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50 ANTIBIOTIC RESISTANCE & STEWARDSHIP Several Classes of Antibiotics May Up Miscarriage Risk, Study Shows By Anuja Vaidya N umerous classes of antibiotics were associated with an uptick in risk of miscarriages, accord- ing to a study published in the Canadian Med- ical Association Journal. These classes of common an- tibiotics include macrolides, quinolones, tetracyclines, sulfonamides and metronidazole. Researchers examined 8,702 cases defined as clini- cally detected spontaneous abortions. They matched the cases with 87,020 control cases. The miscarriage occurred at 14 weeks of pregnancy. The study shows that 1,428 (16.4 percent) of the mis- carriage cases were exposed to antibiotics during ear- ly pregnancy, as compared to 11,018 (12.6 percent) among the control cases. However, erythromycin and nitrofurantoin (a common treatment for urinary tract infections in pregnant women) were not associated with increased risk. "Infections are prevalent during pregnancy," said Dr. Anick Bérard, of the Université de Montréal in Canada and a study author. "Although antibiotic use to treat infections has been linked to a decreased risk of pre- maturity and low birth weight in other studies, our in- vestigation shows that certain types of antibiotics are increasing the risk of spontaneous abortion, with a 60 percent to two-fold increased risk." n Appropriate Antimicrobial Prescribing Improves When Physician Autonomy is Preserved, Study Shows By Anuja Vaidya A behavioral approach focused on preserving physician autonomy and participation helps enhance the appropriateness of antimicrobial prescribing in hospitals, according to a study in JAMA Internal Medicine. e study, conducted by Dutch researchers from Oct. 1, 2011, through Dec. 31, 2015, included seven clinical departments in a ter- tiary care medical center and a general teach- ing hospital in e Netherlands. Researchers assessed 1,121 patient cases with 700 antimi- crobial prescriptions before the approach was implemented. ey assessed 882 patient cases with 531 antimicrobial prescriptions during the intervention period. e behavioral intervention involved offering prescribers a free choice of how to improve their antimicrobial prescribing. Prescribers were urged to choose improvements with higher potential for success based on a root cause analysis of inappropriate prescribing. e study shows that mean antimicrobial appropriateness increased from 64.1 percent at beginning of the intervention implemen- tation to 77.4 percent at the 12-month fol- low-up, a jump of 13.3 percent. Researchers did not identify a decrease in antimicrobial consumption. "Use of a behavioral approach preserving pre- scriber autonomy resulted in an increase in antimicrobial appropriateness sustained for at least 12 months. e approach is inexpen- sive and could be easily transferable to vari- ous healthcare environments," study authors concluded. n Patients More Likely to Receive Antibiotics From Mid- or Late- Career Physicians, Study Shows By Anuja Vaidya A study, published in the Annals of Internal Medicine, ex- amines the factors associated with antibiotic prescrib- ing for acute upper respiratory tract infections. Canadian researchers studied patients, aged 66 years or old- er, with nonbacterial acute upper respiratory tract infections at primary care physician practices. The study included 8,990 primary care physicians and 185,014 patients with a nonbac- terial AURI, including the common cold (53.4 percent), acute bronchitis (31.3 percent), acute sinusitis (13.6 percent) or acute laryngitis (1.6 percent). The study shows that 46 percent of patients received an antibi- otic prescription. Additionally, researchers found patients were more likely to re- ceive prescriptions: • From mid- and late-career physicians (5.1 percent) than early-career physicians (4.6 percent) • From physicians trained outside of Canada or the United States • From physicians who saw more than 25 patients per day as compared to those who saw fewer than 25 patients per day The study did not, however, examine physician rationale for prescribing antibiotics. n