Background: Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia). Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores’ performance in predicting mortality. Results: Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25–0.94) and 0.96 (95% CI = 0.49–1.00), and for CRB-65, 0.09 (95% CI = 0.01–0.48) and 0.93 (95% CI = 0.50–0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73–0.96) and 0.64 (95% CI = 0.45–0.79), and for CRB-65, 0.99 (95% CI = 0.95–1.00) and 0.43 (95% CI = 0.24–0.64). Conclusions: CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).

Objective: To identify drug information (DI) resources commonly used by pharmacy students of King Faisal University, Saudi Arabia, and to assess their ability to determine the appropriate ones for different clinical situations. Methods: A cross-sectional study was conducted in April 2014 (n=92). A paper-based questionnaire was developed, validated, and administered to fifth-year Pharm.D. students and advanced pharmacy practice experience (APPE) interns. It investigated the students’ DI sources preferences. Besides, it evaluated their competency in classifying DI resources and identifying the best resource to answer case-based multiple-choice questions. Moreover, the study aimed at assessing the impact of providing a case-based combined module of evidence-based practice (EBP) and DI for fifth-year students (new study plan) compared to delivering separate EBP and DI modules through theoretical lectures (old study plan–APPE interns). Results: The preferred resources to the students were online recourses (85.86%), soft copy books (26.08%), and mobile applications (25%). For the DI mobile applications, Medscape was the most common (63.4%), followed by Micromedex (53.5%), Lexicomp (42.3%), and Dynamed (16.9%). Fifth-year students’ scores were significantly higher than APPE interns for the case-based questions. Students’ GPAs were moderately correlated with their total scores. Conclusion: Study participants preferred using electronic DI resources to printed ones. The combined EBP-DI course could be a better option as it links the DI knowledge to clinical situations.

The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and abstracts were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time; of these, three explored prescribing trends before and during COVID-19. The impact of ­intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients’ expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers’ experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR. 1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096. 2. Dyrkorn R, Gjelstad S, Espnes KA, Lindbæk M. Peer academic detailing on use of antibiotics in acute respiratory tract infections. A controlled study in an urban Norwegian out-of-hours service. Scand J Prim Health Care. 2016;34(2):180-5.

Background/Objectives: The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. Methods: This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. Results: The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. Conclusions: This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings.

Background: Since 2007, pharmacists in Wales have been able to train and practice as Pharmacist Independent Prescribers (PIPS). In 2020, the PIPS was piloted and later integrated into the community pharmacy contract in 2022. The PIPS specification includes several conditions, many of which require oral antibiotic treatment. Anecdotal evidence suggests that out-of-hours (OOH) services (weekdays 6:30 PM–8:00 AM, weekends, and holidays) contribute considerably to antibiotic prescribing. However, research on this in Wales’ PIPS is lacking. Aim: The study aimed to analyse oral antibiotic prescribing during the OOHs PIPS. Method: Data on All-Wales PIPS consultations were obtained from a national pharmacy database (June 2020–September 2022) and descriptively analysed, focusing on those involving oral antibiotics during OOHs. Prescriptions/consultations lacking explicit diagnoses were categorised using NICE Clinical Knowledge Summaries. Given their Clostridium difficile risk, 4Cs appropriateness (amoxicillin-clavulanate, cephalosporins, clindamycin, and fluoroquinolones) was assessed using local guidelines. Results: Of 30 401 consultations, 1961 were during OOHs; 772 resulted in 773 oral antibiotics prescribed. Most OOH consultations involved females ( n = 575; 74.48%); mean age: 44 years. Most OOH patients self-referred to the service ( n = 646; 83.68%); over half ( n = 409; 52.98%) reported making GP appointments if the service was unavailable. Urinary tract infections were the most treated conditions ( n = 327; 42.31%). Nitrofurantoin was the most prescribed ( n = 243; 31.40%). OOH prescribing of 4Cs was low ( n = 14; 1.81%) and generally guideline based. A small proportion of OOH conditions managed with oral antibiotics were outside the PIPS specification. Conclusion: The study provides insights into how community pharmacists contribute to OOH service delivery and patient care.