The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010–2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010–2019) and a prediction interval was set up to assess whether the pandemic years’ observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.

Drug allergy prevalence is high and predicted to rise in the future. Although allergy labels are essential for patient safety, evidence supports the fact that incorrectly recorded drug allergy labels might lead to suboptimal treatments, increased healthcare costs, prolonged hospital stays, and the emergence of antimicrobial resistance (AMR). Drug allergy risk assessment and subsequent delabeling could be a solution for this problem. Despite the importance of this subject, the number of studies on the prevalence of drug allergies or delabeling is low, especially from Eastern European countries. This study aimed to determine the prevalence and characteristics of drug allergies in hospitalized patients and assess the associated risk of future exposure to the reported culprit drugs to evaluate the potential for allergy delabeling. A cross-sectional study was conducted at the tertiary care teaching hospital of University of Szeged in Hungary, involving adult inpatients across multiple surgical wards. Data collection included patient interviews using a structured questionnaire and subsequent risk assessment. Adverse drug reactions were categorized as high or low risk based on the history of the reported reaction. Of the 1522 study participants, 242 (15.90 %, 95 % CI: 14.14 - 17.82 %) patients reported at least one drug allergy, resulting in a total of 384 reported allergy cases. Among these, 277 cases were included in the risk assessment, with 252 (90.97 %) classified as low risk and eligible for potential allergy delabeling. Antibiotics were the most frequently reported culprit drug, followed by analgesics and anti-inflammatory drugs. Skin manifestations were the most common symptoms. This study highlights the high prevalence of self-reported drug allergies and the significant proportion of low-risk cases suitable for delabeling. Systematic allergy evaluation and delabeling should be a key element of (antibiotic) stewardship programs.

Background: Antimicrobial resistance (AMR) is a global health threat arising from inappropriate antibiotic use. Data on the prescription of antibiotics in emergency departments (EDs), critical care points for infection management, are limited. Objective: This study aimed to assess systemic antibiotic use in an Indonesian ED. Methods: This retrospective observational study was conducted in the Cilacap Teaching Hospital ED in 2022. Data, including patient demographics and systemic antibiotic prescription details (World Health Organization Anatomical Therapeutic Chemical (WHO ATC): J01) were extracted from electronic medical records. Antibiotic use was analyzed according to age groups (children [0–14 years], adults [15–64 years], and the elderly [≥65 years]), administration route, and the World Health Organization Access, Watch, and Reserve classification. Results: Among all ED visits during the study period, 52.1% (14,396/27,640) received systemic antibiotics, and adults comprised 68.5% (9861/14,396) of antibiotic-exposed cases. Cephalosporins were the most frequently prescribed antibiotics in all age groups (42.4–50.9%). Penicillins were more frequently prescribed in children (29.9%) than in adults (10.0%) and the elderly (6.6%), whereas fluoroquinolones were more commonly prescribed in the elderly (21.1%) than in adults (16.2%) and children (3.8%). Watch-class antibiotics, comprising 63.9% of all prescriptions, were commonly prescribed in the elderly (71.9%). Oral route was the predominant form (65.8%), particularly in children (76.5%). The most frequently prescribed antibiotics differed across age groups, with amoxicillin followed by cefixime in children, and cefixime followed by ceftriaxone in both adults and the elderly. Conclusions: This study showed high antibiotic exposure and identified age-related differences in antibiotic prescribing, and patterns that warrant further evaluation within antimicrobial stewardship frameworks, to optimize antibiotic use and mitigate AMR.