Making Antibiotic Choices: Formula Derivation and Usage in the Rational Selection of Antibiotics in the Empirical Treatment of Infections

Purpose: To develop mathematical formulae to aid the selection of antibiotics most appropriate in the empirical treatment of infections.Methods: Formulae quantifying the characteristics of antibiotics with regard to their cost and activity against associated bacterial isolates of given infections were derived from probability laws. Data from records of culture sensitivity test results were compiled and analysed to ascertain bacterial pathogen associations with infections and their sensitivities to prescribed antibiotics. Applicability of derived formulae was demonstrated in the rational selection of antibiotics most appropriate in the empirical treatment of urinary tract infections (UTIs) in selected hospitals in Lesotho.Results: Escherichia. coli, followed by Klebsiella spp, Proteus spp, non-haemolytic Streptococci, Streptococcus pyogenes and then, Pseudomonas spp were identified as the most common uropathogens at the hospitals studied. Two mathematical formulae were derived and used in quantifying activity and cost characteristics of prescribed antibiotics. Cefotaxime, followed by ciprofloxacin - were considered most appropriate for use in treating UTIs empirically among inpatients of the hospitals.Conclusion: Quantifying and using procedurally antibacterial activities and cost characteristics of antibiotics provides a suitable means of making antibiotic choices in the empirical treatment of infections.Keywords: Antibiotics, Derived formulae, Rational selection, Empiric treatment, Urinary tract infection, Lesotho

The prescribing needs of community practitioner nurse prescribers: a qualitative investigation using the theoretical domains framework and COM-B.

With several qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. A qualitative research design. Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations. AIM DESIGN METHODS RESULTS CONCLUSION IMPAC

Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study

Background: Antibiotics are useful but increasing resistance is a major problem. Our objectives were to assess antibiotic use and microbiology testing in hospitalized children in the Gambia. Methods: We conducted a retrospective analysis of paediatric inpatient data at The Edward Francis Small Teaching Hospital in Banjul, The Gambia. We extracted relevant data from the admission folders of all patients (aged >28 days to 15 years) admitted in 2015 (January-December), who received at least one antibiotic for 24 h. We also reviewed the microbiology laboratory record book to obtain separate data for the bacterial isolates and resistance test results of all the paediatric inpatients during the study period. Results: Over half of the admitted patients received at least one antibiotic during admission (496/917) with a total consumption of 670.7 Days of Antibiotic Therapy/1000 Patient-Days. The clinical diagnoses included an infectious disease for 398/496, 80.2% of the patients on antibiotics, pneumonia being the most common (184/496, 37.1%). There were 51 clinically relevant bacterial isolates, Klebsiella species being the most common (12/51, 23.5%), mainly from urine (11/12, 91.7%). Antibiotic resistance was mainly to ampicillin (38/51, 74.5%), mainly reported as Coliform species 11/51, 21.6%. Conclusions: More than half of the admitted patients received antibiotics. The reported antibiotic resistance was highest to the most commonly used antibiotics such as ampicillin. Efforts to maximize definitive antibiotic indication such as microbiological testing prior to start of antibiotics should be encouraged where possible for a more rational antibiotic use

Healthcare providers’ attitudes and perceptions in infection diagnosis and antibiotic prescribing in public health institutions in Lesotho: a cross sectional survey

Background: The decision to prescribe antibiotics and the selection of an appropriate antibiotic are important in the treatment of infectious diseases. As any human decision, it can be influenced by individual attitudes and perceptions. Objectives: To assess the attitudes and perceptions of healthcare providers regarding antibiotic prescribing and the use of laboratory results in infection diagnosis. Methods: A cross sectional survey in five selected Health Service Areas (HSAs) in the Southern Africa country of Lesotho. The questionnaires were self-administered to 67 healthcare providers in public health institutions within the selected HSAs.Data were analyzed using Fisher’s exact test or the McNemar Test for dependent proportions. Results: 51 surveys were returned (39 medical doctors, 12 nurses). Respondents typically practiced in urban settings, worked with both inpatients and outpatients, had over 10 years experience, and attended to at least 26 patients per day. We identify several inappropriate practices related to the use of on-site microbiology laboratories. For example, only 17% always send a sample for microscopic identification prior to prescribing antibiotics and only 32% always send a sample for culture sensitivity tests. Delays in obtaining laboratory results and high patient workloads were cited as reasons for under-utilization of laboratory facilities. Nearly all respondents recognize the need for guidelines and further training in antibiotic prescribing. Conclusions: Healthcare providers demonstrated attitudes and perceptions in antibiotic prescribing or use of laboratory derived information in infection diagnosis that could have negative impacts on antibiotic prescribing