflet was used to respond to UTI symptoms for women under 65 years presenting in community pharmacies. The widespread use of these leaflets was incentivised as part of NHS England’s Pharmacy Quality Scheme (PQS) 2022–23, between October 2022 and March 2023. The TARGET TYI leaflets are aimed to support appropriate antibiotic use and antimicrobial stewardship (AMS) as well as reducing the opportunity for resistance to develop. A total of 8363 community pharmacies completed the AMS criteria within the PQS and collectively submitted data for 104,142 patients presenting with UTI symptoms. The majority, 77% (75,071), of (non-pregnant) women presented with none or only one of the three strongly predictive symptoms of dysuria, new nocturia, cloudy urine, and/or vaginal discharge and, therefore, were less likely to have a UTI, as outlined in the English UTI diagnostic guidance. Conversely, 23% (22,381) of women presented with two or more symptoms of dysuria, new nocturia, cloudy urine, and with no vaginal discharge and, therefore, they were more likely to have a UTI. The TARGET TYI UTI leaflets support community pharmacy teams to differentiate between symptoms more likely to be associated with UTIs and those that could be managed with self-care. The findings suggest that most women presenting to community pharmacies with urinary symptoms were likely to have self-limiting symptoms, and could be suitably managed with self-care, pain relief, and appropriate safety netting. Approximately one-third of patients were managed by community pharmacy team members without the need for referral to a pharmacist and one in five patients presented with escalation symptoms and were signposted to other healthcare settings. A total of 94% (97,452) of women received self-care advice of which 36% (37,565) were also provided with additional patient information leaflets. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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29 pages, 1563 KiB

Open AccessArticle

Prescribing Antibiotics in Public Primary Care Clinics in Singapore: A Retrospective Cohort Study

by Sky Wei Chee Koh, Vivien Min Er Lee, Si Hui Low, Wei Zhi Tan, José María Valderas, Victor Weng Keong Loh, Meena Sundram and Li Yang Hsu

Antibiotics 2023, 12(4), 762; https://doi.org/10.3390/antibiotics12040762 - 16 Apr 2023

Cited by 5 | Viewed by 3012

Abstract

Background: Antibiotic prescription practices in primary care in Singapore have received little scholarly attention. In this study, we ascertained prescription prevalence and identified care gaps and predisposing factors. Methods: A retrospective study was conducted on adults (>21 years old) at six public primary care clinics in Singapore. Prescriptions >14 days were excluded. Descriptive statistics were used to showcase the prevalence data. We used chi-square and logistic regression analyses to identify the factors affecting care gaps. Results: A total of 141,944 (4.33%) oral and 108,357 (3.31%) topical antibiotics were prescribed for 3,278,562 visits from 2018 to 2021. There was a significant reduction in prescriptions (p < 0.01) before and after the pandemic, which was attributed to the 84% reduction in prescriptions for respiratory conditions. In 2020 to 2021, oral antibiotics were most prescribed for skin (37.7%), genitourinary (20.2%), and respiratory conditions (10.8%). Antibiotic use in the “Access” group (WHO AWaRe classification) improved from 85.6% (2018) to 92.1% (2021). Areas of improvement included a lack of documentation of reasons for antibiotic use, as well as inappropriate antibiotic prescription for skin conditions. Conclusion: There was a marked reduction in antibiotic prescriptions associated with the onset of the COVID-19 pandemic. Further studies could address the gaps identified here and evaluate private-sector primary care to inform antibiotic guidelines and the local development of stewardship programs. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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10 pages, 251 KiB

Open AccessArticle

Is Education Alone Enough to Sustain Improvements of Antimicrobial Stewardship in General Practice in Australia? Results of an Intervention Follow-Up Study

by Robin Sangwan, Alicia J. Neels, Stella May Gwini, Sajal K. Saha and Eugene Athan

Antibiotics 2023, 12(3), 594; https://doi.org/10.3390/antibiotics12030594 - 16 Mar 2023

Cited by 4 | Viewed by 2119

Abstract

Sustained behaviour change and practice improvements for the optimal use of antimicrobials remains challenging in primary care. In 2018, a simple antimicrobial stewardship education programme involving guideline recommendations for common infections, antimicrobial audit reports, and local antibiograms resulted in significant improvements in guideline compliance and more appropriate antimicrobial prescribing by GPs. This observational follow-up study aims to examine the sustainability of the positive intervention effect after two years of implementation of the intervention. Practice-based data on all oral antimicrobial prescriptions issued by GPs were collected retrospectively to compare with intervention data and to measure the sustainability of the intervention effect. The data were analysed using a two-sample test of proportions. The primary outcomes included changes in the rate of prescription compliance with the Australian “Therapeutic Guidelines: Antibiotic” and the appropriateness of antimicrobial choice and duration of therapy. Overall, there was a significant decline in guideline compliance, from 58.5 to 36.5% (risk ratio (RR) (95% CI): 0.62 (0.52–0.74)), in the appropriateness of antimicrobial choice, from 92.8 to 72.8% (0.78 (0.73, 0.84)), and in the prescribed duration, from 87.7 to 53.3% (0.61 (0.54, 0.68)) in the intervention follow-up period. In respiratory infections and ear, nose, and throat infections, the rates of guideline compliance and appropriate choice and duration of antimicrobial prescription decreased significantly at p < 0.001. Appropriateness in the duration of antimicrobial therapy also significantly decreased for most antimicrobials. The evidence suggests that a simple and single-occasion antimicrobial stewardship education programme is probably not enough to sustain improvements in the optimal use of antimicrobials by GPs. Future research is needed to validate the results in multiple GP clinics and to examine the effect of sustained education programmes involving infection-specific and antimicrobial-targeted audits and feedback. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

9 pages, 777 KiB

Open AccessArticle

National Disparities in Antibiotic Prescribing by Race, Ethnicity, Age Group, and Sex in United States Ambulatory Care Visits, 2009 to 2016

by Eric H. Young, Kelsey A. Strey, Grace C. Lee, Travis J. Carlson, Jim M. Koeller, Vidal M. Mendoza and Kelly R. Reveles

Antibiotics 2023, 12(1), 51; https://doi.org/10.3390/antibiotics12010051 - 28 Dec 2022

Cited by 13 | Viewed by 2334

Abstract

While efforts have been made in the United States (US) to optimize antimicrobial use, few studies have explored antibiotic prescribing disparities that may drive future interventions. The objective of this study was to evaluate disparities in antibiotic prescribing among US ambulatory care visits by patient subgroups. This was a retrospective, cross-sectional study utilizing the National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was described as antibiotic visits per 1000 total patient visits. The appropriateness of antibiotic prescribing was determined by ICD-9 or ICD-10 codes assigned during the visit. Subgroup analyses were conducted by patient race, ethnicity, age group, and sex. Over 7.0 billion patient visits were included; 11.3% included an antibiotic prescription. Overall and inappropriate antibiotic prescription rates were highest in Black (122.2 and 78.0 per 1000) and Hispanic patients (138.6 and 79.8 per 1000). Additionally, overall antibiotic prescription rates were highest in patients less than 18 years (169.6 per 1000) and female patients (114.1 per 1000), while inappropriate antibiotic prescription rates were highest in patients 18 to 64 years (66.0 per 1000) and in males (64.8 per 1000). In this nationally representative study, antibiotic prescribing disparities were found by patient race, ethnicity, age group, and sex. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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16 pages, 2627 KiB

Open AccessArticle

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

by Alfredo Jover-Sáenz, María Ramírez-Hidalgo, Alba Bellés Bellés, Esther Ribes Murillo, Meritxell Batlle Bosch, José Cayado Cabanillas, Sònia Garrido-Calvo, María Isabel Gracia Vilas, Laura Gros Navés, María Jesús Javierre Caudevilla, Alba Mari López, Lidia Montull Navarro, Mireia Ortiz Valls, Gemma Terrer Manrique, Pilar Vaqué Castilla, José Javier Ichart Tomás, Elena Justribó Sánchez, Ester Andreu Mayor, Joan Carrera Guiu, Roser Martorell Solé, Silvia Pallàs Satué, Mireia Saura Codina, Ana Vena Martínez, José Manuel Albalat Samper, Susana Cano Marrón, Isabel Chacón Domínguez, David de la Rica Escuin, María José Estadella Servalls, Ana M. Figueres Farreny, Sonia Minguet Vidal, Luís Miguel Montaña Esteban, Josep Otal Bareche, Mercè Pallerola Planes, Francesc Pujol Aymerich, Andrés Rodríguez Garrocho, Antoni Solé Curcó, Francisca Toribio Redondo, María Cruz Urgelés Castillón, Juan Valgañon Palacios, Joan Torres-Puig-gros, the P-ILEHRDA Group and on behalf of Translational Research Group on Infectious Diseases of Lleida (Head Group, TRIDLE-IRBLleida) Show full author list Hide full author list

Antibiotics 2022, 11(12), 1776; https://doi.org/10.3390/antibiotics11121776 - 8 Dec 2022

Cited by 4 | Viewed by 2119

Abstract

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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23 pages, 1917 KiB

Open AccessArticle

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists

by Sajal K. Saha, Karin Thursky, David C. M. Kong and Danielle Mazza

Antibiotics 2022, 11(9), 1158; https://doi.org/10.3390/antibiotics11091158 - 27 Aug 2022

Cited by 7 | Viewed by 3719

Abstract

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care. Full article

(This article belongs to the Special Issue Antimicrobial Use and Stewardship in Primary Care)

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