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The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study.

Füri, J; Widmer, A; Bornand, D; Berger, C; Huttner, B; Bielicki, JA (2020) The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study. Antimicrob Resist Infect Control, 9 (1). p. 60. ISSN 2047-2994 https://doi.org/10.1186/s13756-020-00724-7
SGUL Authors: Bielicki, Julia Anna

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Abstract

BACKGROUND: In Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common infections in children and adults. METHODS: Hospital-based guidelines for oral community -based treatment of acute otitis media, sinusitis, tonsillopharyngitis, community-acquired pneumonia and afebrile urinary tract infection were identified in 2017 in an iterative process by contacting hospital pharmacists and infectious diseases specialists. Furthermore, newly available national guidelines published in 2019 were reviewed. Available pack sizes for recommended solid, dispersible and liquid antibiotic formulations were retrieved from the Swiss pharmaceutical register and compared with recommended regimens to determine optimal (no leftovers) and adequate (optimal +/- one dose) matches. RESULTS: A large variety of recommended regimens were identified. For adults, optimal and adequate packs were available for 25/70 (36%) and 8/70 (11%) regimens, respectively. Pack-regimen matching was better for WHO Watch (optimal: 15/24, 63%) than Access antibiotics (optimal: 7/39, 18%). For the four paediatric weight-examples and 42 regimens involving child-appropriate formulations, optimal and adequate packs were available for only 14/168 (8%) and 27/168 (16%), respectively. Matching was better for older children with higher body and for longer treatment courses > 7 days. CONCLUSIONS: Fixed antibiotic packs often do not match recommended treatment regimens, especially for children, potentially resulting in longer than necessary treatments and leftover doses in the community. As part of national stewardship, a move to an exact pill-count system, including for child-appropriate solid formulations, should be considered.

Item Type: Article
Additional Information: © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.
Keywords: Adults, Antibiotic stewardship, Children, Community prescribing, Prescribing guidelines
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Antimicrob Resist Infect Control
ISSN: 2047-2994
Language: eng
Dates:
DateEvent
8 May 2020Published
28 April 2020Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 32384939
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111994
Publisher's version: https://doi.org/10.1186/s13756-020-00724-7

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