1 2 Overview Over time, antibiotics have significantly changed the medical practice; now, untreatable lethal infections can be successfully treated using antibiotics. Antibiotics have also made advancements in cancer treatment and made organ transplants possible (Pollack & Srinivasan, 2019). The benefits of antibiotics are generally suitable for public health; nevertheless, about 30% of the prescribed antibiotics in hospitals are either unnecessary or suboptimal. This fact has led patients to have serious effects because, like any other medications, antibiotics can cause harmful effects if used unnecessarily. The unnecessary use has also led to patients developing antibiotic resistance, a threat to public health. The reference (Pollack & Srinivasan, 2019) provides stewardship programs that can help the general clinical outcomes of antibiotics and reduce harm. Excessive use of antibiotics has also led to other related complications in a patient; this can be multi-drug resistance bacteria. The article by Labi et al. (2018) evaluated the use of antibiotics to promote the surveillance of antibiotics as a WHO recommendation to improve antibiotic use and control resistance. This next article by Nair et al. (2019) seeks to examine the informal and formal providers of the antibiotics and their knowledge of the effects and use while evaluating their practices on the same; antibiotic use. The patients are generally not versed with the correct information concerning antibiotics. A similar study was done in China to document the overuse and misuse of antibiotics, why they happen in the pastoral care systems, and the impact that non-degree trained physicians have on the misuse and overuse of antibiotics (Chang et al., 2019). The following qualitative study explores the drivers of antibiotic use among health workers, whether formal or informal, to explain 3 why they make prescription choices as they provide care. This study will also give an insight into patient knowledge, attitude, and expectation when seeking care (Nair et al., 2019). Hospital-acquired infections are on the rise in European countries, America, and other parts of the world. A study was done in three Swiss acute-care hospitals to reduce the infections and the role antibiotics play in doing so (Metsni et al., 2018). Inappropriate and unnecessary use of antibiotics leads to high costs and expenditure. Some antibiotics are prescribed for viral infections, the inappropriate use of antibiotics, especially in inpatient care, has generally led to high rates of bacterial resistance culminating in a public health crisis. Suda et al. (2018), Argue that decreasing the inappropriate use of antibiotics will potentially reduce the cost of medication. Much efforts have been made to improve antibiotic use without much success, no single intervention seems to work or have significant results, but a combination of varying interventions is more effective. The campaign was done to reduce this was targeted at healthcare workers and patients; the intervention focuses on educational sessions and informative resources for professionals in the health care and patients from urban and suburban areas in Egypt (Kandeel et al., 2019). A similar study was carried out in Germany to evaluate the determinants of practice in antibiotic prescribing patterns. It also evaluates the impact of the complex multi-intervention program in the hybrid approach (Poss-Doering et al., 202). The study was done on a sample of health professionals: physicians, medical assistants, and stakeholders. A study targeted the intervention stewardship program to ICU patients who have extensive use of antibiotics. The ICU is an appropriate place to measure the validity of antibiotic use, as stated by Kallen et al. (2018). Previous studies have used hospitalized non-ICU adults to implement the stewardship program, and most have left some room for improvement. 4 References Chang, Y., Chusri, S., Sangthong, R., McNeil, E., Hu, J., Du, W., … & Tang, L. (2019). Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China. PLoS One, 14(6), e0214779. Kallen, M. C., Roos-Blom, M. J., Dongelmans, D. A., Schouten, J. A., Gude, W. T., de Jonge, E., … & de Keizer, N. F. (2018). Development of actionable quality indicators and an action implementation toolbox for appropriate antibiotic use at intensive care units: a modified-RAND Delphi study. PLoS One, 13(11), e0207991. Kandeel, A., Palms, D. L., Afifi, S., Kandeel, Y., Etman, A., Hicks, L. A., & Talaat, M. (2019). An educational intervention to promote appropriate antibiotic use for acute respiratory infections in a district in Egypt-pilot study. BMC Public Health, 19(3), 1-10. Labi, A. K., Obeng-Nkrumah, N., Nartey, E. T., Bjerrum, S., Adu-Aryee, N. A., Ofori-Adjei, Y. A., … & Newman, M. J. (2018). Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey. Antimicrobial Resistance & Infection Control, 7(1), 1-9. Metsini, A., Vazquez, M., Sommerstein, R., Marschall, J., Voide, C., Troillet, N., … & Zingg, W. (2018). Point prevalence of healthcare-associated infections and antibiotic use in three large Swiss acute-care hospitals. Swiss medical weekly, 148, w14617. Nair, M., Tripathi, S., Mazumdar, S., Mahajan, R., Harshana, A., Pereira, A., … & Burza, S. (2019). Knowledge, attitudes, and practices related to antibiotic use in Paschim 5 Bardhaman District: a survey of healthcare providers in West Bengal, India. PLoS One, 14(5), e0217818. Nair, M., Tripathi, S., Mazumdar, S., Mahajan, R., Harshana, A., Pereira, A., … & Burza, S. (2019). “Without antibiotics, I cannot treat”: A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India. PLoS One, 14(6), e0219002. Pollack, L., & Srinivasan, A. (2019). Core Elements of Hospital Antibiotic Stewardship Programs From the Centers for Disease Control and Prevention. Clinical Infectious Diseases, 59(suppl_3), S97-S100. https://ift.tt/oOAnitd Poss-Doering, R., Kühn, L., Kamradt, M., Stürmlinger, A., Glassen, K., Andres, E., … & Wensing, M. (2020). Fostering appropriate antibiotic use in a complex intervention: Mixed-methods process evaluation alongside the cluster-randomized trial arena. Antibiotics, 9(12), 878. Suda, K. J., Hicks, L. A., Roberts, R. M., Hunkler, R. J., Matusiak, L. M., & Schumock, G. T. (2018). Antibiotic expenditures by medication, class, and healthcare setting in the United States, 2010–2015. Clinical Infectious Diseases, 66(2), 185-190.

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