Flu contributing to inappropriate antibiotics for respiratory infections
An analysis of patients in a California health system found relatively high rates of flu-associated prescribing of select antibiotics in certain age-groups, researchers reported today in Epidemiology & Infection.
Researchers with Kaiser Permanente and Harvard T.H. Chan School of Public Health estimated influenza-associated prescribing for five antibiotic classes (macrolides, aminopenicillins, protected aminopenicillins, quinolones, and third-generation cephalosporins) from 2010 through 2018 among patients in the Kaiser Permanente of Northern California health system.
Using data on weekly prescribing counts and weekly rates of respiratory samples positive for influenza A and B, they calculated annual rates of influenza-associated prescribing for the different classes per 100,000 individuals in five age-groups—under 5 years, 5 to 17 years, 18 to 49 years, 50 to 64 years, and over 65 years.
The analysis estimated that 3.4% of all macrolide prescriptions, 2.7% of all aminopenicillin prescriptions, 2.2% of all protected aminopenicillin prescriptions, 3.1% of all third-generation cephalosporin prescriptions, and 1.3% of all quinolone prescriptions were influenza-associated.
Corresponding proportions were higher for certain age-groups. For example, influenza accounted for 4.3% of all macrolide prescriptions in patients 50 and older, 3.3% of all aminopenicillin prescriptions in children under 5, and 5.1%, 5.2%, 4.2%, and 3.4% of aminopenicillin, third-generation cephalosporin, quinolone, and protected aminopenicillin prescriptions in patients aged 5 to 17 years, respectively.
Additionally, the relative contribution of influenza to antibiotic prescribing for any respiratory diagnosis without a bacterial indication in patients over 5 was higher than the corresponding relative contribution to prescribing for any diagnosis.
"Our results suggest a modest benefit of increasing influenza vaccination coverage for reducing antibiotic prescribing for the five studied antibiotic classes, particularly for macrolides in ages over 50y, aminopenicillins in children aged under 18y and 3rd generation cephalosporins in ages over 65y, as well as the potential benefit of other measures to reduce unnecessary antibiotic prescribing for respiratory diagnoses with no bacterial indication in persons aged over 5y, both of which may further contribute to the mitigation of antimicrobial resistance," the study authors wrote.
Oct 26 Epidemiol Infect abstract
Private-sector antibiotic use falls in India, but inappropriate use rises
Private-sector antibiotic consumption fell in India over the previous decade, but rates varied widely across states, with some seeing increased inappropriate use of broad-spectrum antibiotics, researchers reported today in JAC-Antimicrobial Resistance.
Using a nationally representative drug sales audit dataset, researchers with the Public Health Foundation of India and Boston University School of Public Health calculated annual private-sector antibiotic consumption rates from 2011 through 2019 across national, state, and state-group (high focus [HF] and non-high focus [nHF]) levels. They analyzed consumption across different characteristics, including World Health Organization AWaRE (Access, Watch and Reserve) classification, product type, and essentiality.
Overall, the annual consumption rate of private-sector antibiotics decreased by 3.6% from 2011 through 2019, falling from 10.7 defined daily doses per 1,000 persons per day (DIDs) to 10.3 DIDs. But the proportion of Access antibiotics, which are first-line recommended agents, declined (compound annual growth rate [CAGR], -1.7%) while the proportion of Reserve, or last-resort antibiotics, increased (CAGR, 16.8%), and the Access/Watch ratio fell from 0.59 to 0.49, suggesting increased use of broad-spectrum antibiotics.
Analysis of state-level consumption showed that consumption varied widely, with HF states—those states with weak public health infrastructure and indicators—reporting lower overall rates of consumption but increased inappropriate antibiotic use over time, reflected by an increasing consumption of Watch antibiotics and fixed-dose combinations and a significant decline in Access/Watch ratio.
The study authors say the overall decline in private-sector antibiotic consumption could reflect national regulatory reforms that went into effect in 2014. But they note that the increasing consumption of broad-spectrum Watch antibiotics correlates with comparatively higher rates of resistance to these antibiotics in India.
"The rapid decline in Access/Watch ratios in HF states is a serious concern as these states have a considerable population share and they lag in socioeconomic and health indicators," the authors wrote. "The significant variations of inappropriate use at the state level called for state-specific studies to understand the factors—at the health-system, provider and patient level—that drive inappropriate use."
Oct 26 JAC-Antimicrob Resist study