Stewardship / Resistance Scan for Apr 05, 2021

Global hospital antibiotic use
Dental prescribing rates in four countries

Hospitals worldwide display wide variation in antibiotic consumption

A worldwide analysis of hospital antibiotic prescribing patterns found considerable differences between countries and regions in proportional use of Access, Watch, and Reserve (AWaRe) antibiotics, researchers reported today in the Journal of Antimicrobial Chemotherapy.

Using data collected in 2015, 2017, and 2018 by the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS), researchers from the University of Antwerp analyzed hospital antibiotic use at 664 hospital in 69 countries. They categorized inpatient antibiotic consumption using the AWaRe classification system, introduced by the World Health Organization (WHO) in 2017 to provide an indirect indication of the appropriateness of antibiotic use at national and global levels, then calculated proportional Access, Watch, and Reserve use by region and country. The final dataset included 80,671 patients who received at least one systemic antibiotic.

Regional use of Access antibiotics, which are first- and second-line agents that should be widely available and affordable, ranged from 28.4% in West and Central Asia to 57.7% in Oceania. Regional use of Watch antibiotics—broad-spectrum drugs that are not recommended for routine use because of their higher potential for resistance—was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). The overall use of Reserve antibiotics, which are last-resort antibiotics, ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America.

Stratified by World Bank country classification, low-income countries had the highest Access use (62.8%) and the lowest Watch antibiotic use (36%). Beyond that, the proportion of Watch antibiotic use was 63.4% in lower-middle-income countries, 62.2% in upper-middle-income countries, and 53.1% in high-income countries. Reserve antibiotic use was highest in upper-middle-income countries (3.0%).

By country, Access use was highest in Guinea (66.7%) and lowest in Armenia (12.1%), while Watch use was highest in Armenia (87.9%) and lowest in Guinea (32.1%). Reserve antibiotic use was highest in Argentina (12.6%), India (7.8%), and Brazil (7.1%). The median Access-to-Watch ratio was 0.7.

"We observed large heterogeneity in AWaRe prescribing at country, regional and income levels," study authors conclude. "Further research on local levels, integrating contextual information, could usefully explore some of the drivers behind the prescribing patterns reported here."
Apr 5 J Antimicrob Chemother study


Dental antibiotic prescribing significantly higher in US

A comparison of dental antibiotic prescribing rates found that US dentists prescribe antibiotics much more frequently than those in England, Australia, and Canada, researchers reported today in Infection Control & Hospital Epidemiology.

The population-level analysis of dental antibiotic prescribing looked at pharmacy-dispensed systemic antibiotic prescriptions by dentists in the United States, England, Australia, and British Columbia in 2017. The three outcomes analyzed for each country were the rate of antibiotic prescribing per 1,000 population, the relative proportions of each antibiotic class, and the prescribing rate per 1,000 population of each antibiotic type.

Dentists in the United States prescribed 23.6 million antibiotic items in 2017, compared with 3 million in England, 0.8 million in Australia, and 0.3 million in British Columbia. US dentists also had the highest prescribing rate (72.6 antibiotic items per 1,000), more than twice the rate of Australia, which had the lowest (33.2 per 1,000). Penicillins, mainly amoxicillin, were the most prescribed antibiotic class in each country (highest at 80.5% in British Columbia and lowest at 66.8% in England). Lincosamides (eg, clindamycin) comprised the second most frequently prescribed class of antibiotics in the United States (14.3%) and British Columbia (12.4%), while nitroimidazoles (eg, metronidazole) comprised the second most frequently prescribed class of antibiotics in England (28.4%) and Australia (13.2%).

Broad-spectrum agents, such as amoxicillin-clavulanic acid and azithromycin, were most frequently used in Australia and the United States, respectively.

The study authors say the variation in dental antibiotic prescribing rates among the four countries does not seem to be explained by differences in dental health, but may be related to differences in use of prophylactic antibiotics in certain patients to reduce infection risk during invasive procedures—a frequent practice among US dentists. Whatever the reasons, they say the variation, and the frequent, unnecessary use of broad-spectrum antibiotics in all countries, is a concern.

"Dental antibiotic stewardship programs are urgently required as part of national responses to delivering the WHO global action plan on tackling antimicrobial resistance," they write. "Further research to understand locally relevant factors driving unnecessary dental antibiotic prescribing in each country is needed to support the development of context-appropriate stewardship solutions to the global problem of antibiotic resistance."
Apr 5 Infect Control Hosp Epidemiol abstract

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