-
Bulletin of the World Health... Apr 2018To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries. (Review)
Review
OBJECTIVE
To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.
METHODS
We searched MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials and regional indexes for studies of interventions to improve appropriate prescribing and use of antibiotics for hospitalized patients in low- and middle-income countries. We included controlled trials, controlled before-and-after studies and interrupted time-series studies published up to December 2017. We report prescribing, clinical and microbiological outcomes using a narrative approach.
FINDINGS
We screened 7342 original titles and abstracts, assessed 241 full-text articles and included 27 studies from 2 low-income and 11 middle-income countries. We found a medium (11 studies) or high risk (13 studies) of bias. Generally, all types of interventions (structural, persuasive and enabling) and intervention bundles were reported to improve prescribing and clinical outcomes. However, the studied interventions and reported outcomes varied widely. The most frequent intervention was procalcitonin-guided antibiotic treatment (8 of 27 studies, all randomized controlled trials). The intervention was associated with a relative risk for patients receiving antibiotics ranging between 0.40 and 0.87.
CONCLUSION
The majority of studies reported a positive effect of hospital antibiotic stewardship interventions. However, we cannot draw general conclusions about the effectiveness of such interventions in low- and middle-income countries because of low study quality, heterogeneity of interventions and outcomes, and under-representation of certain settings. To strengthen the evidence base, action needs to be taken to address these shortcomings.
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Bacterial Infections; Child; Cross Infection; Drug Resistance, Bacterial; Female; Hospitals; Humans; Practice Patterns, Physicians'; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 29695883
DOI: 10.2471/BLT.17.203448 -
The Journal of Antimicrobial... Jul 2016Determinants of inappropriate antibiotic prescription in the community are not clearly defined. The objective of this study was to perform a systematic review and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Determinants of inappropriate antibiotic prescription in the community are not clearly defined. The objective of this study was to perform a systematic review and meta-analysis evaluating gender differences in antibiotic prescribing in primary care.
METHODS
All studies analysing antibiotic prescription in primary care were eligible. PubMed and MEDLINE entries with publication dates from 1976 until December 2013 were searched. The primary outcomes were the incidence rate ratio (IRR) (measured as DDD/1000 inhabitants/day) and the prevalence rate ratio (PRR) (measured as prevalence rate/1000 inhabitants) of antimicrobial prescription, stratified by gender, age and antibiotic class. Random-effects estimates of the IRR and PRR and standard deviations were calculated.
RESULTS
Overall, 576 articles were reviewed. Eleven studies, comprising a total of 44 333 839 individuals, were included. The studies used data from prospective national (five studies) or regional (six studies) surveillance of community pharmacy, insurance or national healthcare systems. Women were 27% (PRR 1.27 ± 0.12) more likely than men to receive an antibiotic prescription in their lifetimes. The amount of antibiotics prescribed to women was 36% (IRR 1.36 ± 0.11) higher than that prescribed for men in the 16 to 34 years age group and 40% (IRR 1.40 ± 0.03) greater in the 35 to 54 years age group. In particular, the amounts of cephalosporins and macrolides prescribed to women were 44% (IRR 1.44 ± 0.30) and 32% (IRR 1.32 ± 0.15) higher, respectively, than those prescribed for men.
CONCLUSIONS
This meta-analysis shows that women in the 16 to 54 years age group receive a significantly higher number of prescriptions of cephalosporins and macrolides in primary care than men do. Prospective studies are needed to address reasons for gender inequality in prescription and to determine whether a difference in adverse events, including resistance development, also occurs.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Drug Prescriptions; Drug Utilization; Female; Humans; Inappropriate Prescribing; Male; Middle Aged; Outcome Assessment, Health Care; Practice Patterns, Physicians'; Primary Health Care; Prospective Studies; Sex Characteristics; Young Adult
PubMed: 27040304
DOI: 10.1093/jac/dkw054 -
PloS One 2018In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the... (Review)
Review
OBJECTIVE
In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery.
METHODS
Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR.
RESULTS
Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total,14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information.
CONCLUSION
With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Orthognathic Surgical Procedures; Surgical Wound Infection
PubMed: 29385159
DOI: 10.1371/journal.pone.0191161 -
Acta Obstetricia Et Gynecologica... May 2021To evaluate the effect of antibiotic regimens for chorioamnionitis on maternal and neonatal outcomes. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To evaluate the effect of antibiotic regimens for chorioamnionitis on maternal and neonatal outcomes.
MATERIAL AND METHODS
We conducted a systematic review, wherein we searched six bibliographic databases until June 2020 and included randomized clinical trials describing antibiotic regimens for treating chorioamnionitis. Risk of bias was assessed using the Cochrane Risk of Bias tool V2.0. Random-effects meta-analysis was performed and results were presented as risk ratio (RR) and mean differences (MD) with 95% CI.
RESULTS
Fourteen trials at low-to-high risk of bias were included. Three trials (n = 244), comparing different intrapartum antibiotic regimens, showed no difference in outcomes except for lower composite maternal morbidity (endometritis, pneumonia, sepsis, blood transfusion, and ileus) with ampicillin/sulbactam vs ampicillin/gentamicin in one study (0/43 vs 6/49, P = .03). Three trials (n = 295) comparing different doses of intrapartum antibiotics showed no differences in maternal and neonatal outcomes, although one study showed a shorter duration of antibiotic treatment in the experimental arm (4 mg/kg gentamicin q24h + 1200 mg clindamycin q12h) vs conventional arm (1.33 mg/kg gentamicin + 800 mg clindamycin q8h) (48.0 ± 36 hours vs 55.2 ± 48 hours, P = .04). Four trials (n = 484) comparing postpartum antibiotics vs no antibiotics showed no difference in outcomes except for a shorter hospital stay (two studies, MD -7.90 hours, 95% CI -13.52 to -2.27 hours). Three trials (n = 447) comparing single vs multiple doses of postpartum antibiotics showed shorter hospital stay [MD -19.14 hours, 95% CI -29.88 to -8.41 hours), but no differences in treatment failure (RR 1.73, 95% CI 0.69-4.30) or total antibiotic dose (MD -9.24, 95% CI -19.49 to 1.01). One trial (n = 48) comparing intrapartum vs postpartum initiation of treatment found benefits to intrapartum (vs postpartum) initiation of antibiotics, in terms of postpartum maternal hospital stay (MD -24 hours, 95% CI -45.56 to -1.44 hours), neonatal hospital stay (MD -45.6 hours, -93.84 to -11.76 hours), and neonatal pneumonia or sepsis (RR 0.06, 95% CI 0.00-0.95).
CONCLUSIONS
Upon diagnosis of chorioamnionitis, there is limited evidence to recommend the prompt initiation of intrapartum antibiotics, and to consider a single dose of postpartum antibiotics over multiple doses or no treatment. Well-designed trials using standard definitions of chorioamnionitis, outcome measures, and newer antibiotics are required to inform clinical practice with regard to the preferred antibiotic regimen, dose, and duration to optimize maternal and neonatal outcomes.
Topics: Anti-Bacterial Agents; Chorioamnionitis; Female; Humans; Infant, Newborn; Peripartum Period; Postpartum Period; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 33191493
DOI: 10.1111/aogs.14044 -
EBioMedicine Dec 2023Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the...
BACKGROUND
Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A).
METHODS
We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines.
FINDINGS
We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing.
INTERPRETATION
A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours.
FUNDING
The Wellcome Trust, grant agreement number 215490/Z/19/Z.
Topics: Child; Humans; Anti-Bacterial Agents; Pharyngitis; Streptococcus pyogenes; Streptococcal Infections; Vaccines
PubMed: 37950997
DOI: 10.1016/j.ebiom.2023.104864 -
The British Journal of Surgery Jun 2016Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective... (Review)
Review
BACKGROUND
Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC.
METHODS
A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non-operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random-effects model.
RESULTS
Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent.
CONCLUSION
Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy.
Topics: Anti-Bacterial Agents; Cholecystectomy; Cholecystitis, Acute; Emergencies; Humans; Postoperative Complications; Preoperative Care; Recurrence
PubMed: 27027851
DOI: 10.1002/bjs.10146 -
Clinical Microbiology and Infection :... Mar 2022In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and needing urgent... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and needing urgent effective actions. Our objectives were to systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers' antibiotic use globally, in order to inform future interventions to improve practices in antibiotic use.
METHODS
Data sources were PubMed, EMBASE, PsycINFO, and Cochrane. Study eligibility criteria were original and empirical studies that identified factors for healthcare consumers' antibiotic use. Participants were healthcare consumers. Assessment of risk of bias used adapted BMJ survey appraisal tools, the Critical Appraisal Skills Programme checklist, and the Mixed Methods Appraisal Tool for quality assessment. Methods of data synthesis employed the Social Ecological Framework and Health Belief Model for data synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use.
RESULTS
We included 71 articles for systematic review and analysis; 54 were quantitative, nine were qualitative, and eight were mixed-methods studies. Prevalent non-prescription antibiotic use and irresponsible prescriptions were reported globally, especially in low-to-middle-income countries. Barriers to healthcare-wait time, transportation, stigmatization-influenced people's practices in antibiotic use. Further, lack of oversight and regulation in the drug manufacturing and a weak supply chain have led to the use of substandard or falsified antibiotics. Knowledge had mixed effects on antibiotic use behaviours. Meta-analyses identified pro-attitudes towards self-medication with antibiotics, relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for self-medication with antibiotics.
CONCLUSIONS
Non-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and are driven largely by a mixed collection of non-biomedical factors specific to the respective setting. Future antimicrobial resistance strategies should incorporate an implementation science approach for community-based complex interventions that address drivers of the target behaviours tailored to local contexts.
Topics: Anti-Bacterial Agents; Humans; Prescriptions
PubMed: 34768017
DOI: 10.1016/j.cmi.2021.10.017 -
Expert Review of Anti-infective Therapy May 2015Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this. (Review)
Review
BACKGROUND
Knowledge, perceptions and prescribing behaviour are key to antibiotic prescribing. The aim of this paper is to systematically review this.
METHOD
An extensive literature search from 1990 to 2014.
RESULTS
Nineteen articles were included; eight in ambulatory care, seven in hospital settings and four in both, across all countries. Physicians still have inadequate knowledge and misconceptions about antibiotic prescribing. Moreover, some physicians, although aware that antibiotics are of limited benefit in some conditions, still prescribed them. Several factors influenced prescribing, including patients' expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients and influence of pharmaceutical companies. Pocket-sized guidelines seen as an important source of information for physicians.
CONCLUSION
Inadequate knowledge of prescribing is prevalent among physicians. However, many physicians were interested in improving their antibiotic prescribing. Multifaceted interventions targeting all key stakeholders, including patients, are needed to improve future antibiotic prescribing.
Topics: Anti-Bacterial Agents; Attitude of Health Personnel; Clinical Competence; Drug Prescriptions; Humans; Practice Patterns, Physicians'
PubMed: 25813839
DOI: 10.1586/14787210.2015.1025057 -
Journal of Global Antimicrobial... Sep 2023The incidence of Helicobacter pylori (HP) is 25-50% in developed countries and 80% in developing countries, including 56.2% in China. However, antibiotic resistance of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The incidence of Helicobacter pylori (HP) is 25-50% in developed countries and 80% in developing countries, including 56.2% in China. However, antibiotic resistance of HP is a threat to HP control. The purpose of this study was to comprehensively evaluate primary drug resistance of HP in China.
METHODS
The full text of reports of the primary antibiotic resistance prevalence of HP was obtained from multiple databases (PubMed, Web of Science, Evimed, Cochrane Library, and China National Knowledge Internet). Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis, and bias analysis. The Newcastle-Ottawa Scale was used to assess the article quality.
RESULTS
In total, 38804 HP samples from 22 trials were extracted. The results suggested that the overall prevalence of amoxicillin, clarithromycin, metronidazole, and levofloxacin resistance among HP in adults was as follows: mean difference (MD) = 1.35%, 95% confidence interval (CI) [1.03%, 1.68%]; MD = 23.76%, 95% CI [20.23%, 27.3%]; MD = 69.32%, 95% CI [64.85%, 73.8%]; and MD = 29.45%, 95% CI [4.90, 176.96], respectively. From the results of sensitivity and publication bias, we find that these results are robust and had little publication bias.
CONCLUSION
Our research showed that in China, the prevalence of HP resistance to primary antibiotics warrants attention, especially with regard to metronidazole, levofloxacin, and clarithromycin.
Topics: Adult; Humans; Metronidazole; Clarithromycin; Levofloxacin; Helicobacter pylori; Helicobacter Infections; Drug Resistance, Bacterial; Anti-Bacterial Agents; China
PubMed: 37315738
DOI: 10.1016/j.jgar.2023.05.014 -
British Journal of Cancer Dec 2020It is understudied whether the posed association of oral antibiotics with colorectal cancer (CRC) varies between antibiotic spectrums, colorectal continuum, and if a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is understudied whether the posed association of oral antibiotics with colorectal cancer (CRC) varies between antibiotic spectrums, colorectal continuum, and if a non-linear dose-dependent relationship is present.
DESIGN
Three electronic databases and a trial platform were searched for all relevant studies, from inception until February 2020, without restrictions. Random-effects meta-analyses provided pooled effect-sizes (ES) with 95% confidence intervals (CI). Dose-response analyses modelling the relationship between number of days exposed to antibiotics and CRC risk were extended to non-linear multivariable random-effects models.
RESULTS
Of 6483 identified publications ten were eligible, including 4.1 million individuals and over 73,550 CRC cases. The pooled CRC risk was increased among individuals who ever-used antibiotics (ES = 1.17, 95%CI 1.05-1.30), particularly for broad-spectrum antibiotics (ES = 1.70, 95%CI 1.26-2.30), but not for narrow-spectrum antibiotic (ES = 1.11, 95% 0.93-1.32). The dose-response analysis did not provide strong evidence of any particular dose-response association, and the risk patterns were rather similar for colon and rectal cancer.
DISCUSSION
The antibiotic use associated CRC risk seemingly differs between broad- and narrow-spectrum antibiotics, and possibly within the colorectal continuum. It remains unclear whether this association is causal, requiring more mechanistic studies and further clarification of drug-microbiome interactions.
Topics: Anti-Bacterial Agents; Colonic Neoplasms; Colorectal Neoplasms; Confidence Intervals; Databases as Topic; Dose-Response Relationship, Drug; Gastrointestinal Microbiome; Humans; Rectal Neoplasms; Risk Factors
PubMed: 32968205
DOI: 10.1038/s41416-020-01082-2