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Overuse Of Antibiotics: It's A Worldwide Problem

Discussion in 'General Practitioner' started by Dr.Scorpiowoman, Jan 1, 2017.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

    May 23, 2016
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    CDC: 1 in 3 antibiotic prescriptions unnecessary


    New CDC data show large percentage of antibiotics misused in outpatient settings

    At least 30 percent of antibiotics prescribed in the United States are unnecessary, according to new data published today in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC), in collaboration with Pew Charitable Trusts and other public health and medical experts.

    The study analyzed antibiotic use in doctors’ offices and emergency departments throughout the United States. CDC researchers found that most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses – including common colds, viral sore throats, bronchitis, and sinus and ear infections – which do not respond to antibiotics. These 47 million excess prescriptions each year put patients at needless risk for allergic reactions or the sometimes deadly diarrhea, Clostridium difficile.

    The researchers also estimated the rate of inappropriate antibiotic use in adults and children by age and diagnosis. These data will help inform efforts to improve antibiotic prescribing over the next five years.

    “Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden, M.D., M.P.H. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

    The fight to stop antibiotic resistance

    In 2015, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which set a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020. This means that 15 percent of antibiotic prescriptions (or half of the 30 percent that are unnecessary) must be eliminated by 2020 to meet the CARB goal.

    As part of the effort to achieve the national goal, CDC researchers analyzed the 2010–2011 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the number of outpatient visits resulting in antibiotic prescriptions by age, region, and diagnosis in the United States from 2010-2011. They found that:

    • Of the estimated 154 million prescriptions for antibiotics written in doctor’s offices and emergency departments each year, 30 percent are unnecessary. This finding creates a benchmark for improving outpatient antibiotic prescribing and use.
    • About 44 percent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia. An estimated half of these outpatient prescriptions are unnecessary.
    “Setting a national target to reduce unnecessary antibiotic use in outpatient settings is a critical first step to improve antibiotic use and protect patients,” said Lauri Hicks, D.O., director of the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, and commander in the U.S. Public Health Service. “We must continue to work together across the entire health care continuum to make sure that antibiotics are prescribed only when needed, and when an antibiotic is needed that the right antibiotic, dose, and duration are selected.”

    Health care professionals, health systems, and patients must take these actions to improve antibiotic use:

    • Outpatient health care providers can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing, when appropriate, into their practices.
    • Health systems can improve antibiotic prescribing in offices and outpatient facilities within their networks by providing communications training, clinical decision support, patient and health care provider education, and feedback to providers on their performance.
    • Patients can talk to their health care providers about when antibiotics are needed and when they are not. These conversations should include information on patients’ risk for infections by antibiotic-resistant bacteria.
    Doctors write 10m needless antibiotics prescriptions a year, says Nice

    Guidance warns that patients’ demand for antibiotics is fuelling crisis of antimicrobial resistance that threatens ‘whole basis of medicine’

    A GP writing a prescription. Patients’ expectations of getting antibiotics are ‘entrenched’, according to Nice.
    About one in four prescriptions issued for antibiotics in England each year – about 10m in all – are likely to be unnecessary as patients deliberately look for “soft-touch” doctors who give in to their demands for the medicines, a leading health official has said.

    Mark Baker, director of clinical practice at the National Institute for Health and Care Excellence (Nice), has warned that the growing crisis of antimicrobial resistance, in which the profligate use of drugs has allowed bacteria to develop resistance, threatened healthcare and the “whole basis of medicine”. He said infections would have to be treated by surgery if drugs no longer worked.

    Nice published guidance on the issue on Tuesday for doctors, dentists, podiatrists, pharmacists and other professionals.

    Are UAE doctors prescribing antibiotics unnecessarily?


    According to studies, although non-prescription sale of antibiotics is illegal in the GCC states, 68 per cent of pharmacies in Abu Dhabi, 78 per cent in Riyadh and 87 out of 88 pharmacies in Saudi Arabia sell them without a prescription.

    Experts say that while physicians are prescribing antibiotics unnecessarily, patients are popping pills without the right prescriptions.

    "Physicians are under pressure from patients. They feel that if they don't prescribe the antibiotic, they will be blamed if something goes wrong later," said Dr Ashraf ElHoufi, head of the Hospital Infection Control Committee at Dubai Hospital.

    According to studies, although non-prescription sale of antibiotics is illegal in the GCC states, 68 per cent of pharmacies in Abu Dhabi, 78 per cent in Riyadh and 87 out of 88 pharmacies in Saudi Arabia sell them without a prescription. Researchers have also found that poor hand-hygiene compliance in hospitals and the region's large population of migrant workers could have contributed to the spread of antibiotic-resistant bacteria.

    "Other doctors think that starting a super strong antibiotic is necessary for patient betterment," he said, adding that physicians should do a risk assessment for patients, investigate and then prescribe.

    Dr Laila Al Dabal, head of infectious diseases unit at Rashid Hospital said: "Unfortunately, antibiotics are being prescribed wrongly by the physicians or under pressure from patients.

    "Another common mistake is incomplete courses of antibiotics, so the patient might take two or three doses of antibiotics and as soon as she/he feels better, they stop the antibiotic without going back to the prescribing physician.

    "This will obviously lead to the creation of drug resistance and there is a cumulative risk every time an antibiotic is used or prescribed inappropriately," she added.

    Dr Laila said that the situation was scarier when it came to drug-resistant bacteria in hospital. "Admitted patients have more serious illnesses. In these patients, a simple pneumonia or urinary tract infection can be a terminal event if we lack the proper antibiotic that can control the infection as early as possible. This can be complicated further if an outbreak of infection with these bacteria takes place in the hospital."

    Antibiotic prescription pattern among Indian oral healthcare providers: a cross-sectional survey

    Objectives:Inappropriate prescribing of antibiotics by healthcare professionals is a worldwide concern. The purpose of this study was to determine the pattern of antibiotic prescription among oral healthcare providers in India.

    Methods: A one-page questionnaire was sent to 1600 oral healthcare practitioners registered under the Indian Dental Association by using multistage sampling; 552 (34.5%) responded to the survey. The data were analysed using the x2 test and multiple logistic regression analysis.

    Results: Of 552 questionnaire respondents, 405 (73.4%) chose amoxicillin in non-allergic patients, alone [279 (50.5%)] or associated with clavulanic acid [126 (22.8%)]. The average duration of antibiotic therapy was 4.26+1.26 days. The drug of first choice for patients with an allergy to penicillin was erythromycin [242 (43.8%) of respondents]. A majority prescribed antibiotics for irreversible pulpitis and acute apical periodontitis [395 (71.6%)] and necrotic pulp, acute apical periodontitis and no swelling [326 (59.1%)]. Five hundred and ten (92.4%) of the oral healthcare providers overprescribed antibiotics.

    Conclusions: Oral healthcare providers in India are overprescribing, which could be a major contributor to the world problem of antimicrobial resistance. As there is overprescription of antibiotics by Indian oral healthcare providers, there is an urgent need to raise public and professional awareness regarding the risks of antibiotic use.

    Antibiotic dispensing in Egyptian community pharmacies: An observational study


    Antibiotics are commonly dispensed medications from community pharmacies, and they are frequently prescribed for inappropriate indications. In many countries, they are easily accessible without prescriptions. The inappropriate use of antibiotics results in the emergence of resistant bacterial strains, which represents a considerable public health problem, particularly in developing countries.

    This study aimed to describe the pattern of antibiotics dispensing from Egyptian community pharmacies and to collect baseline descriptive data on the antibiotics dispensed and their appropriateness.

    A cross-sectional, observational study of antibiotic dispensing encounters was conducted at 36 randomly selected pharmacies in Greater Cairo, Egypt. Data were collected during one shift at each pharmacy. Structured questionnaires recording patient demographics, antibiotics dispensed and reasons for dispensing were completed for each antibiotic dispensing encounter. The data were descriptively analysed.

    Overall, 1158 antibiotics were dispensed during the study period with a total cost of L.E. 24,487 (approximately 3,673 $USD). While self-medication and purchasing without medical prescriptions were common, representing around 23.3% of the antibiotics (n = 270), most antibiotics were prescribed by a doctor or dentist (n = 736, 63.6%). Pharmacist recommendations accounted for the remainder (n = 152, 13.1%). The main reasons for antibiotic use were respiratory tract ailments and gastroenteritis symptoms. The antibiotics most commonly dispensed were: penicillins, erythromycin, metronidazole, neomycin, clotrimoxazole and tetracyclines. Approximately 70% of the antibiotics dispensed on prescriptions were judged to be appropriate for the indications while this percentage was around 61% for antibiotics dispensed on pharmacist recommendation and patient's request.

    The results of this study show that antibiotics are frequently dispensed from community pharmacies in Egypt without appropriate prescriptions and for inappropriate indications. These findings support the need for strict enforcement of pharmacy laws through improved inspection processes. They highlight the need for evidence-based guidelines and educational interventions to improve antibiotic prescribing and dispensing practices.

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    Last edited: Jun 23, 2018

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