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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 14315

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Special Issue Editors

Dr. Juan Manuel Vázquez-Lago

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Guest Editor

Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
Interests: epidemiology; antimicrobial resistance; social behavior; antimicrobial prescribing; qualitative research; global health; bioethics
Special Issues, Collections and Topics in MDPI journals

Dr. Ana Estany-Gestal

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Guest Editor

Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
Interests: clinic epidemiology; public health; methodology; biostatistics; bioethics
Special Issues, Collections and Topics in MDPI journals

Dr. Angel Salgado-Barreira

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Guest Editor

Departament of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain
Interests: pharmacology; public health; vaccines; methodology; ecological studies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, antimicrobial resistance to antibiotics has generated a major public health problem. It has become a threat to global health, and even the World Health Organization (WHO) warns of the existence of new resistance mechanisms that spread globally and affect our ability to treat common infectious diseases. There is evidence that resistance at the community level is related to poor prescription and population misuse of antimicrobials, and the poor development of new antibiotic molecules contributes to aggravating the problem. From the point of view of public health, it is essential to understand and quantify the factors, both medical and population-related, associated with the misuse of antibiotics, as well as those interventions that can improve this use.

For all this, in this Special Issue, we seek manuscripts that allow us to understand and deepen our knowledge of the factors related to the misuse of antimicrobials, as well as those strategies and interventions in public health that have a positive effect in improving this misuse.

Dr. Juan Manuel Vázquez-Lago
Dr. Ana Estany-Gestal
Dr. Angel Salgado-Barreira
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

epidemiology
social behavior
antibiotic resistance
social factors
attitudes
qualitative research
community care

Published Papers (9 papers)

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Research

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17 pages, 2509 KiB

Open AccessArticle

Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years

by Alfredo Jover-Sáenz, María Ramírez-Hidalgo, Alba Bellés Bellés, Esther Ribes Murillo, Meritxell Batlle Bosch, Anna Ribé Miró, Alba Mari López, José Cayado Cabanillas, Neus Piqué Palacín, Sònia Garrido-Calvo, Mireia Ortiz Valls, María Isabel Gracia Vilas, Laura Gros Navés, María Jesús Javierre Caudevilla, Lidia Montull Navarro, Cecilia Bañeres Argiles, Pilar Vaqué Castilla, José Javier Ichart Tomás, Mireia Saura Codina, Ester Andreu Mayor, Roser Martorell Solé, Ana Vena Martínez, José Manuel Albalad Samper, Susana Cano Marrón, Cristina Soler Elcacho, Andrés Rodríguez Garrocho, Gemma Terrer Manrique, Antoni Solé Curcó, David de la Rica Escuin, María José Estadella Servalls, Ana M. Figueres Farreny, Luís Miguel Montaña Esteban, Lidia Sanz Borrell, Arancha Morales Valle, Mercè Pallerola Planes, Aly Hamadi, Francesc Pujol Aymerich, Francisca Toribio Redondo, María Cruz Urgelés Castillón, Juan Valgañon Palacios, Marc Olivart Parejo, Joan Torres-Puig-gros, the P-ILEHRDA Group and on behalf of Clinical Microbiology and Antibiotic Resistance Group -IRBLleida- Show full author list Hide full author list

Antibiotics 2024, 13(1), 92; https://doi.org/10.3390/antibiotics13010092 - 18 Jan 2024

Viewed by 887

Abstract

Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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19 pages, 833 KiB

Open AccessArticle

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

by Lindsey A. Laytner, Kiara Olmeda, Juanita Salinas, Osvaldo Alquicira, Susan Nash, Roger Zoorob, Michael K. Paasche-Orlow, Barbara W. Trautner and Larissa Grigoryan

Antibiotics 2023, 12(9), 1419; https://doi.org/10.3390/antibiotics12091419 - 08 Sep 2023

Viewed by 1122

Abstract

Using antibiotics without medical guidance (non-prescription antibiotic use) may contribute to antimicrobial resistance. Hispanic individuals are a growing demographic group in the United States (US) with a high prevalence of non-prescription antibiotic use. We investigated the effects of acculturation and subjective norms on Hispanic individuals’ intentions to use antibiotics without a prescription from the following sources: (1) markets in the United States (not legal), (2) other countries (abroad), (3) leftovers from previous prescriptions, and (4) friends/relatives. We surveyed self-identified Hispanic outpatients in eight clinics from January 2020 to June 2021 using the previously validated Short Acculturation Scale for Hispanics (SASH). Of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to use antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to use non-prescription antibiotics from friends/relatives (p = 0.034). Other predictors of intention to use non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic. Antibiotic stewardship interventions in Hispanic communities in the United States should consider the sociocultural and healthcare barriers influencing non-prescription use and promote language-concordant healthcare. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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15 pages, 674 KiB

Open AccessArticle

Hospital Pharmacists’ Viewpoint on Quality Use of Antibiotics and Resistance: A Qualitative Exploration from a Tertiary Care Hospital of Quetta City, Pakistan

by Maryam Farooqui, Zaffar Iqbal, Abdul Sadiq, Abdul Raziq, Mohammed Salem Alshammari, Qaiser Iqbal, Sajjad Haider and Fahad Saleem

Antibiotics 2023, 12(8), 1343; https://doi.org/10.3390/antibiotics12081343 - 21 Aug 2023

Cited by 2 | Viewed by 1062

Abstract

Suboptimal antibiotics use and the development of antibiotic resistance is a universal calamity. The theoretical model of therapeutic efficacy correlates quality use of antibiotics with healthcare practitioners’ understanding of antibiotic use and resistance. Keeping this phenomenon in mind, we aimed to evaluate hospital pharmacists’ understanding of antibiotic use and resistance at a public healthcare institute in Quetta city, Pakistan. This was a qualitative study that employed a semi-structured interview guide for data extraction. The phenomenology-based approach commissioned in-depth, face-to-face interviews with hospital pharmacists stationed at the surgical unit of Sandeman Provincial Hospital, Quetta. The interviews were audio taped followed by transcribed verbatim and were then analyzed for thematic contents by the standard content analysis framework. Although the saturation was reached after the 10th interview, we conducted two additional interviews for definite validation. Content analysis revealed five major themes: (1) Defining antibiotics, quality use of antibiotics and resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. The knowledge of quality use of antibiotics and resistance was promising, and the respondents were eager to address the drastic situation. The respondents were aware of the critical situation and provided valuable insights that can offer valued input while promoting the quality use of antibiotics in a developing country. The current study managed to identify an adequate understanding of antibiotic use and resistance among hospital pharmacists. Additionally, prospective concerns and possible predictors of antibiotic resistance were also highlighted. The current findings must be disseminated to the policymakers and prescribers to take prompt restorative actions to address antibiotic use and the development of antibiotic resistance in a developing country like Pakistan. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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16 pages, 679 KiB

Open AccessArticle

Knowledge, Attitudes, and Practices in Antibiotic Dispensing amongst Pharmacists in Trinidad and Tobago: Exploring a Novel Dichotomy of Antibiotic Laws

by Rajeev P. Nagassar, Amanda Carrington, Darren K. Dookeeram, Keston Daniel and Roma J. Bridgelal-Nagassar

Antibiotics 2023, 12(7), 1094; https://doi.org/10.3390/antibiotics12071094 - 23 Jun 2023

Viewed by 1295

Abstract

The inappropriate consumption, use, and dispensing of antibiotics are problems faced globally, with a pattern of inappropriate consumption differing in higher-income countries due to the ease of accessibility of antibiotics. The main drivers of consumption and inappropriate use are the over-the-counter sales of antibiotics by pharmacies. Trinidad and Tobago (T&T), a twin island state in the Caribbean, has two Acts of Parliament that regulate antibiotics: the Antibiotics Act and the Food and Drug Act, yet the Over-the-Counter (OTC) sale of antibiotics still exists. This study sought to determine the knowledge, attitudes, and practices regarding the OTC dispensing of antibiotics in T&T. A cross-sectional study gathered data from pharmacists in both the private and public sectors of Trinidad over 7 months. The results showed that antibiotic resistance and antibiotic abuse were seen as significant problems. The level of experience, gender (female), and age (younger) were significantly associated with having good overall knowledge of good dispensing habits and antibiotic laws (p = 0.036, p = 0.047, and p = 0.001, respectively). Pharmacists generally agreed that antibiotics under the Food and Drug Act may have contributed to OTC dispensing in the private sector (p = 0.013) and that all antibiotics should be under the Antibiotic Act (p = 0.002). Additionally, it was found that the dispensing of antibiotics OTC in the private sector (p = 0.006) occurred: without doctors’ advice and without requesting prescriptions; because it was perceived as lawful (especially by older pharmacists); and because of the perceived motivation of profit. Regulation enforcement was perceived as deficient. OTC dispensing for reasons, such as misunderstanding of laws, occurs in T&T. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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19 pages, 1025 KiB

Open AccessArticle

Antibiotic Use in Pregnancy: A Global Survey on Antibiotic Prescription Practices in Antenatal Care

by Carlotta Gamberini, Sabine Donders, Salwan Al-Nasiry, Alena Kamenshchikova and Elena Ambrosino

Antibiotics 2023, 12(5), 831; https://doi.org/10.3390/antibiotics12050831 - 29 Apr 2023

Cited by 1 | Viewed by 2559

Abstract

Antibiotic prescription and use practices in the antenatal care setting varies across countries and populations and has the potential to significantly contribute to the global spread of antibiotic resistance. This study aims to explore how healthcare practitioners make decisions about antibiotic prescriptions for pregnant women and what factors play a role in this process. A cross-sectional exploratory survey consisting of 23 questions, including 4 free-text and 19 multiple-choice questions, was distributed online. Quantitative data were collected through multiple-choice questions and was used to identify the most common infections diagnosed and the type of antibiotics prescribed. Qualitative data were gathered through free-text answers to identify gaps, challenges, and suggestions, and the data were analyzed using thematic analysis. A total of 137 complete surveys mostly from gynecologists/obstetricians from 22 different countries were included in the analysis. Overall, national and international clinical guidelines and hospital guidelines/protocols were the most frequently used sources of information. This study highlights the crucial role of laboratory results and guidelines at different levels and emphasizes region-specific challenges and recommendations. These findings underscore the pressing need for tailored interventions to support antibiotic prescribers in their decision-making practice and to address emerging resistance. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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13 pages, 286 KiB

Open AccessArticle

Prevalence and Predictors of Antibiotic Self-Medication in Sudan: A Descriptive Cross-Sectional Study

by Mohamed A. Hussain, Ahmed O. Mohamed, Omalhassan A. Abdelkarim, Bashir A. Yousef, Asma A. Babikir, Maysoon M. Mirghani, Entsar A. Mohamed, Wadah Osman, Ramzi A. Mothana and Rashid Elhag

Antibiotics 2023, 12(3), 612; https://doi.org/10.3390/antibiotics12030612 - 20 Mar 2023

Cited by 3 | Viewed by 2224

Abstract

Background: Self-medication with antibiotics (SMA) is one of the common factors which precipitate antimicrobial resistance, yet if effective implementations are amended it can be effortlessly controlled. The present study aimed to estimate the prevalence and predictors of SMA in Sudan. Methods: The study adopted a cross-sectional study design conducted in all Sudan states between June and December 2021. Multi-stage stratified cluster sampling was used. A semi-structured questionnaire was used for data collection. Descriptive statistics were used to present the data. Binary logistic regression was computed to investigate the possible factors which associated with SMA. Results: Out of 1492 participants surveyed, 71.3% utilize antibiotics as self-medication. The derived reasons for SMA were convenience (63.3%) and cost-saving (34.8%). Tonsillitis was the most common ailment behind SMA (55.5%). Log-binominal regression revealed that non-insured and low level of education participants were more likely to predict SMA. Regarding the practice, 40% changed the dose and/or antibiotics mainly owing to improvement (53.7%) or worsening of the condition (37.9%). The most commonly used antibiotic was amoxicillin/clavulanic acid (32.5%). Conclusions: Two out of three individuals in Sudan practice SMA mainly to manage upper respiratory tract ailments. Thus, the necessity of implementing an antimicrobial stewardship program throughout the country, as well as implementing effective legislation to prohibit dispensing antibiotics without prescription is urgently required. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

12 pages, 561 KiB

Open AccessArticle

Factors Influencing Antibiotic Consumption in Adult Population of Kazakhstan

by Nazym Iskakova, Zaituna Khismetova, Dana Suleymenova, Zhanat Kozhekenova, Zaituna Khamidullina, Umutzhan Samarova, Natalya Glushkova and Yuliya Semenova

Antibiotics 2023, 12(3), 560; https://doi.org/10.3390/antibiotics12030560 - 11 Mar 2023

Cited by 2 | Viewed by 1531

Abstract

Poor or suboptimal knowledge of appropriate antibiotic use is a cause for global concern and little is known about Central Asian countries. Therefore, this survey is aimed at evaluating awareness about antibiotic use and resistance among the adult population of Kazakhstan. A cross-sectional study of a random sample was conducted between October 2021 and February 2022 among 727 individuals without medical education and followed the methodology described in the WHO report “Antibiotic Resistance: Multi-country public awareness survey”. Half of the respondents (50.4%) received antibiotic therapy within the last 12 months, 40.1% had no prescription for this and 40.4% received no advice from a medical professional. Nearly two-thirds of respondents (65.3%) never heard about antibiotic resistance and 57.2% believed that it is worth requesting the same antibiotic if it helped to treat a similar condition previously. In general, knowledge about antibiotic use proved to be low in 82.1% of respondents and 91.9% agreed with the statement that a common cold requires antibiotics. There is a need for awareness-raising campaigns to improve the knowledge about antibiotic use and resistance in the population of Kazakhstan. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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12 pages, 289 KiB

Open AccessArticle

Knowledge, Perceptions, and Perspectives of Medical Students Regarding the Use of Antibiotics and Antibiotic Resistance: A Qualitative Research in Galicia, Spain

by Juan M. Vázquez-Lago, Rodrigo A. Montes-Villalba, Olalla Vázquez-Cancela, María Otero-Santiago, Ana López-Durán and Adolfo Figueiras

Antibiotics 2023, 12(3), 558; https://doi.org/10.3390/antibiotics12030558 - 11 Mar 2023

Cited by 1 | Viewed by 1615

Abstract

Antibiotic resistance is a significant public health concern, with numerous studies linking antibiotic consumption to the development of resistance. As medical students will play a pivotal role in prescribing antibiotics, this research aimed to identify their perceptions of current use and factors that could influence future inappropriate use of antibiotics. The study employed a qualitative research approach using Focus Group discussions (FGs) consisting of students from the final theoretical course of the Medicine degree. The FGs were conducted based on a pre-script developed from factors contributing to antibiotic misuse identified in previous studies. All sessions were recorded and transcribed for analysis by two independent researchers, with all participants signing informed consent. Seven focus groups were conducted, with a total of 35 participants. The study identified factors that could influence the future prescription of antibiotics, including the low applicability of knowledge, insecurity, clinical inertia, difficulties in the doctor-patient relationship, unawareness of available updates on the topic, and inability to assess their validity. The students did not perceive antibiotic resistance as a current problem. However, the study found several modifiable factors in medical students that could explain the misuse of antibiotics, and developing specific strategies could help improve their use. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

Review

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19 pages, 1100 KiB

Open AccessReview

Antimicrobial Resistance in Papua New Guinea: A Narrative Scoping Review

by Brady Page and Simeon Adiunegiya

Antibiotics 2023, 12(12), 1679; https://doi.org/10.3390/antibiotics12121679 - 29 Nov 2023

Viewed by 1268

Abstract

Antimicrobial-resistant bacterial infections are a known threat to the public health of low-income countries and are undercharacterized in Papua New Guinea. A scoping literature review of scientific peer-reviewed publications on antimicrobial resistance in Papua New Guinea was conducted, and their results were summarized. Many of the available data on resistant bacteria in Papua New Guinea have come from Port Moresby and Goroka and have been focused on Staphylococcus aureus, as well as important pediatric pathogens such as Streptococcus pneumoniae and Haemophilus influenzae. Progressive resistance to the commonly used antibiotics penicillin and chloramphenicol among most clinically important bacterial pathogens has prompted healthcare workers to adopt expensive broad-spectrum antibiotics. There is already evidence of resistance to newly adopted antibiotics among several Gram-negative organisms. Drivers of antimicrobial resistance in Papua New Guinea include a high burden of infectious diseases, inappropriate antibiotic prescription practices, poor regulation of antibiotics, incomplete adherence, substandard drug quality, and overcrowding of healthcare facilities. There is a lack of information on antimicrobial resistance among priority pathogens and from several important regions of Papua New Guinea. Full article

(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health)

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