Antibiotic Consumption in Primary Care in Costa Rica and Italy: A Retrospective Cross-Country Analysis.

BACKGROUND AND OBJECTIVE:  The increasing emergence and spread of drug-resistant pathogens resulting from inappropriate antibiotic usage have become more evident in recent years, particularly with the rising incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections. Since joining the Organization for Economic Cooperation and Development (OECD), Costa Rica can now compare its healthcare system with other countries, and similarities have been noted with Italy regarding health indicators. Both nations have universal healthcare systems, covering their entire populations, and hold similar positions in the Human Development Index (HDI). Consequently, the goal is to compare antibiotic prescribing and consumption patterns to collaboratively develop strategies against bacterial resistance. METHODS:  In order to compare antibiotic consumption between regions, a standardized contrast was utilized, specifically using the defined daily dose (DDD). An Orthogonal Contrast test was performed to test the means, followed by the application of the Student's t-test on these contrasts. This analysis aimed to assess the potential influence of regions on DDD values. Antibiotic consumption data were collected between January 2021 and December 2022 from the Local Health Authority of Naples 3 South (LHANS) in Italy and IMS Health, Q Quintiles, and VIA by way of (IQVIA) reports in Costa Rica. RESULTS:  LHANS shows a considerable disparity in gross expenditure compared to Italy's overall expenditure, while the private sector of Costa Rica exhibits even lower gross expenditure than Italy. Antibiotic consumption in Italy exceeds that of Costa Rica, with Costa Rica's consumption amounting to 47.70% of Italy's total consumption. Additionally, LHANS exhibited a 22.43% higher gross expenditure compared to the Campania region, emphasizing the variability in antibiotic usage within the same country The results indicated no statistically significant differences in antibiotic consumption between the regions, as none of the null hypotheses were rejected. CONCLUSIONS: The study provides valuable insights into expenditure patterns and antibiotic consumption, highlighting the need for improved prescribing practices and awareness campaigns to address the issue of antibiotic resistance. The findings emphasize the importance of implementing international guidelines to combat the growing threat of antibiotic resistance and ensure the effective management of infectious diseases.

Antibiotic prescription patterns and non-clinical factors influencing antibiotic use by Ecuadorian veterinarians working on cattle and poultry farms: A cross-sectional study.

Understanding antibiotic prescription patterns and non-clinical factors influencing antibiotic use is essential for implementing strategies to promote appropriate antibiotic use. There is, however, limited research exploring these issues with Ecuadorian veterinarians. Therefore, a questionnaire was developed and applied cross-sectionally to veterinarians (n = 173) from two professional organizations to explore the antibiotic prescription patterns and non-clinical factors (e.g., attitudes and perceptions) influencing antibiotic use, and to identify strategies to reduce antibiotic use. The response rate was 78.4%. Responses were compared between veterinarians working mainly on cattle and poultry farms using Mann-Whitney U tests. The most important attitudes, beliefs and perceptions towards antimicrobial resistance (AMR) and antibiotic use were identified with the Relative Importance Index (RII). Veterinarians showed high awareness of AMR and its implications for public health, as well as the necessity of reducing antibiotic use. However, some veterinarians appear to underestimate the potential contribution of veterinary antibiotic use on AMR in humans. Veterinarians self-reported high prescription (> 20%) of antibiotics for cattle and poultry that are critically important for human medicine, such as 3rd and 4th generation cephalosporins, polymyxins and quinolones. Further, antibiotic therapy was not tailored to disease type. Cattle and poultry veterinarians perceived similar barriers to increasing antibiotic stewardship including: poor biosecurity measures, animal confinement, low feed quality, farmers' behaviors (such as stopping antibiotic treatment, storing antibiotics on farms, buying antibiotics in veterinary supply stores), and sales agents' roles as non-professional prescribers of antibiotics. Overall, veterinarians were broadly supportive (>90%) of most strategies to promote appropriate antibiotic use. They saw more merit in improving biosecurity of farms and implementing educational programs for farmers and veterinarians. This study provides insight into the complexity of antibiotic use on Ecuadorian farms and the need for holistic strategies in a One Health context, to achieve antibiotic stewardship.

Office-based approach to urinary tract infections in 50 000 patients: results from the REWIND study.

OBJECTIVES: The REWIND study sought to describe the real-world clinical and prescribing practices for the management of urinary tract infection (UTI) in Italy, Belgium, Russia and Brazil in order to compare current practices with international, European and national guidelines. METHODS: An integrated mixed-methods approach was adopted that used information from primary care electronic medical records in longitudinal patient databases available in Italy and Belgium, and surveys of physicians in Russia (general practitioners) and Brazil (gynaecologists). RESULTS: In total, 49 548 female patients were included in the study. Antibiotics were the most common management option for UTI in Italy (71.1%, n=27 600), Belgium (92.4%, n=7703), Russia (81.9%, n=1231) and Brazil (82.4%, n=740). Fosfomycin trometamol was the first-choice antibiotic for the treatment of UTI in all countries. Ciprofloxacin was also commonly prescribed in Italy (24.6%, n=6796), Belgium (17.8%, n=1373), Russia (14.9%, n=184) and Brazil (9.6%, n=71), while prescription of nitrofurantoin was common in Belgium (24.5%, n=1890) alone. CONCLUSIONS: Despite differences in study designs and data sources, fosfomycin trometamol was found to be the most commonly prescribed treatment for UTI in all participating countries. In Belgium, real-world prescribing practices for UTI adhered more closely to European guidelines than national guidelines. Although not recommended in international and European guidelines for lower UTI management, the use of fluoroquinolones was still widespread.

Encuesta de conocimientos, actitudes y prácticas sobre el uso de antibióticos en médicos colombianos / Survey of Knowledge, Attittudes and Practices about Antibiotic Use in Colombian Physicians

Describir algunos conocimientos, actitudes y prácticas de médicos en 3 ciudades colombianas con respecto a la prescripción de antibióticos. Se realizó una encuesta sobre conocimientos, actitudes y prácticas de la prescripción de antibióticos en médicos asistentes a 3 conferencias científicas de la Asociación Colombiana de Infectología en Febrero de 2008. La encuesta fue anónima e individual. Los resultados se analizaron usando Excel 2007 y STATA 2000. Se realizaron 96 encuestas a 29 médicos generales y 67 médicos especialistas. Entre el 29,2% y el 67,42% tienen conocimientos equivocados respecto a la prescripción de antibióticos. El 97,4% de los médicos encuestados considera que la venta de antibióticos debe realizarse únicamente bajo prescripción médica. La mayoría de los encuestados reconoce limitaciones del intervalo de dosificación y de la seguridad para la prescripción de antibióticos. El 60% se mostró en desacuerdo con la aplicación de guías de otros países en nuestros medio y el 76% de los consideran que los infectólogos aportan al manejo clínico de los pacientes. El 72% de los encuestados reportó tener apoyo de un infectólogo y en su institución existen estrategias de restricción de uso de antibióticos, refieren además utilizar asilamiento de contacto frente a organismos multiresistentes. Las respuestas no son significativamente diferentes de acuerdo a los años de experiencia. Los médicos reportaron en su mayoría prácticas conservadoras y racionales del uso de antibióticos aunque algunas limitaciones en el conocimiento farmacológico de los mismos.

Describe knowledge, attittudes and, practices about antibiotic use in Colombian physicians from three different cities. We applied a voluntary survey about knowledge, attittudes and practices about antibiotic prescription at three scientific meetings of the Asociacion Colombiana de Infectología, on February 2008. The survey was anonimous and individual. The results were analyzed using Excel 2007 and STATA 2000. We analyzed 96 surveys, 29 from general practitioners and 67 medical specialists. Physicians had wrong knowledge about antibiotic use between 29,2% and 67,42%. Most physicians (97.4%) considered the antibiotics have to be sold only under medical prescription. Many physicians recognized having limited knowledge about antibiotic dosing interval and security. 60% physicians disagreed with the application of guidelines from other countries in our enviroment and 76% physician consider the infectious disease experts contribute to clinical management of patients. Physicians reported having support from an infectious disease expert on 72%, and had strategies to restrict the use of some antibiotics, likecontact isolation when multi-resistant organisms had been suspected. There were not differences between answers according to years of experience. Several physcians reported conservative practices and rational antibiotic use with limited knowledge about antibiotic pharmacokinetics and pharmacodynamics.

Factors affecting adherence to evidence-based guidelines in the treatment of URI, sinusitis, and pharyngitis.

INTRODUCTION: Sinus infections, sore throats, and upper respiratory tract infections (URI) are common reasons patients seek medical care. Well-established treatment guidelines exist for prescribing antibiotics in these clinical scenarios, but are not often followed. OBJECTIVE: The objective of this study is to determine practice patterns related to prescribing antibiotics for sinusitis, URI, and pharyngitis. The main hypothesis is that attending physicians improve their adherence to antibiotic guidelines with a learner present. METHODS: A retrospective cohort study was performed on patients treated for URI, sinusitis, and pharyngitis at an ambulatory faculty practice. The use of relevant ICD-9 codes from January 1, 2008 to January 30, 2012 resulted in 1,548 patient encounters which were reviewed for guideline adherence. Univariate analysis and multivariate logistic regression was performed for each outcome variable to determine if they influence antibiotic adherence. Variables studied were physician, presence of a learner, BMI, age, gender, day of the week, month, diabetes, immunosuppression, and COPD. RESULTS: Multivariate analysis showed the statistically significant variables were age (p=0.038) for pharyngitis and provider (p=0.013) for URI. There were no significant findings for sinusitis. Guideline adherence was 24% in patients with pharyngitis, 42% in acute sinusitis, 79% in URI, and 57% overall. CONCLUSION: Guideline adherence varies depending on the treating physician and decreases when treating younger patients with pharyngitis. The presence of a learner did not improve prescribing habits. The reason for these findings remain unclear, but considerations for improvement could include following antibiotic adherence as a quality measure, giving patients handouts educating them about the impact of overprescribing antibiotics, and further education amongst faculty and residents about adhering to nationally recognized guidelines.

A survey of physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies / Un estudio sobre los conocimientos y actitudes de los médicos en relación con la resistencia antimicrobiana y la práctica de prescripción de antibióticos en el Hospital Universitario de West Indies

OBJECTIVE: To identify physicians' knowledge and attitudes regarding antimicrobial resistance and antibiotic prescribing practices at the University Hospital of the West Indies (UHWI). METHODS: A cross-sectional survey of physicians at the UHWI was conducted between September 2008 and April 2009 using a 28-item, self-administered questionnaire. Eligible physicians from several specialities were identified from departmental rotas. RESULTS: A total of 174 physicians completed the questionnaire, a response rate of 73%. Most physicians considered antibiotic resistance to be an extremely important global problem (55%) but less significant nationally (35%). Factors identified as important in producing resistance included wide-spread use of antibiotics (91%), inappropriate empiric choices (79%) and use of broad-spectrum agents (70%). Hand-washing was not considered to be important in reducing resistance. Useful interventions included access to current information on local resistance patterns (90%), institutional specific antibiotic guidelines (89%) and educational programmes (89%). Antibiotic cycling (40%) and restriction (35%) were regarded as less helpful. Knowledge of resistance-prone antibiotics and specific resistant organisms at the UHWI was poor, except for methicillin-resistant Staphylococcus aureus (MRSA). Empiric therapy for common infections was appropriate in most cases, and antibiotic choices were guided by availability of drugs (89%) and patient factors such as renal disease or allergy (80%). Only 45% of physicians would de-escalate to a narrow-spectrum antibiotic guided by a microbiology report, and consultants were more likely to de-escalate therapy than junior staff (p = 0.002). CONCLUSIONS: Although physicians were aware of the problem of resistance to antibiotics and the contributory factors, their practice did not reflect measures to reduce it. Continuing educational programmes and institution-specific antibiotic prescribing guidelines are needed.

OBJETIVO: Identificar los conocimientos y actitudes de los médicos con respecto a la resistencia antimicrobiana y la práctica de prescripción de antibióticos en el Hospital Universitario de West Indies (UHWI). MÉTODOS: Se llevó a cabo un estudio transversal en UHWI, entre septiembre del 2008 y abril del 2009 de abril, usando un cuestionario autoadministrado de 28 puntos. Los médicos elegibles de varias especialidades fueron identificados de las listas departamentales. RESULTADOS: Un total de 174 médicos completaron el cuestionario, para una tasa de respuesta del 73%. La mayor parte de los médicos consideró que la resistencia antibiótica constituye un problema sumamente importante desde un punto de vista global (55%) pero menos significativo desde una perspectiva nacional (35%). Los factores identificados como importantes en la formación de la resistencia incluyeron el uso generalizado de antibióticos (91%), las elecciones empíricas inapropiadas (79%), y el uso de agentes de amplio espectro (70%). El lavarse las manos no se consideró importante para la reducción de la resistencia. Las intervenciones útiles incluyeron el acceso a la información corriente sobre patrones de resistencia locales (90%), normas institucionales específicas sobre el uso de antibióticos (89%) y programas educativos (89%). El ciclo (40%) y la restricción (35%) de los antibióticos se consideraron menos útiles. El conocimiento de antibióticos con tendencia a la resistencia y organismos resistentes específicos en el HUWI era pobre, excepto en el caso del Staphylococcus aureus resistente a la meticilina (SARM). La terapia empírica para las infecciones comunes fue apropiada en la mayoría de los casos, y las opciones antibióticas estuvieron dictadas por la disponibilidad de medicamentos (89%) y factores relacionados con los pacientes, tales como enfermedades renales o alergias (80%). Sólo el 45% de los médicos desescalarían a un antibiótico de estrecho espectro guiado por un informe microbiológico, y los consultantes mostraron una tendencia mayor a desescalar la terapia, en comparación con la observada en el personal subalterno (p = 0.002). CONCLUSIONES: Aunque los médicos tenían conciencia del problema de la resistencia a los antibióticos y los factores contribuyentes, su práctica no reflejó las medidas para reducirla. Se necesitan programas de educación continua y normas institucionales específicas para la prescripción de antibióticos.