The Antibiotic Puzzle: Guidelines for the Family Physician (original) (raw)
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Improving antibiotic use: 25 years of antibiotic guidelines and related initiatives
Communicable diseases intelligence quarterly report, 2003
In the late 1970s concern in Melbourne teaching hospitals over the increasing incidence of antibiotic-resistant microorganisms and inappropriate antibiotic prescribing, led to the establishment of a working party to produce guidelines on appropriate antimicrobial therapy. Therapeutic Guidelines: Antibiotic is now produced, marketed and sold by Therapeutic Guidelines Limited, an independent, not-for-profit enterprise that distils best-practice prescribing guidelines for Australian health professionals. Therapeutic Guidelines now cover all major therapeutic areas. Mere distribution of the guidelines had little impact on prescribing habits. However, targeted education campaigns have helped to improve antibiotic prescribing. The Antibiotic title remains the flagship of Therapeutic Guidelines Limited with sales, surveys and endorsements over 11 editions attesting to its wide acceptance and use. Therapeutic Guidelines: Antibiotic is one of many initiatives that have contributed to improvi...
BMC Health Services Research, 2010
Background: Diabetic foot infections are common, serious, and diverse. There is uncertainty about optimal antibiotic treatment, and probably substantial variation in practice. Our aim was to document whether this is the case: A finding that would raise questions about the comparative cost-effectiveness of different regimens and also open the possibility of examining costs and outcomes to determine which should be preferred. Methods: We used the Veterans Health Administration (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct a retrospective observational study of hospitalized patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for VA patients with diabetes since 1998, including demographics, ICD-9-CM diagnostic codes, antibiotics prescribed, and VA facility. We identified all patients with ICD-9-CM codes for cellulitis/abscess of the foot and then sub-grouped them according to whether they had cellulitis/abscess plus codes for gangrene, osteomyelitis, skin ulcer, or none of these. For each facility, we determined: 1) The proportion of patients treated with an antibiotic and the initial route of administration; 2) The first antibiotic regimen prescribed for each patient, defined as treatment with the same antibiotic, or combination of antibiotics, for at least 5 continuous days; and 3) The antibacterial spectrum of the first regimen.
Use of Restricted Antibiotics in Primary Care
DICP, 1991
The objective of this study was to detect and evaluate the use of restricted antibiotics (RAs) in our ambulatory care site. We retrospectively analyzed 1084 treatments of a selected group of intramuscularly administered antibiotics that are usually considered restricted for use in hospitals. Five cephalosporins, four aminoglycosides, and one acylureidopenicillin were analyzed. The study was conducted in 47 primary health centers over six months. We reported the information on a special order form for parenteral prescriptions and evaluated the selection and the dosing interval of each antibiotic. Of the 1084 treatments, cefonicid was the antibiotic most frequently prescribed (61.3 percent), followed by tobrarnycin (15.3 percent), cefotaxime sodium (6.7 percent), amikacin (3.8 percent), cefuroxime (3.8 percent), mezlocillin (3.7 percent), netilmicin sulfate (3.7 percent), ceftizoxime sodium (0.8 percent), cefoxitin (0.5 percent), and streptomycin sulfate (0.4 percent). Based on our survey criteria, 59 percent of the 710 orders that indicated diagnosis had a correct or possibly correct indication; the remaining percentage was considered unnecessary therapy or poor drug choice. Of the 1050 orders that indicated a dosing interval, 75.4 percent showed an appropriate dosing interval. We assume that most of the infections treated in our ambulatory care site could be resolved with or without common antibiotics. In this study we obtained objective data of the use of ten RAs in order to determine if their use in ambulatory patients was justified. We observed that a small number of prescriptions agreed with the recommended criteria stated in this survey for use of these antibiotics in outpatient infections.
Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action
World Journal of Emergency Surgery
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement o...
Declines in Outpatient Antimicrobial Use in Canada (1995–2010)
PLoS ONE, 2013
Background: With rising reports of antimicrobial resistance in outpatient communities, surveillance of antimicrobial use is imperative for supporting stewardship programs. The primary objective of this article is to assess the levels of antimicrobial use in Canada over time.