Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010–13

Kourlaba, Georgia; Kourkouni, Εleni; Spyridis, Νikos; Gerber, Jeffrey S.; Kopsidas, Ioannis; Mougkou, Katerina; Lourida, Athanasia; Zaoutis, Theoklis E.

doi:10.1093/jac/dkv091

Cited by 26 publications

(26 citation statements)

References 20 publications

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“…This finding was consistent with a previous study by Li H et al [40] that the percentage of broad-spectrum antibiotic prescriptions did not achieve significant decline after intervention, which were attributed to less attention on the appropriateness of antibiotic types. Based on the comparison with other previous studies [38,[41][42][43][44][45][46], the increase of the ratio between broad-and narrowspectrum antibiotic use in this study may result from the following reasons. First, our restrictive-prescribing stewardship lacked multi-faceted intervention (e.g.…”

Section: Strengths and Limitations Of The Studysupporting

confidence: 59%

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Wang

Tang

Liu

et al. 2020

Antimicrob Resist Infect Control

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Background The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. Methods Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. Results Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = − 2.4518, P = 0.005) and showed a downward trend (coefficient = − 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = − 0.0553, P = 0.035; coefficient = − 0.0294, P = 0.037; coefficient = − 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = − 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = − 0.0423, P = 0.017; coefficient = − 0.0223, P = 0.006, respectively). An immediate decline (coefficient = − 1.9292, P = 0.002) and a downward trend (coefficient = − 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. Conclusions Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.

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Section: Strengths and Limitations Of The Studysupporting

confidence: 59%

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Wang

Tang

Liu

et al. 2020

Antimicrob Resist Infect Control

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“…2 Second, at least two-thirds and up to 90% of outpatient antibiotic prescriptions in young children are for respiratory tract infections (RTIs). 28,[35][36][37][38][39][40][41][42][43][44][45] These include upper RTIs, mainly otitis media and pharyngitis, in which antibiotic treatment may not necessarily be required in many cases. Equally, when antibiotics are prescribed, most international guidance suggests that narrow-spectrum options such as amoxicillin or phenoxymethylpenicillin should be used.…”

Section: Discussionmentioning

confidence: 99%

“…10,29,39,57 In contrast, low amoxicillin use, often below 10%, has been observed in Greece, Italy and South Korea. 27,36,58 In these countries, other Access antibiotics, for example coamoxicillin, may be used preferentially.…”

Section: Discussionmentioning

confidence: 99%

Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Hsia

Sharland

Jackson

et al. 2019

The Lancet Infectious Diseases

169

151

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“…En un estudio sobre la variabilidad del manejo de la bronquiolitis en la atención pública de Argentina, el uso de antibióticos obtuvo una tasa de 48.4% en casos no complicados. Se trata de cuadros de bronquiolitis sin asociación a comorbilidades de tipo bacteriano (otitis o neumonía), ya que se seleccionaron las recetas con diagnóstico único, siendo la causa más frecuente del uso inadecuado de medicamentos de amplio espectro ambulatoriamente en infecciones de las vías respiratorias en pacientes pediátricos (Kourlaba et al, 2015;Bernztein et al, 2008). En un estudio se pudo comprobar el aumento del riesgo a sufrir asma en la adolescencia, en pacientes con bronquiolitis, histo-ria familiar de asma y exposición a antibióticos durante los primeros años.…”

Section: Antibióticos En Bronquiolitisunclassified

Actualización sobre bronquiolitis y los beneficios en su manejo con antibióticos – Una revisión sistemática

et al. 2016

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Bronchiolitis is defined as the first wheezing episode in children under the age of 2, preceded by catarrhal respiratory symptoms. This disease is infectious in nature and is linked to viral etiology, the respiratory syncytial virus (RSV) is the cause of over 50% of cases. Currently, the modified Woods scale allows to assess the severity of the infection in order to decide which patients require inpatient treatment. This scale has become a necessary tool, since the therapy approach varies according to the place where therapy is provided. Nebulizations with hypertonic saline solution are the preferred therapy and together with general supportive care, they must be provided only in an inpatient environment. Recently, additional therapeutic measures have been studied, including the helium-oxygen mixture therapy, which has been found to reduce the oxygen requirements and PaCO2 as well as the use of antibiotics, which is restricted to the treatment of bacterial infections, although there is new evidence supporting an immunomodulatory effect in patients with bronchiolitis obliterans.

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Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010–13

Abstract: Broad-spectrum antibiotic prescribing is common in outpatient paediatric patients. These data provide important targets to inform the development of an outpatient antimicrobial stewardship programme targeting specific practices, providers and conditions.

Cited by 26 publications

References 20 publications

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Actualización sobre bronquiolitis y los beneficios en su manejo con antibióticos – Una revisión sistemática

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