“Ten commandments” for the appropriate use of antibiotics by the practicing physician in an outpatient setting

Levy-Hara, Gabriel; Amábile-Cuevas, Carlos F.; Gould, Ian M.; Hutchinson, Jim; Abbo, Lilian M.; Saxynger, Lynora; Vlieghe, Erika; Cardoso, Felipe de Souza; Methar, Shaheen; Kanj, Souha S.; Ohmagari, Norio; Harbarth, Stéphan Juergen

doi:10.3389/fmicb.2011.00230

Cited by 22 publications

(14 citation statements)

References 72 publications

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“… 12 , 13 There is on-going debate about the safety and efficacy of generic antibiotics in this context. 14 Generics have a vital role in standard treatment guidelines and essential medicine lists, provided that they are equivalent to the brand products. Lack of confidence in generics may influence health-care workers and patients to choose more expensive branded products.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescription behaviours in Lao People's Democratic Republic: a knowledge, attitude and practice survey

Quet

Vlieghe

Leyer

et al. 2015

Bull. World Health Organ.

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ObjectiveTo assess the antibiotic prescribing practices of doctors working in the Lao People's Democratic Republic and their knowledge of local antibiotic resistance patterns.MethodsDoctors attending morning meetings in 25 public hospitals in four provinces were asked to complete a knowledge, attitude and practice survey. The questionnaire contained 43 multiple choice questions that the doctor answered at the time of the meeting.FindingsThe response rate was 83.4% (386/463). Two hundred and seventy doctors (59.8%) declared that they had insufficient information about antibiotics. Only 14.0% (54/386) recognized the possibility of cephalosporin cross-resistance in methicillin-resistant Staphylococcus aureus. Most participants had no information about local antibiotic resistance for Salmonella Typhi (211/385, 54.8%) and hospital-acquired pneumonia (253/384, 65.9%). Unnecessary antibiotic prescriptions were considered as harmless by 115 participants and 148 considered locally-available generic antibiotics to be of poor quality. Nearly three-quarters (280/386) of participants agreed that it was difficult to select the correct antibiotics. Most participants (373/386) welcomed educational programmes on antibiotic prescribing and 65.0% (249/383) preferred local over international antibiotic guidelines.ConclusionDoctors in the Lao People's Democratic Republic seem to favour antibiotic prescribing interventions. Health authorities should consider a capacity building programme that incorporates antibiotic prescribing and hospital infection control.

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Section: Discussionmentioning

confidence: 99%

Antibiotic prescription behaviours in Lao People's Democratic Republic: a knowledge, attitude and practice survey

Quet

Vlieghe

Leyer

et al. 2015

Bull. World Health Organ.

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“…The main study outcome is the appropriate use of antibiotics and its determinants. In this study, the provision of antibiotics is considered to be appropriate if all of the following conditions are met: presence of original packaging, before expiration date, supplied with prescription, and with proper indications for use 9, 10 . If any of these conditions is not met, the provision of antibiotics is considered to be inappropriate.…”

Section: Study Populationmentioning

confidence: 99%

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

Wertheim¹,

Chúc²,

Punpuing³

et al. 2017

Wellcome Open Res

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In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

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“… Rephrased: Using antibiotics only to prevent or cure infections for which antibiotic treatment provides a proven benefit. 3 Antibacterial Activity 29 , 41–43 , 45 , 46 , 48 , 50 , 52–55 , 59 , 64 , 66 , 67 , 69–71 , 75 , 76 , 79 , 80 , 85 , 87 , 89 , 93 , 94 , 97–152 Labelled for rephrasing Rephrased and selected Rationally selecting antibiotics based on their antibacterial activity. Rephrased: Selecting antibiotics based on their antibacterial activity.…”

Section: Resultsmentioning

confidence: 99%

“… 12 Documentation 41 , 47 , 49 , 88 Selected – Fully documenting the antibiotic regimen including indication in the medical record. 13 Patient Compliance 47 , 50 , 60 , 154 Selected – Ensuring patient compliance with the antibiotic prescription. 14 Patient Outcome 20 , 29 , 41 , 42 , 45 , 47 , 48 , 50 , 52–54 , 57 , 59 , 62 , 66 , 71–74 , 77 , 79 , 83 , 85 , 89 , 91 , 93 , 97 , 98 , 101 , 106 , 107 , 109 , 110 , 114–116 , 118 …”

Section: Resultsmentioning

confidence: 99%

Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure

Monnier

Eisenstein²,

Hulscher

et al. 2018

Journal of Antimicrobial Chemotherapy

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BackgroundConducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project, this study aimed to identify key elements for a global definition of responsible antibiotic use based on diverse stakeholder input.MethodsA three-step RAND-modified Delphi method was applied. First, a systematic review of antibiotic stewardship literature and relevant organization web sites identified definitions and synonyms of responsible use. Identified elements of definitions were presented by questionnaire to a multidisciplinary international stakeholder panel for appraisal of their relevance. Finally, questionnaire results were discussed in a consensus meeting.ResultsThe systematic review and the web site search identified 17 synonyms (e.g. appropriate, correct) and 22 potential elements to include in a definition of responsible use. Elements were grouped into patient-level (e.g. Indication, Documentation) or societal-level elements (e.g. Education, Future Effectiveness). Forty-eight stakeholders with diverse backgrounds [medical community, public health, patients, antibiotic research and development (R&D), regulators, governments] from 18 countries across all continents participated in the questionnaire. Based on relevance scores, 21 elements were retained, 9 were rephrased and 1 was added. Together, the 22 elements and associated best-practice descriptions comprise an exhaustive list of elements to be considered when defining responsible use.ConclusionsCombination of concepts from the literature and stakeholder opinion led to an international multidisciplinary consensus on a global definition of responsible antibiotic use. The widely diverging perspectives of stakeholders providing input should ensure the comprehensiveness and relevance of the definition for both individual patients and society. An aspirational goal would be to address all elements.

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“Ten commandments” for the appropriate use of antibiotics by the practicing physician in an outpatient setting

Cited by 22 publications

References 72 publications

Antibiotic prescription behaviours in Lao People's Democratic Republic: a knowledge, attitude and practice survey

Antibiotic prescription behaviours in Lao People's Democratic Republic: a knowledge, attitude and practice survey

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure

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