Brazilian restriction on antibiotic sales linked to decline in resistance
A national policy restricting over-the-counter (OTC) antibiotic sales in Brazil was linked with a drop in antimicrobial resistance (AMR) in two pathogens that frequently cause community-acquired infections, Brazilian researchers reported yesterday in Emerging Infectious Diseases.
To assess the impact on AMR from a 2010 National Health Surveillance Agency of Brazil policy that required a prescription to buy antibiotics from private pharmacies, the researchers analyzed sales of six oral antibiotics from private pharmacies in Sao Paulo, along with AMR data on Escherichia coli and Streptococcus pneumoniae isolates collected from Sao Paulo hospitals, from 2008 through 2016. They used a dynamic regression model based on a Bayesian approach to analyze the effect of the restriction policy on the association between antibiotic sales and resistance.
During the study period, sales of the six antibiotics—amoxicillin, azithromycin, cephalexin, ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole—combined in the Sao Paulo region fell from 7.86 defined daily doses per 1,000 inhabitants per day (DID) to 7.65, with a steep drop in sales observed after the implementation of the policy in 2010.
But the decline in sales was driven by amoxicillin and sulfamethoxazole. Sales of all the other antibiotics rose over the study period.
The analysis showed a substantial drop in AMR in both pathogens following decreased sales of amoxicillin and trimethoprim/sulfamethoxazole. The researchers also noticed, however, that increased sales of ciprofloxacin were associated with increased ciprofloxacin resistance and increased prevalence of extended-spectrum beta-lactamase–positive isolates in E coli, while increased sales of azithromycin after 2013 were associated with erythromycin resistance in S pneumoniae.
"Restricting OTC antimicrobial sales was associated with a drop in resistance to amoxicillin and trimethoprim/sulfamethoxazole but not to quinolones, macrolides, or cephalexin," the study authors wrote. "Our findings suggest that strategies to reduce overdependence on antimicrobial drugs might have an effect on resistance in those drugs. However, any such strategy will likely need to be multifaceted, because AMR is a complex problem."
Dec 13 Emerg Infect Dis study
Stewardship intervention tied to better antibiotic use in hospitalized kids
A multifaceted intervention to enhance timely conversion of intravenous (IV) to oral antibiotic therapy in children helped safely optimize pediatric antibiotic use in Australian hospitals, researchers reported yesterday in the Journal of Global Antimicrobial Resistance.
The study, conducted in seven healthcare facilities in Queensland, evaluated a package of interventions to guide the timing and process of switching from IV to oral antibiotics in children hospitalized with community-acquired pneumonia and skin and other soft-tissue infections. The package included clinician guidelines, medication review stickers, patient information leaflets, and educational resources.
Over a period of 7 months, which included the baseline and intervention periods, the researchers collected data on time taken to switch patients from IV to oral antibiotics, length of hospital stay, duration of IV and oral antibiotic therapies, and adverse events. A total of 357 pediatric patients were enrolled in the study, with 178 in the baseline and 179 in the intervention phase.
The percentage of patients who were eligible to switch to oral therapy within 24 hours of eligibility increased from 87.6% (156/178) in the baseline phase to 97.2% (174/179) in the intervention phase (P = 0.003). The average number of extra IV days decreased from 0.45 days in the baseline period to 0.18 days in the intervention period (P < 0.001). The median patient length of stay was 2 days for both phases. The only adverse events recorded were line-associated infiltrates, with a decrease from 34.3% (61/178) in the baseline period to 17.9% (32/179) in the intervention period (P < 0.001).
"In conclusion, a multifaceted package of tailored interventions to enhance timely IV to oral conversion of antibiotic therapy for children in remote and regional facilities is an effective antimicrobial stewardship initiative," the study authors wrote.
Dec 13 J Glob Antimicrob Resist study