Time series analysis of the impact of an intervention in Tayside, Scotland to reduce primary care broad-spectrum antimicrobial use

Hernández-Santiago, Virginia; Marwick, Charis; Patton, Andrea; Davey, Peter; Donnan, Peter T.; Guthrie, Bruce

doi:10.1093/jac/dkv095

Cited by 31 publications

(41 citation statements)

References 30 publications

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“…Our study found that in regular fusafungine prescribing GP and ENT practices in Germany, the withdrawal of fusafungine was associated with an immediate change in health care professional behaviour with increased prescribing of other N&T products for URAD. In this regard, there was no significant change in the proportion of untreated patients, an effect similarly noted in other interventions resulting in changing antibacterial guideline recommendations [14]. Importantly, we observed no statistically significant increase in prescribing of systemic antibiotics and only a small temporary increase in prescribing of tyrothrocin-containing products from ENT practices, which is reassuring in terms of the risk of antibiotic resistance and other antibiotic-related adverse drug reactions that may have occurred.…”

Section: Discussionsupporting

confidence: 68%

Effect of withdrawal of fusafungine from the market on prescribing of antibiotics and other alternative treatments in Germany: a pharmacovigilance impact study

Hedenmalm

Kurz²,

Moralès³

2019

Eur J Clin Pharmacol

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in regular fusafungine-prescribing practices. Trends in the quarterly prevalence of antibiotics (AB), other nasal or throat preparations (N&T) and tyrothricin were analyzed. Practices with no fusafungine prescribing during the study served as controls. Changes in prescribing trend were evaluated using interrupted time series regression analysis. Results In fusafungine-prescribing practices, withdrawal of fusafungine was associated with an immediate increase in prescribing of other N&Ts among patients consulting for URAD (+ 6.4%, 95% CI 2.3-10.5% in GP practices and + 9.0%, 95% CI 5.5-12.5% in ENT practices). There was no increase in antibiotic prescribing. In ENT practices; a small transient increase in tyrothricin prescribing occurred. No changes were seen in non-fusafungine-prescribing practices. Conclusions Withdrawal of fusafungine was not associated with increased prescribing of antibiotics but was associated with increased prescribing of other N&Ts. The unintended impact of substitution to other treatments should be considered routinely when products are withdrawn or restricted in other ways.

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Section: Discussionsupporting

confidence: 68%

Effect of withdrawal of fusafungine from the market on prescribing of antibiotics and other alternative treatments in Germany: a pharmacovigilance impact study

Hedenmalm

Kurz²,

Moralès³

2019

Eur J Clin Pharmacol

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“…In Scotland, a model utilizing a primary care antimicrobial management team was utilized as part of a national initiative to reduce broad spectrum antimicrobial prescribing in a large region. [44] In the current study, a local team of a physician, pharmacist and administrative staff acted as site champions to promote the uptake of ASP information and resources.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

et al. 2020

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The overuse of antimicrobials in primary care can be linked to an increased risk of antimicrobial-resistant bacteria for individual patients. Although there are promising signs of the benefits associated with Antimicrobial Stewardship Programs (ASPs) in hospitals and long-term care settings, there is limited knowledge in primary care settings and how to implement ASPs in these settings is unclear. In this context, a qualitative study was undertaken to explore the perceptions of primary care prescribers of the usefulness, feasibility, and experiences associated with the implementation of a pilot community-focused ASP intervention in three primary care clinics. Qualitative interviews were conducted with primary care clinicians, including local ASP champions, prescribers, and other primary health care team members, while they participated in an ASP initiative within one of three primary care clinics. An iterative conventional content analyses approach was used to analyze the transcribed interviews. Themes emerged around the key enablers and barriers associated with ASP implementation. Study findings point to key insights relevant to the scalability of community ASP activities with primary care providers.

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“…This study revealed that restrictive-prescribing stewardship led to a significant downward trend in broad-and narrow-spectrum antibiotic use, but an immediate increase was observed in the ratio between them. Hernandez-Santiago V et al [34]found that the broad-spectrum antibiotic prescription achieved a significant sustained reduction after introducing an intervention combing guidelines, education and feedback in Scotland.Kuyvenhoven M et al [35] pointed out that a decrease of narrow-spectrum antibiotic use has been accompanied by an increase of broad-spectrum antibiotics in America. Aabenhus R et al [36] also found that the consumption of broad-spectrum antibiotics increased while narrow-spectrum antibiotics declined in primary care in Denmark.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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

Preprint

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Abstract 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. This study aimed to evaluate the effects of a restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provideevidence-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) methodologywere 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 (declined by 32.58%) 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 of 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 an ascending 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 use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were mixed. Stronger administrative regulation focusing on specific antibiotics, such as the third and fourth-generation cephalosporins, fluoroquinolones, broad-spectrum antibiotics and parenteral antibiotics, is in urgent need in the future.

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Time series analysis of the impact of an intervention in Tayside, Scotland to reduce primary care broad-spectrum antimicrobial use

Cited by 31 publications

References 30 publications

Effect of withdrawal of fusafungine from the market on prescribing of antibiotics and other alternative treatments in Germany: a pharmacovigilance impact study

Effect of withdrawal of fusafungine from the market on prescribing of antibiotics and other alternative treatments in Germany: a pharmacovigilance impact study

Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study

Effects of Restrictive-prescribing Stewardship on Antibiotic Consumption in Primary Care in China: An Interrupted Time Series Analysis, 2012-2017

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