Data from primary care facilities in Japan indicate that antibiotic prescriptions for COVID-19 were clustered among a small proportion of clinics, researchers reported today in JAMA Network Open.

Using data from the Japan Medical Data Survey database, a team of US and Japanese researchers found that from April 2020 through February 2023, among 528,676 patients with COVID-19, 47,329 (9%) received antibiotic prescriptions, most commonly clarithromycin (25.1%), followed by cefcapene (19.9%), cefditoren (10.2%), levofloxacin (9.9%), and amoxicillin (9.4%). Monthly antibiotic prescription rates fell sharply in January 2022, dropping from 24.8% before to 7.5% after. Patients seen after January 2022 were older (31.8 vs 34.1 years) and less likely to have comorbidities (18.2% vs 10.7%) than those seen before January 2022.

While antibiotic prescription rate varied by clinic, the top 10% with the highest absolute number of antibiotic prescriptions accounted for 85.2% of all antibiotic prescriptions for COVID-19, with a mean antibiotic prescription rate of 29.0% before January 2022 vs 26.0% after. In comparison, the remaining 90% of clinics has a mean antibiotic prescription rate of 1.9% before and 1.6% after January 2022.

Antibiotic prescription rates were higher among adults aged 18 to 39 (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.37 to 2.09) and those aged 40 to 64 (aOR, 1.36; 95% CI, 1.11 to 1.66) than among children 18 and under. The presence of comorbidities was associated with higher prescription rates [aOR, 1.48; 95% CI, 1.09 to 2.00). Physicians aged 60 years and older were more than twice as likely to prescribe antibiotics (aOR, 2.38; 95% CI, 1.19 to 4.47) than those aged 44 years and younger.

"Our findings may be helpful for policy makers to develop interventions to encourage appropriate antibiotic use," the study authors wrote.

Yesterday in Pediatrics researchers mined vaccine records of 16,365 US children ages 19 to 35 months in 2019 to determine how many complete the seven common multidose vaccine series given in infancy and early childhood. They found 1 in 6 US children had incomplete vaccine series.

Currently the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends several vaccine series, each consisting of 1 to 4 doses, to protect against 15 diseases in the first 2 years of a child's life.

The present study surveyed a random sample of US caregivers who provided vaccine records for their children. The main outcome was uptake for the seven series of vaccines deemed most important for preventing childhood illness, which includes diphtheria, tetanus, and acellular pertussis (DTaP, 4 doses), pneumococcal conjugate vaccine (PCV, 4 doses), Haemophilus influenzae type b (Hib, 3–4 doses depending on brand), hepatitis B (HepB, 3 doses), polio (IPV, 3 doses), measles, mumps and rubella (MMR, 1 dose), and varicella (VAR, 1 dose) vaccines.

A total of 72.9% of children completed the entire vaccine series. Four out of seven of the vaccines had complete coverage 90% or greater, which is needed to confer herd immunity (IPV: 92.3%, MMR: 91.8%, HepB: 91.3%, and VAR: 90.9%). But DTaP, PCV, and Hib remained under target, at 83.3%, 82.5%, and 81.0% completion, respectively.

"Non-Hispanic White children, children whose families accessed care at private facilities, firstborn children, and children with private health insurance were more likely to have completed the combined 7-vaccine series," the authors wrote.

According to the authors, non-Hispanic Black children were at greater risk of not completing multidose series as compared with non-Hispanic White children (adjusted prevalence ratio [aPR]  1.28). And children from lower-income households and in rented homes were 25% to 30% more likely to fail to complete multidose vaccine series.

• Following Peru's emergency declaration earlier this month regarding a rise in Guillain-Barre syndrome (GBS) cases, the World Health Organization (WHO) today issued a risk assessment, which said more investigations are needed to determine the cause. Though the country typically registers fewer than 20 GBS cases a month, 130 suspected cases, 44 of them confirmed, were reported between June 10 and July 15. Peru experienced an unprecedented outbreak in 2019 that was linked to a specific Campylobacter jejuni genotype. Lab tests this year have confirmed the bacteria in 63% of 22 samples tested since the middle of June.
• In its latest mosquito-borne illness update, the Florida Department of Health (Florida Health) reported two more locally acquired dengue cases, raising the year's total to five. The state eliminated the virus in the 1930s and has often reported sporadic infections. Like the earlier cases, the two latest patients were both from Miami-Dade County. In other developments, Florida Health last week reported the first Eastern equine encephalitis (EEE) case of the year, which involved a patient from St Johns County, which is near St Augustine. Florida Health said the state typically records one or two human EEE cases each year.
• With sexually transmitted infections (STIs) on the rise in the wake of the COVID-19 pandemic, the WHO yesterday released new guidance updates to improve testing and diagnosis. It noted that challenges include new diseases such as mpox, alongside re-emerging ones and the spread of a Neisseria gonorrhoea isolate that is resistant to ceftriaxone. The guidance update includes target product profiles for point-of-care diagnostics for syphilis, Chlamydia, N gonorrhoea, and Trichomonas. A new edition of a lab manual now includes information on the use of molecular tests, rapid point-of-care tests, and quality management of diagnostic tests. It also unveiled a new publication on the diagnostics landscape to help meet the growing testing demands of low- and middle-income countries.