Background: Electronic medical record systems (EMRS) have transformed healthcare by improving quality, efficiency, and safety through centralized patient data and streamlined workflows. Challenges such as budget constraints and staff resistance hinder its adoption, particularly in resource-limited settings like India; however, they have not been investigated thoroughly. The objective of our study is to explore the benefits and barriers perceived by medical doctors in implementing EMRS in an Indian private-sector hospital. Methods: A cross-sectional study was conducted at a private hospital in a rural area of the Ujjain district, Madhya Pradesh, India. All 130 doctors pursuing postgraduate studies were invited to participate in person using a convenience sampling method. Responses from 105 doctors were received using a self-administered questionnaire. The survey captured participants’ attitudes, perceived benefits, and barriers to EMRS implementation in the facility. Descriptive statistics were used to analyse the data. Results: Of the respondents, 93% expressed a desire for EMRS implementation. Identified barriers included financial constraints, insufficient infrastructure, staffing shortages, and technological challenges, such as unreliable internet access. Participants highlighted the anticipated benefits, such as improved data accessibility, enhanced operational efficiency, and preferences for digitizing lab reports and e-prescriptions. Conclusion: Exploring and addressing the financial, organizational, and technological barriers as perceived by the participants are crucial steps to facilitate EMRS implementation in healthcare facilities. Larger in-depth studies are necessary to develop tailored strategies for overcoming these challenges in similar settings.

Patient-centered pharmacovigilance: A review

Background: Antibiotic resistance (ABR) remains a global health threat that requires urgent action. Antibiotic use is a key driver of ABR and is particularly problematic in the outpatient setting. General practitioners (GPs), the public, and pharmacists therefore play an important role in safeguarding antibiotics. In this study, we aimed to gain a better understanding of the antibiotic prescribing-use-dispensation dynamic in Malta from the perspective of GPs, pharmacists, and parents; Methods: we conducted 8 focus groups with 8 GPs, 24 pharmacists, and 18 parents between 2014 and 2016. Data were analysed using inductive and deductive content analysis; Results: Awareness on antibiotic overuse and ABR was generally high among interviewees although antibiotic use was thought to be improving. Despite this, some believed that antibiotic demand, non-compliance, and over-the-counter dispensing are still a problem. Nevertheless, interviewees believed that the public is more accepting of alternative strategies, such as delayed antibiotic prescription. Both GPs and pharmacists were enthusiastic about their roles as patient educators in raising knowledge and awareness in this context; Conclusions: While antibiotic use and misuse, and knowledge and awareness, were perceived to have improved in Malta, our study suggests that even though stakeholders indicated willingness to drive change, there is still much room for improvement.

Background: Antibiotic resistance (ABR) is a critical global health threat, disproportionately affecting low- and middle-income countries (LMICs) where systemic constraints, economic pressures and sociocultural factors drive inappropriate antibiotic use. While quantitative studies describe prevalence patterns, they fail to capture the underlying motivations and contextual barriers influencing prescribing and dispensing behaviors. This systematic review synthesizes qualitative evidence on the perceptions of healthcare professionals, patients, and caregivers regarding antibiotic use and explores the barriers and facilitators for implementing antibiotic stewardship programs in LMIC healthcare settings. Methods: We conducted a systematic review following PRISMA 2020 guidelines, based on a registered protocol in PROSPERO ID: CRD42024583749. Searches were performed in Medline, Embase, Cochrane Library, Web of Science, and Google Scholar for English-language studies published between 2014 and 2024. Qualitative and mixed-method studies examining stakeholder perspectives on antibiotic use and antibiotic stewardship implementation in LMICs were included. Studies were excluded if they focused exclusively on pediatric or neonatal populations, veterinary medicine, or quantitative outcomes without qualitative components. The data were analyzed using thematic analysis to identify and categorize codes and identify themes following methodological quality assessment of included studies using the Critical Appraisal Skills Programme Qualitative Studies Checklist by two independent reviewers. Results: Out of 2214 studies screened, a total of 119 studies from 33 LMICs were included, encompassing over 4000 participants across hospital, primary care, and community settings. Five interlinked themes emerged: (1) antibiotic use as a pragmatic response to diagnostic uncertainty and resource constraints; (2) financial and commercial drivers shaping prescribing and dispensing practices; (3) the disconnect between knowledge, sociocultural norms, and clinical behavior; (4) multi-level structural and professional barriers to antibiotic stewardship implementation; and (5) the critical role of health system vulnerabilities in perpetuating misuse. Conclusions: Inappropriate antibiotic use in LMICs reflects rational adaptations to systemic limitations rather than isolated knowledge gaps. Effective ABS strategies must address structural deficiencies, economic incentives, and sociocultural norms, while integrating context-specific interventions that strengthen health systems and engage all levels of care. The findings should, however, be evaluated in light of the geographic unevenness of the evidence base, the exclusion of non-English and gray literature, and lack of certainty assessments for synthesized themes.

Background: Digital databases such as pharmacovigilance (PV) databases could provide unique opportunities to monitor trends in suspected antibiotic resistance, ineffectiveness, and misuse, extending beyond their traditional role of tracking adverse drug reactions (ADRs). This approach is potentially valuable globally but particularly advantageous in lower‐middle‐income countries (LMICs) where formal resistance surveillance systems are often insufficiently developed. Leveraging PV data could help generate early signals of resistance and inappropriate antibiotic use and support antimicrobial stewardship in resource‐constrained settings. Objectives: To explore the potential use of PV databases in monitoring suspected antibiotic resistance trends and inappropriate use in LMICs. Methods: A retrospective cross‐sectional study was conducted using VigiBase. Data were extracted in October 2024 from inception to January 1, 2024. Reports involving antibacterials for systemic use, Anatomical Therapeutic Chemical (ATC) codes J01 and J04 from LMICs were included. Selected Medical Dictionary for Regulatory Activities (MedDRA) preferred terms were mapped according to RIOLE classification to the “resistance,” “ineffectiveness,” “off‐label use,” and “error” categories to identify reporting patterns. Descriptive statistics were used to summarize reports' characteristics, and associations between categorical variables were examined using chi‐squared tests. Results: A total of 1570 ICSRs from 37 LMICs were identified, yielding 2958 drug–adverse event pairs, with reporting increasing markedly after 2016. The “off‐label use” (38.6%) and “ineffectiveness” (37.0%) were the dominant RIOLE categories, driven mainly by the preferred terms (PTs) of Off‐label use (795; 26.4%) and Drug ineffective (751; 25.4%). Resistance‐related PTs accounted for 12.7% of pairs, most frequently Drug resistance (210; 7.0%) and Pathogen resistance (132; 4.5%), while “error” category (11.7%) was led by Product use issue (60; 2.0%) and Medication error (44; 1.5%). Watch antibiotics predominated, especially azithromycin, ceftriaxone, and meropenem, with significant associations observed between RIOLE categories and age, reporter type, ATC class, reaction outcome, AWaRe category, and WHO region. Conclusions: These findings demonstrate that PV databases can provide valuable insights into suspected antibiotic resistance and inappropriate use patterns in LMICs, supporting their potential role as additional data sources in antimicrobial stewardship.

Background: Pharmacovigilance (PV) is the activity to identify comprehensive information on the safety characteristics of the drug after its marketing. The PV data sources are dynamic, large, structured, and unstructured; therefore, the automation of data processing is essential. Purpose: This review aims to identify the machine learning applications in PV activities. Methods: Nine (9) studies that were published within the period from 2016 to 2020 were reviewed. The studies were extracted from two databases; PubMed and web of science. The review and analysis were done in December 2020. Results: The supervised and semi-supervised learning techniques are applied in the main three PV group activities; adverse drug reactions (ADRs) and signal detection, individual case safety reports (ICSRs) identification, and ADRs prediction. Future research is needed to identify the applicability of unsupervised learning in PV and to formulate the legal framework of the false positive predicted data.