Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports

Milani, Richard V.; Wilt, Jonathan K.; Entwisle, Jonathan; Hand, Jonathan; Cazabon, Pedro; Bohan, Jefferson

doi:10.1136/bmjoq-2018-000351

Cited by 43 publications

(41 citation statements)

References 23 publications

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“…AMR is expected to be responsible for 10 million deaths annually by 2050 1 . Excessive and otherwise inappropriate prescription of antibiotics promotes resistance; an estimated 30–50% of all antimicrobial prescriptions are unnecessary 2 . The rapid rise in multi- and pan-drug resistant infections highlights an urgent need to improve infection diagnosis and management tools to improve the stewardship of a dwindling stock of effective antibiotics.…”

Section: Introductionmentioning

confidence: 99%

A fast impedance-based antimicrobial susceptibility test

et al. 2020

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There is an urgent need to develop simple and fast antimicrobial susceptibility tests (ASTs) that allow informed prescribing of antibiotics. Here, we describe a label-free AST that can deliver results within an hour, using an actively dividing culture as starting material. The bacteria are incubated in the presence of an antibiotic for 30 min, and then approximately 105 cells are analysed one-by-one with microfluidic impedance cytometry for 2–3 min. The measured electrical characteristics reflect the phenotypic response of the bacteria to the mode of action of a particular antibiotic, in a 30-minute incubation window. The results are consistent with those obtained by classical broth microdilution assays for a range of antibiotics and bacterial species.

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Section: Introductionmentioning

confidence: 99%

A fast impedance-based antimicrobial susceptibility test

et al. 2020

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“…However, patient educational materials alone have shown minimal beneficial effect on professional practice outcomes . When patient educational materials were combined with unblinded provider antibiotic prescription comparison reports for treatment of URTIs, inappropriate prescribing decreased 40% in the first year . This may serve as an example of an intervention rural clinics could implement.…”

Section: Discussionmentioning

confidence: 99%

Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics

Kufel

Mastro

Mogle

et al. 2020

J Am Coll Clin Pharm

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Background: Variation in providers' education and training may contribute to potential antibiotic overprescribing in outpatient settings. Providers in rural settings may not be exposed to or have similar resources readily available as those in urban settings, or be affiliated with academic medical centers. Thus, we sought to evaluate providers' knowledge and perceptions towards antibiotic stewardship (AS) and antibiotic prescribing in rural primary care clinics. Methods:A cross-sectional, multicenter, electronic survey assessing providers' knowledge and perceptions towards AS and antibiotic prescribing was distributed to family medicine and internal medicine clinic providers in rural New York and Pennsylvania.Results: Seventy responses were included resulting in a survey response rate of 33.5% (70/209) with 42.9%, 30%, and 27.1% of responses from physicians, advanced practice providers, and resident physicians, respectively. The most common barrier to improving antibiotic prescribing was patient demands (54.3%). Providers felt more pressured to prescribe antibiotics based on appointment visits of ≤20 minutes compared with >20 minutes (46.4% vs 7.1%, P = .006), as well as those that encountered ≥50 patients in a week compared with <50 patients (55% vs 16.7%, P = .001). All providers strongly agreed or agreed that antibiotics are overprescribed and inappropriate antibiotic use can lead to resistance. However, only 42.9% of providers selected correctly that 90% to 98% of rhinosinusitis are viral and only 5.7% recommended supportive care without antibiotics. Ten percent of providers never heard of AS, yet most providers (84.3%) were interested in receiving more AS education. Importantly, most providers (57.1%, 40/70) indicated that pharmacists were useful resources to assist in appropriate antibiotic prescribing. Conclusions: Variability exists among providers' knowledge and perceptions towardsAS and antibiotic prescribing in rural primary care clinics, yet most providers are interested in additional AS education. Pharmacists are well-positioned to educate providers and implement initiatives related to AS and appropriate antibiotic prescribing.

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“…In some countries, antibiotics are available as over-the-counter medications [ 9 ]. By contrast, in countries where antibiotics are prescription-only, the majority of prescriptions are inappropriate [ 10 , 11 ]. For example, physicians may pre-emptively prescribe an antibiotic based on symptoms of disease, without confirmation of a bacterial infection [ 12 ].…”

Section: History Of Antibiotics and Resistancementioning

confidence: 99%

A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides

Browne

Chakraborty

Chen

et al. 2020

IJMS

303

241

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Antimicrobial resistance is a multifaceted crisis, imposing a serious threat to global health. The traditional antibiotic pipeline has been exhausted, prompting research into alternate antimicrobial strategies. Inspired by nature, antimicrobial peptides are rapidly gaining attention for their clinical potential as they present distinct advantages over traditional antibiotics. Antimicrobial peptides are found in all forms of life and demonstrate a pivotal role in the innate immune system. Many antimicrobial peptides are evolutionarily conserved, with limited propensity for resistance. Additionally, chemical modifications to the peptide backbone can be used to improve biological activity and stability and reduce toxicity. This review details the therapeutic potential of peptide-based antimicrobials, as well as the challenges needed to overcome in order for clinical translation. We explore the proposed mechanisms of activity, design of synthetic biomimics, and how this novel class of antimicrobial compound may address the need for effective antibiotics. Finally, we discuss commercially available peptide-based antimicrobials and antimicrobial peptides in clinical trials.

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Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports

Cited by 43 publications

References 23 publications

A fast impedance-based antimicrobial susceptibility test

A fast impedance-based antimicrobial susceptibility test

Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics

A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides

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