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The increasing supply shortages of antibacterial drugs presents significant challenges to public health in Germany. This study aims to predict the future consumption of the ten most prescribed antibacterial drugs in Germany up to 2040 using ARIMA (Auto Regressive Integrated Moving Average) models, based on historical prescription data. This analysis also evaluates the plausibility of the forecasts. Our findings represent one of the first long-term national forecasts for antibacterial drug consumption. ARIMA( 0,1,0 ), a random walk model with drift, is the best-fitting model to capture trends across all antibacterial drugs. While more complex models offer greater detail, they seem less suitable for long-term forecasting. In a short-term forecast of 5 and 10 years, predictions between significant models vary very little. Predictions indicate increasing DDD-prescriptions for amoxicillin, cefuroxime axetil, amoxicillin clavulanic acid, clindamycin, azithromycin, nitrofurantoin, and ciprofloxacin, while declines are forecasted for doxycycline, phenoxymethylpenicillin, and sulfamethoxazole-trimethoprim. The reliability of the predictions varies. Forecasts for azithromycin, phenoxymethylpenicillin, and sulfamethoxazole-trimethoprim are likely accurate, whereas uncertainties exist for doxycycline, amoxicillin clavulanic acid, nitrofurantoin, and ciprofloxacin, though general trends appear valid. Potential discrepancies may arise in the predictions for amoxicillin, cefuroxime axetil, and clindamycin. These forecasts highlight the urgent need for proactive healthcare planning to prevent future shortages, a problem underscored by recent supply disruptions in Germany. Future research should extend this analysis to the development of bacterial resistance and other frequently used drug classes.

Previous research from our group revealed a strong association between daily defined dose (DDD)-costs and -prescriptions of antibacterial drugs in Germany ( https://pubmed.ncbi.nlm.nih.gov/38842562/ ; https://pubmed.ncbi.nlm.nih.gov/39042156/ ). These data indicate that low costs are major driver of high prescription numbers. This study examines the relationship between bacterial resistance and DDD-prescriptions of antibacterial drugs using data from the Arzneiverordnungsreport (AVR) from 2008 to 2022 and the Antibiotic Resistance Surveillance (ARS) statistics provided by the Robert Koch Institute (RKI). We hypothesized that semi-rational or irrational prescribing behavior of antibacterial drugs is evident in Germany, i.e., prescriptions are driven to a greater extents by low DDD-costs than bacterial resistance. A bivariate correlation analysis was performed to test these models. Our data point to irrational prescribing behavior for amoxicillin, cefuroxime axetil, doxycycline, nitrofurantoin, ciprofloxacin, and clarithromycin. For amoxicillin clavulanic acid and sulfamethoxazole-trimethoprim, data point to semi-rational prescribing. For no antibacterial drug, a model pointing to rational drug prescribing was found. In conclusion, our study shows that DDD-costs exert a more significant influence on DDD-prescriptions than bacterial resistance, indicating that economic factors, rather than scientific evidence, primarily drive antibacterial drug prescriptions in outpatient settings in Germany. It will be important to conduct similar studies on the prescription of antibacterial drugs in other countries. It will also be important to study the relation between DDD-costs and -prescriptions for other drug classes and assess the scientific basis for these relations.

Rising bacterial resistance is a global threat, causing rising financial burdens on healthcare systems and endangering effective treatment of bacterial infections. To ensure the efficacy of antibacterial drugs, it is essential to identify the most dangerous pathogens and vulnerable antibacterial drugs. Previous research by our group suggested irrational outpatient prescribing practices in Germany, supporting a growing bacterial resistance. This study analyses developments and characteristics for the ten most prescribed antibacterial drugs in Germany from 2008 to 2022. Conclusions are based on the development of bacterial resistance levels and an analysis of correlations between pathogens. We identified cefuroxime axetil, sulfamethoxazole-trimethoprim and nitrofurantoin as the most problematic drugs. Particularly problematic pathogens include E. faecalis , E. faecium , K. pneumoniae , and P. mirabilis . Besides increasing bacterial resistance, they are characterised by a high proportion of significant positive correlations, indicating a high potential for mutually reinforcing resistance development. Alarmingly, most of the antibacterial drugs analysed showed a growing resistance to at least one of the analysed pathogens. In most cases, the best treatment option is threatened by increasing bacterial resistance. We also identified several differences between current bacterial resistance data and therapeutic guidelines. In aggregate, our findings support irrational prescribing behaviour and underscore the urgent need for improved prescribing practices to counter rising bacterial resistance in Germany. Moreover, therapeutic guidelines for bacterial infections, the “holy grail” of pharmacotherapy, must be updated more frequently.

Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of \"noninterference' in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a \"prescribing etiquette,\" which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills （IM B） model to identify the predictors of essential medicines prescribing behavior （EMPB） among doctors and to examine the association between demographic variables, IMB, and EMPB. Methods： A cross-sectional study was carried out to assess predictive relationships among demographic variables and IM B model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the I MB model to test the instruments using analysis of moment structures 17.0. Results： A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old （range： 22-67 years old）. The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 a： 7.34 （hundred mark system： 75.77） and 19.92 ± 3.44 （hundred mark system： 79.68）, respectively. Approximately half（50.8%） of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data （x^2/df= 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066）. More work experience （β = 0.153, P 〈 0.001 ） and behavioral skills （β = 0.449, P 〈 0.001 ） predicted more EMPB. Higher income predicted less information （β = -0.197, P 〈 0.001） and motivation （β =0.204, P 〈 0.001 ）. Behavioral skills were positively predicted by information （β = 0.135, P 〈 0.001 ） and motivation （β = 0.742, P 〈 0.001 ）. Conclusion： The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.

Background Prescription drugs constitute the primary source of revenue for the pharmaceutical industry. Most pharmaceutical companies commit a great deal of time and money to market in hopes of convincing physicians about their products. The objective of this study is to assess perceived influence of pharmaceutical marketing mix strategies on physicians’ prescribing behaviors in hospitals, Dessie, Ethiopia. Methods Mixed methods sequential explanatory design was employed in two public and three private hospitals. A cross-sectional study design was employed by including (136) physicians working in public and private hospitals. Percentage, mean, standard deviation, and multiple linear regressions were computed using Statistical Package for Social Science. In the second phase, the phenomenological design was employed to fully explore in-depth information. Purposive sampling was used to select key informants and 14 in-depth interviews were conducted by the principal investigator. Content analysis was performed using Nvivo 11 plus and interpretation by narrative strategies. Results The overall perceived influence of pharmaceutical marketing mix strategies in physicians’ prescribing behavior was 55.9%. The influence of promotion, product, place and price strategy perceived by physicians in their prescribing behavior was 83 (61%), 71(52.2%), 71 (52.2%), 80 (58.8%) respectively. There was a statistically significant difference among marketing mix strategies (β = 0.08, p  = < 0.001). Determinants on the influence of physicians’ prescribing behavior were specialty ( p  = 0.01) and working areas ( p  = 0.04). The qualitative design also generates additional insights into the influence of pharmaceutical marketing mix strategies on physician prescribing behavior. Conclusions More than half of physicians perceived that pharmaceutical marketing mix strategies influence their prescribing behavior. The qualitative design also revealed that pharmaceutical marketing mix strategies influenced physicians prescribing behavior. Strengthening the regulation and maintaining ethical practice would help to rationalize the physicians’ prescribing practice.

This study used prescription data from four medical institutions in representative cities in Central, Western and Eastern China, focusing on changes in antibiotic use under the National Centralized Drug Procurement Policy (NCDP) and calculating the contribution of NCDP and non-NCDP varieties to the changes. In outpatient settings, NCDP policy had little impact on the antibiotic prescription rate. Changes in antibiotic utilization rates were predominantly driven by non-NCDP varieties, particularly newer-generation antibiotics with enhanced therapeutic profiles. However, the policy more effectively facilitated the substitution of non-NCDP varieties with NCDP varieties in inpatient settings compared to outpatient settings. The overall and injectable antibiotic utilization rates remained within the specified range and continued to decline, although the downward trend was more gradual compared to the pre-intervention period. In conclusion, the substitution effect of NCDP varieties has affected antibiotic usage in inpatient settings, directly influencing both the overall antibiotic prescription rate and the prescription rate of injectable antibiotics. Therefore, for optimizing antibiotic stewardship under China’s NCDP policy, regular monitoring and managing of antibiotics is essential to ensure the rational use of antibiotics.

Purpose It is crucial to understand the influencing factors of physicians’ intravenous infusion prescribing behavior for intravenous infusion and take precise interventions to regulate the use of intravenous infusion. This study uses the PRECEDE model framework to clarify the determining factors that affect doctors’ decisions on intravenous infusion prescriptions and then designs targeted intervention measures to guide the correct use of intravenous infusion, thereby optimizing patient care outcomes and resource allocation. Methods This study used a cross‐sectional survey method and designed a questionnaire based on the PRECEDE model to collect and analyze the determining factors that affect doctors’ practice of intravenous infusion prescriptions. At the same time, a structural equation model was constructed to investigate the influencing factors of doctors’ intravenous infusion prescription behavior. This study conducted an online questionnaire survey of doctors from different medical institutions in Pidu District, Chengdu, from April to May 2023. Subsequently, statistical methods such as t‐test, analysis of variance, and Student–Newman–Keuls (SNK) were used for data comparison. Meanwhile, multiple linear regression analysis and structural equation modeling were employed to elucidate the complex relationships between different factors, as well as the influence of healthcare professionals’ attitudes and tendencies toward these factors. Results The results revealed statistically significant differences in the predisposing factor‐attitude (PFA) scores among doctors with varying titles, hospital levels, predisposing factor‐knowledge (PFK) scores, enabling factor (EF) scores, and reinforcing factor (RF) scores. Physicians with deputy senior titles and higher PFK and RF scores exhibited higher PFA scores. In addition, the structural equation model also showed that PFK and RF mitigate a physician’s attitudinal inclination toward prescribing IV fluids, whereas EF augments such attitudinal propensity. Conclusion In primary healthcare institutions in China, there is an urgent need for training on intravenous infusion‐related knowledge for medical staff with lower education and professional titles.

Abstract Objective In this study, we explored key prescription drug monitoring program-related outcomes among clinicians from a broad cohort of Massachusetts healthcare facilities following prescription drug monitoring program (PDMP) and electronic health record (EHR) data integration. Methods Outcomes included seven-day rolling averages of opioids prescribed, morphine milligram equivalents (MMEs) prescribed, and PDMP queries. We employed a longitudinal study design to analyze PDMP data over a 15-month study period which allowed for six and a half months of pre- and post-integration observations surrounding a two-month integration period. We used longitudinal mixed effects models to examine the effect of EHR integration on each of the key outcomes. Results Following EHR integration, PDMP queries increased both through the web-based portal and in total (0.037, [95% CI = 0.017, 0.057] and 0.056, [95% CI = 0.035, 0.077]). Both measures of clinician opioid prescribing declined throughout the study period; however, no significant effect following EHR integration was observed. These results were consistent when our analysis was applied to a subset consisting only of continuous PDMP users. Conclusions Our results support EHR integration contributing to PDMP utilization by clinicians but do not support changes in opioid prescribing behavior.