ABSTRACT
Antibiotic resistance is a significant global health issue, exacerbated by the indiscriminate use of antibiotics without antibiograms. Implementing appropriate stewardship programs that monitor and control antibiotic use is essential to minimize resistance development and ensure optimal patient outcomes. This study aims to assess the impact of antibiogram availability and utilization on antibiotic use among healthcare providers in Saudi Arabia, focusing on whether antibiogram data and utilization influence the appropriateness of antibiotic prescribing practices. A cross-sectional study design was employed, utilizing a self-administered online survey distributed to physicians, pharmacists, and other healthcare providers across various healthcare settings in Saudi Arabia. Data were collected over a 90-day period, from 1 December 2023 to 29 February 2024. Descriptive statistics were used to summarize participants' characteristics, and data were analyzed based on geographical region, participants' positions, and other predetermined differences. Out of 23,860 contacted individuals, 333 responded, and 283 were included in the analysis. The majority (62.2%) reported the availability of antibiograms at their facilities, with 84.1% utilizing them in clinical practice. The frequency of consulting antibiograms varied, with only 21.6% doing so daily. Key barriers to antibiogram availability included lack of expertise, technological infrastructure, and funding. Most participants (68.8%) observed changes in antibiotic prescription practices post-antibiogram introduction, and 86.9% believed antibiograms could shorten patients' length of stay and improve outcomes. However, only 40.9% had received training on antibiogram use. While healthcare providers in Saudi Arabia have a relatively high level of antibiogram availability and utilization, several barriers hinder their consistent use. Enhancing accessibility, promoting frequent use, and providing targeted training could strengthen the impact of antibiograms on antibiotic prescribing practices and antimicrobial stewardship efforts.
ABSTRACT
BACKGROUND: Topical corticosteroids are commonly used to treat several skin conditions, most notably atopic dermatitis. Many studies have found that patients lack knowledge about the safety, potency, and appropriate use of topical corticosteroids. This can be due to ineffective education by pharmacists and other healthcare providers. This study aims to evaluate the appropriateness of dispensing and counseling practices of community pharmacists towards topical corticosteroids in Saudi Arabia. METHODS: A cross-sectional survey study was conducted in Saudi Arabia among 418 community pharmacists from different regions of Saudi Arabia. Data were collected using a validated questionnaire that covered community pharmacists' sociodemographic information, their perceptions of patient knowledge about topical corticosteroid use, and their dispensing and their counseling practices, in addition to their perceived barriers to counseling. RESULTS: The majority of the participating community pharmacists were Saudi (57.4%), female (66.7%), holding a bachelor's degree (63.4%), and full-time workers (91.1%). Most of the time, community pharmacists counseled patients on the frequency of application per day and the duration of treatment (75.8% and 74.8%, respectively). The median counseling practice score was 17, with an IQR of 14-21. The main barrier to counseling was lack of time (33.7%). Only 15% of community pharmacists accurately identified all scenarios that necessitate medical referrals. Dry skin, itchiness, and irritation were the most common side effects reported by community pharmacists for patients to complain about (69.4%). Most pharmacists agreed that misuse is the most likely cause of topical corticosteroid adverse drug events (53.7%), followed by medication overuse, such as patient self-treatment (48%). CONCLUSION: Community pharmacists counseling practices to their patients about the use of topical corticosteroids require improvement. Continuing education and hands-on training are needed for community pharmacists regarding counseling about topical corticosteroids use.
ABSTRACT
BACKGROUND: Procalcitonin (PCT) has been used as a biomarker to guide antibiotic therapy in various patient populations. However, its role in optimizing antibiotic use in COVID-19 patients has not been well studied to date. Thus, we aimed to evaluate the use of serial PCT monitoring as an antimicrobial stewardship tool for COVID-19 patients. METHODS: This retrospective study included 240 COVID-19 patients who were admitted to a tertiary medical institution in Saudi Arabia between January 2020 and February 2022. Patients who received empiric antibiotic therapy for community-acquired pneumonia (CAP) and had serial procalcitonin levels were included. The patients were divided into two groups: the normal procalcitonin arm (PCT level < 0.5 ng/mL) and the elevated PCT arm (PCT level > 0.5 ng/mL). The primary and secondary outcomes were the effect of PCT monitoring on the duration of antibiotic exposure and the length of hospital stay, respectively. To measure the accuracy of PCT, the receiver-operating characteristic area under the curve (ROC-AUC) was determined. RESULTS: Among the included patients, 142 were in the normal procalcitonin arm (median PCT, 0.12 ng/mL), and 78 were in the elevated PCT arm (median PCT, 4.04 ng/mL). The baseline characteristics were similar between the two arms, except for the higher prevalence of kidney disease in the elevated PCT arm. There was no statistically significant difference in the duration of antibiotic exposure between the normal and elevated PCT arms (median duration: 7 days in both arms). However, the length of hospital stay was significantly shorter in the normal PCT arm (median stay, 9 days) than in the elevated PCT arm (median stay, 13 days; p = 0.028). The ROC-AUC value was 0.54 (95% CI: 0.503-0.595). CONCLUSIONS: Serial PCT monitoring did not lead to a reduction in the duration of antibiotic exposure in COVID-19 patients. However, it was associated with a shorter hospital stay. These findings suggest that PCT monitoring may be useful for optimizing antibiotic use and improving outcomes in COVID-19 patients. While PCT-guided algorithms have the potential to enable antibiotic stewardship, their role in the context of COVID-19 treatment requires further investigation.
ABSTRACT
BACKGROUND: The World Health Organization (WHO) estimates that 20-50% of antibiotics are misused in society. In addition to the development of antimicrobial resistance, topical antibiotics have been associated with adverse effects such as allergic contact dermatitis (ACD) and inadequate wound healing. This study investigated the appropriateness of topical antibiotic prescriptions among primary care providers in Saudi Arabia. METHODS: A cross-sectional survey was conducted among Saudi Arabian primary care providers (physicians (general, family, and internal medicine)) employed in governmental and non-governmental healthcare facilities (primary care centers and outpatient clinics). RESULTS: In total, 222 participants were included in the analysis. A total of 73% agreed that inappropriate topical antibiotic use puts patients at risk, and 43% reported antibiotic resistance in daily practice. Many respondents lacked knowledge of the proper indications for topical antibiotics, and 66.2% attributed this to a lack of updated knowledge, while 45% blamed inadequate supervision. CONCLUSION: Antibiotic prescription patterns deviated from the standards recommended by WHO. This calls for continuous review at all levels of healthcare, providing more physician education and ensuring that antibiotic therapy guidelines are easily accessible and effectively used to avoid the negative consequences of inappropriate antibiotic prescription.