BACKGROUND: Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital.
METHODS: This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics.
RESULTS:  Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters.
CONCLUSIONS: The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings.
CONCLUSIONS:  Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

BACKGROUND: Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone.
METHODS: This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16.
RESULTS: The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days).
CONCLUSIONS: Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.

OBJECTIVE: This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality.
METHODS: A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24 h and one week after SMILE.
RESULTS: The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24 h and one week after SMILE (p > 0.05).
CONCLUSIONS: The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.

Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency >80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs.

UNASSIGNED: Inappropriate use of antibiotics may increase antimicrobial resistance (AMR) among different microorganisms and may lead to treatment failure in neonatal septicemia. The aim of this study was to recognize the most common microorganisms responsible for neonatal sepsis and to evaluate the trend of change of resistance pattern among microorganisms.
UNASSIGNED: This study was done retrospectively on 344 cases diagnosed with neonatal sepsis, including both early and late onset cases, admitted to the tertiary care teaching hospital of southern India from January 2012 to July 2017. Accordingly, 231 culture positive neonatal sepsis cases were collected from hospital data base and analyzed. Culture positive cases within 72 hours of life were termed as early onset while after 72 hours were late onset. Antibiotics utilization during the period was calculated using WHO AMC tool and reported as (DDD)/100 bed days.
UNASSIGNED: Klebsiella pneumoniae with 56 (21.8%) and Coagulase negative Staphylococcus with 52 (20.2%) cases were the most frequent isolated organisms which were responsible for 55.8% and 14.6% of deaths among the study subjects respectively. Amikacin (86.7%), vancomycin (52.3%) and ampicillin (40.6%) were the most used antibiotics in terms of DDD/100 bed days.
UNASSIGNED: The results obtained from our study have brought substantial information on the antibiotic resistance pattern among microorganisms causing neonatal sepsis. Moreover, results obtained from this study can be used for designing antibiotic stewardship policies to prevent the emergence of resistance and to improve the treatment outcome.

Food-producing animals, including dairy cattle, are potential reservoirs of antimicrobial resistance. However, there is limited data on antimicrobial use and the selection of resistant bacteria. Therefore, we investigated the association between antimicrobial use and resistance to mastitis pathogens using 2016 data from milk samples collected from cows with mastitis in 134 dairy farms in Chiba Prefecture, one of the principal dairy production prefectures in Japan. We recorded the antimicrobial use and isolation of methicillin-resistant staphylococci (MRS) and extended-spectrum beta-lactamase (ESBL)-producing coliforms (E. coli and Klebsiella spp.), and used the antimicrobial treatment incidence (ATI; the theoretical number of animals per 1000 animal-days subjected to antimicrobial treatment) to indicate antimicrobial use on each farm. The farms in which MRS or ESBL-producing coliforms were isolated from at least one mastitic milk sample were classified as antimicrobial resistance (AMR)-positive, and those in which neither MRS nor ESBL-producing coliforms were isolated were classified as AMR-negative. The AMR-positive farms showed a significantly higher ATI (median 45.17) than AMR-negative farms (median 38.40). The results indicate that high antimicrobial usage is associated with AMR in staphylococci and coliforms isolated from mastitic milk on dairy farms in Chiba Prefecture.

The use of antimicrobial agents in food-producing animals may lead to the emergence and spread of antimicrobial resistance in bacteria of animal origin. However, there is a paucity of data on the quantity of antimicrobials use on dairy farms in Japan. This study describes antimicrobial use on dairy farms from 1 January 2014 to 31 December 2016 in five administrative districts (central, eastern, western, southern and northern) of Chiba Prefecture. The use of antimicrobial agents in dairy cattle over these three years was evaluated in terms of the antimicrobial treatment incidence (ATI; theoretical number of animals per 1,000 animal-days subjected to antimicrobial treatment) using data collected from a total of 442 dairy farms in that prefecture. Our results revealed that the average ATI on these farms for these years ranged from 38.7 to 39.4 with no significant difference between years and that the average ATI for these administrative districts varied between 32.9 and 43.2 with a significant variation between some of the districts. Approximately 84% of antimicrobials were administered intramammarily, 13-14% by injection and 1-2% orally. Scenario analyses were performed to assess the effect of changes in some of the defined daily dose (DDDjp) values used to calculate the ATI. Our results revealed that the calculated ATI is considerably affected by the changes in the long-acting factor used for assigning the DDDjp values of intramammary products for dry cows and the way in which DDD values are assigned for combination products.

BACKGROUND: A significant Antibiotic-Monitoring-System is essential to analyse the use of antibiotics and to a better understanding of trends in resistance development. In human and veterinary medicine, for example, a system based on defined daily and treatment doses (Defined Daily Dose: DDD and Defined Course Dose: DCD) is applied. These definitions can be used to estimate the number of treatment days and treatments with antimicrobial agents in a population. For veterinary medicine, the European Medicines Agency (EMA) has published the European values DDDvet and DCDvet in the farm animal sector. The aim of this study was to define Swiss daily and treatment doses (DDDch and DCDch) for the treatment of pigs and to compare them with the EMA values in order to investigate the differences between individually collected national doses and average international doses. For the comparison, the quotient of Swiss and European values was calculated and the influence of the application form of an active substance and the number of active substances contained in a preparation was investigated. One hundred and three veterinary preparations with 138 active substances were assigned a DDDch and DCDch value. A comparison with EMA values was possible for 118 active substances. The comparison showed median values of 0.91 for the daily doses and 0.90 for the treatment doses, so that the daily and treatment doses in Switzerland are lower than the corresponding EMA doses. Both the form of application (injection solutions: 1.00; premixes: 0.76; P=0.02) and the number of active substances in the preparation (one active substance: 1.00; two active substances: 0.76; three active substances: 0.43; each P.
BACKGROUND: Zur Analyse des Antibiotikaeinsatzes und zum besseren Verständnis von Tendenzen in der Resistenzentwicklung ist ein aussagekräftiges Antibiotika-Monitoring- System essentiell. In der Human- und Veterinärmedizin wird beispielsweise ein System angewendet, das auf definierten Tages- und Behandlungsdosierungen (Defined Daily Dose: DDD und Defined Course Dose: DCD) beruht. Mittels dieser Definitionen lassen sich die Anzahl der Behandlungstage und Behandlungen mit antimikrobiellen Wirkstoffen in einer Population abschätzen. Die European Medicines Agency (EMA) hat für die Veterinärmedizin die europäischen Werte DDDvet und DCDvet im Nutztierbereich veröffentlicht. Ziel dieser Studie war es, schweizerische Tages- und Behandlungsdosierungen (DDDch und DCDch) für die Behandlung von Schweinen zu definieren und mit den Werten der EMA zu vergleichen, um die Unterschiede zwischen einzeln erhobenen, nationalen Dosierungen und durchschnittlichen, internationalen Dosierungen zu untersuchen. Für den Vergleich wurde der Quotient aus schweizerischen und europäischen Werten berechnet und der Einfluss der Anwendungsform eines Wirkstoffes sowie der Anzahl enthaltener Wirkstoffe in einem Präparat untersucht. Einhundertdrei Tierarzneimitteln mit 138 Wirkstoffen wurde ein DDDch- und DCDch- Wert zugewiesen. Für 118 Wirkstoffe war ein Vergleich mit Werten der EMA möglich. Aus dem Vergleich ergaben sich für die berechneten Quotienten Medianwerte von 0.91 bei den Tagesdosierungen und 0.90 bei den Behandlungsdosierungen, sodass in der Schweiz die Tages- und die Behandlungsdosierungen tiefer sind als die entsprechenden Dosierungen der EMA. Sowohl die Anwendungsform (Injektionslösungen: 1.00; Arzneimittelvormischungen: 0.76; P=0.02) als auch die Anzahl der Wirkstoffe im Präparat (ein Wirkstoff: 1.00; zwei Wirkstoffe: 0.76; drei Wirkstoffe: 0.43; je P.
BACKGROUND: Pour analyser l’utilisation des antibiotiques et mieux comprendre les tendances dans le développement de résistances, un système significatif de surveillance des antibiotiques est essentiel. En médecine humaine et vétérinaire, un système basé sur des dosages journaliers et des dosages par traitement définis (Defined Daily Dose: DDD et Dose Course Dose: DCD) est par exemple utilisé. Ces définitions peuvent être utilisées pour estimer le nombre de jours de traitement et le nombre de traitements antimicrobiens dans une population. L’Agence européenne des médicaments (EMA) a publié les valeurs européennes DDDvet et DCDvet dans le secteur de l’élevage pour la médecine vétérinaire. Le but de cette étude était de définir les doses journalières et les doses par traitement en Suisse (DDDch et DCDch) pour le traitement des porcs et de les comparer aux valeurs de l’EMA pour examiner les différences entre les doses nationales collectées individuellement et les doses internationales moyennes. Pour la comparaison, le quotient des valeurs suisses et européennes a été calculé et l’influence de la forme d’application d’une substance active ainsi que le nombre de substances actives contenues dans une préparation ont été examinés. Cent trois médicaments vétérinaires contenant 138 substances actives ont reçu une valeur DDDch et DCDch. Pour 118 médicaments, une comparaison avec les valeurs EMA était possible. D’après la comparaison, les valeurs médianes pour les quotients calculés étaient de 0,91 pour les doses journalières et de 0,90 pour les doses de traitement, de sorte qu’en Suisse, les doses journalières et de traitement sont inférieures aux doses correspondantes de l’EMA. La forme d’application (solutions injectables: 1.00, prémélanges médicamenteux: 0.76, P = 0.02) et le nombre de substances actives dans la préparation (une substance active: 1.00, deux substances actives: 0.76, trois substances actives: 0.43, P.
BACKGROUND: Un sistema significativo di monitoraggio degli antibiotici (Antibiotika-Monitoring-System) è essenziale per analizzarne l›uso e per comprendere meglio le tendenze nello sviluppo delle resistenze. Nella medicina umana e veterinaria, ad esempio, viene utilizzato un sistema che si basa su dosi giornaliere e terapeutiche definite (Defined Daily Dose: DDD e Defined Course Dose: DCD). Queste definizioni possono essere utilizzate in una popolazione, per stimare il numero di giorni di trattamento e i trattamenti con agenti antimicrobici. L’Agenzia europea per i medicinali (EMA) ha pubblicato i valori europei DDDvet e DCDvet per la medicina veterinaria nel settore dell’allevamento degli animali da reddito. Lo scopo di questo studio era di determinare, le dosi giornaliere e le dosi terapeutiche in Svizzera ­(DDDch e DCDch) per il trattamento dei suini e di confrontarle con i valori dell’EMA alfine di esaminare le differenze tra le dosi nazionali raccolte individualmente e le dosi internazionali medie. Per il confronto è stato calcolato il quoziente dei valori svizzeri ed europei ed è stata esaminata l’influenza della forma di applicazione di un principio attivo e il numero di principi attivi contenuti in un preparato. A 103 medicamenti veterinari con 138 sostanze attive è stato assegnato un valore DDDch e DCDch. Per 118 sostanze attive è stato possibile effettuare un confronto con i valori dell’EMA. Dal confronto sono emersi valori medi di 0,91 per le dosi giornaliere e di 0,90 per le dosi terapeutiche, per cui in Svizzera le dosi giornaliere e quelle terapeutiche sono inferiori alle corrispondenti dosi dell’EMA. Sia la forma di applicazione (soluzioni iniettabili: 1.00; premiscele di farmaci: 0.76; P=0.02) che il numero di principi attivi presenti nel preparato (un principio attivo: 1.00; due principi attivi: 0.76; tre principi attivi: 0.43; P.

BACKGROUND: This study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system.
METHODS: Utilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred.
RESULTS: The indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels.
CONCLUSIONS: The ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.

This study aimed to investigate the effect of antibiotic stewardship programs (ASP) on reducing antimicrobial resistance rate, antibiotics consumption and multi-drug resistance bacterial infections in the pediatric patients.
This study was carried out in the Pediatric Center of a tertiary hospital of Shandong Province, China. The study duration was separated into two periods according to introduction of ASP (began from April 2011). Before intervention: from April 2009 to March 2011; after intervention: from April 2012 to March 2014. The consumption of antibiotics, defined daily dose (DDD), isolation of multidrug-resistant organisms (MDRO) and resistance rate of antibiotics were analyzed and compared between the two study periods.
Total antibiotics consumption (DDDs) reduced from 56,725 in 2011 to 31,380 in 2014; antibiotic use density (AUD) reduced from 93.8 to 43.5; mean (± SD) antibiotic costs per patient (per quarter) decreased from 637 (± 29) RMB to 462 (± 49) RMB; and the mean total drug consumption (g)/DDD (DDDs) for inpatients decreased from 90.4 (± 3.3) to 56.4 (± 9.5). Multidrug-resistant microorganisms isolation reduced significantly from 463 (20.0) to 216 (6.9%). Resistance rate of general spectrum antibiotics reduced remarkably after intervention. The proportion of patients colonized or infected with Carbapenems-resistant Acinetobacter baumannii was correlated with DDDs of carbapenem.
Implementation of ASP leads to reduced medical expense, decrease of improper and abuse of antibiotics, and reduced antibiotics resistance rate and MDRO isolation. Continuous efforts to improve antibiotic use are required.