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The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of \"antibiotic-de-escalation\" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.

Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014–2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014–2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.

Objectives: Meropenem has become one of the most widely used antibiotics and is considered to be the drug of choice for empirical treatment in patients with pneumonia. The aim of this study is to evaluate factors associated with the use of Meropenem as a broad-spectrum antibiotic in a referral hospital in Makassar. Methods: In a retrospective observational study we conducted over one-month period (January- February 2024), adult patients diagnosed with pneumonia who received Meropenem were selected. We included data such as length of stay, admission to the intensive care unit, use of ventilator, basis of prescription (either empirical or culture-based), and laboratory profiles such as white blood cell count, procalcitonin levels, blood culture and resistance towards antibiotics. Results: Over one-month period, thirty patients admitted to our hospital with pneumonia were evaluated. Among these patients, several factors such as admission in intensive care unit, use of ventilator, and procalcitonin levels showed statically significance (p < 0,05) while blood culture and antibiotic resistance showed minimal impact towards utilization of Meropenem in patients with pneumonia. Conclusions: In conclusion, our study indicates that Meropenem usage for pneumonia treatment is significantly influenced by admission to the intensive care unit, use of ventilator, and specific laboratory parameters such as procalcitonin levels. Further research with larger scale is needed to evaluate utilization of Meropenem in clinical practices.

Background: Antibiotics are frequently prescribed to critically ill patients admitted to intensive care units (ICUs). About 30–60% of antibiotics prescribed in ICUs are unnecessary, inappropriate, or suboptimal and contribute substantially to the development of antimicrobial resistance. Aims and Objectives: The present study was undertaken to assess the use of antibiotics based on the World Health Organization (WHO) access, watch, and reserve (AWaRe) index in a multidisciplinary ICU of a medical college and hospital in Eastern India. Materials and Methods: The descriptive past record-based study was carried out among patients admitted in the multidisciplinary ICU of a medical college and hospital over 6 months. Information from the ICU bed head tickets (BHTs) was captured in a data record form and analyzed. Results: A total of 97 BHTs were reviewed, and 257 antibiotics were prescribed to 90 patients. The prevalence of antibiotic use was 92.78%. Average number of antibiotics per patient was 2.85. In most instances (88.89%, 80), either two (28.88%), three (27.77%), or even four (20%) antibiotics were used. Frequency of use of AWaRe antibiotics was 21.43% (51/238), 67.23% (160/238), and 11.34% (27/238), respectively. Meropenem (15.12%, 36), piperacillin-tazobactam (36, 15.12%), and ceftriaxone (35, 14.70%) were the three most frequently prescribed watch group antibiotics. Most antibiotics were used empirically (60%), and 40% (36/90) use was targeted. Conclusion: Empirical treatment with antibiotics is common in ICUs. The WHO AWaRe tool may check the injudicious and unnecessary use of antibiotics and thus promotes the rational use of antibiotics and prevent the development of antibiotic resistance in ICUs.

Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action. Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

Background Burn injuries are a significant public health concern in low‐ and middle‐income countries, associated with high morbidity and mortality due to infections and antimicrobial resistance (AMR). However, data on these aspects from Nepal remain limited. The study aimed to assess antibiotic utilization patterns and cost analysis among burn patients at a tertiary care hospital in Nepal. Methods A retrospective cross‐sectional study was conducted using medical records of 249 burn patients admitted to a tertiary care hospital between June 2018 and May 2019. Antibiotic consumption was assessed using the WHO Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. A generalized linear model (GLM) with a gamma distribution and log‐link function was employed to identify factors influencing antibiotic costs. Results Total antibiotic consumption was 2213.38 DDDs, corresponding to 82.47 DDDs per 100 bed‐days. Cephalosporins were the most frequently prescribed class (57.6%), with ceftriaxone being the most commonly used agent. Empirical therapy was initiated in 55% of cases, and 96.4% of antibiotics were administered parenterally. Multidrug‐resistant (MDR) and extensively drug‐resistant (XDR) infections were identified in 35.3% and 14.5% of patients, respectively. The median antibiotic cost per patient was US $18.18 (IQR: US$ 63.90). Higher costs were significantly associated with age between 15 and 44 years, greater total body surface area (TBSA) involvement, third‐degree burns, and the presence of MDR/XDR infections (p < 0.001). Conclusion The study reveals a high rate of empirical antibiotic use and substantial costs in burn care, primarily driven by resistant infections and burn severity. These findings underscore the urgent need for implementing antimicrobial stewardship interventions and culture‐guided therapy to improve clinical outcomes and reduce the financial burden.

Background The emerging of antimicrobial resistant strains is destroying the paradigm-shifting power of antibiotics. The main driver of antimicrobial resistance inappropriate prescribing practices, primarily in institutions like Sub-Saharan Africa. Hence, this study aims to evaluate real antibiotic use patterns among inpatients at four public hospitals in Jimma, Ethiopia. Methods Across-sectional point prevalence survey using standardized World Health Organization (WHO)’s point-prevalence survey (PPS) was employed to conduct this study in August 2023. All hospitalized patients at adult and pediatric wards before or at 08:00 on the survey date were enrolled. Data collection tool was adopted and customized to collect hospital antibiotic use pattern using a standardized PPS method. Data were collected using Open Data Kit (ODK) and analyzed using SPSS version 27; where the p-value < 0.05 was considered statistically significant. Results A total of 344 patients were enrolled, with a male predominance (57.6%) and a majority (58.4%) aged over 18 years. The common clinical indications for antibiotic prescriptions were gastrointestinal infections (28.5%) followed by Respiratory tract (upper and lower) infections (27.4%). The antibiotics were mainly indicated for therapeutic purpose (59.3%). The antibiotic use prevalence was 85.8% with high rate (59.0%) of patients were receive “Watch” group antibiotics mainly from cephalosporin class. Empirical therapy was the predominant treatment approach (95.3%), with ceftriaxone being the most frequently prescribed agent, accounting for 43.3% of all empirical antibiotic use. Surgical prophylaxis accounted for the majority (88%) of prophylactic antibiotic use. Notably, nearly three-quarters (74%) of these patients received prophylaxis for longer than the recommended 24-hours. Only 4.0% of patients receiving parenteral antibiotics were switched to oral therapy. Furthermore, 37.1% of prescriptions deviated from guideline recommendations or lacked documentation to assess adherence. The treatment approach was rarely evidence-based, with microbiological testing absent in 90% of cases. Of patients who had culture results, gram-negative bacteria (e.g., E. coli , Klebsiella spp. , Citrobacter spp. ) were a common bacterial isolates. Multivariable analysis showed that surgical procedures (AOR = 5.96) and peripheral catheters (AOR = 6.81) were significantly associated with increased antibiotic use. Conclusion The findings reveal alarmingly high antibiotic utilization in Ethiopian hospitals, primarily driven by excessive empirical prescribing, insufficient microbiological testing, and inappropriate and prolonged surgical prophylaxis. These results highlight the urgent need for multifaceted interventions, including strengthening diagnostic capabilities to support evidence-based prescribing, implementing robust antimicrobial stewardship programs with regular ward-level audits, and ensuring strict adherence to treatment guidelines.

Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization’s “Access, Watch and Reserve” (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.

[This corrects the article DOI: 10.3389/fphar.2021.639207.].

Objectives: The objective of this study was to analyze antibiotic prescribing patterns in pediatric outpatients in a tertiary care teaching hospital in Eastern India, to identify use of World Health Organization (WHO) access, watch and reserve (AWaRe) antibiotics and to identify rationality of prescribing on the basis of WHO core prescribing indicators. Materials and Methods: Scanned copies of prescriptions were collected from the pediatrics outpatients and antibiotic utilization pattern was analyzed in reference to WHO AWaRe groupings and core prescribing indicators. Results: Over the 3 months study period, 310 prescriptions were screened. The prevalence of antibiotic use 36.77%. The majority of the 114 children who received antibiotics were males (52.64%, 60) and belonged to 1-5 year age group (49.12%, 56). The highest number of antibiotic prescriptions was from the penicillin class (58, 46.60%) followed by cephalosporin (23.29%) and macrolide (16.54%). Most number of prescribed antibiotics belonged to Access group (63, 47.37%), followed by Watch group (51, 38.35%). Average number of drugs per prescription was 2.66, percentage of encounters with injections were 0.64%. Most of the prescriptions were prescribed using generic name (74.18%, 612), 58.30% (481) of drugs were from WHO Model List of Essential Medicines for children. Conclusion: If antibiotics are indicated, more number of antibiotics from the Access group may be used for ambulatory children who attend outpatient department of tertiary care hospitals. A simple combination of metrics based on AWaRe groups and core prescribing indicators may eliminate the problem of unnecessary antibiotic prescribing in children and may broaden the antibiotic stewardship opportunities.