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Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities. PLoS One 2020; 15:e0231798. [PMID: 32302359 PMCID: PMC7164616 DOI: 10.1371/journal.pone.0231798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To describe antibiotic prescription rates for Australian Aboriginal children aged <2 years living in three remote Northern Territory communities. DESIGN A retrospective cohort study using electronic health records. SETTING Three primary health care centres located in the Katherine East region. PARTICIPANTS Consent was obtained from 149 mothers to extract data from 196 child records. There were 124 children born between January 2010 and July 2014 who resided in one of the three chosen communities and had electronic health records for their first two years of life. MAIN OUTCOME MEASURES Antibiotic prescription rates, factors associated with antibiotic prescription and factors associated with appropriate antibiotic prescription. RESULTS There were 5,675 Primary Health Care (PHC) encounters for 124 children (median 41, IQR 25.5, 64). Of the 5,675 PHC encounters, 1,542 (27%) recorded at least one infection (total 1,777) and 1,330 (23%) had at least one antibiotic prescription recorded (total 1,468). Children had a median five (IQR 2, 9) prescriptions in both their first and second year of life, with a prescription rate of 5.99/person year (95% CI 5.35, 6.63). Acute otitis media was the most common infection (683 records, 38%) and Amoxycillin was the most commonly prescribed antibiotic (797 prescriptions, 54%). Of the 1,468 recorded prescriptions, 398 (27%) had no infection recorded and 116 (8%) with an infection recorded were not aligned with local treatment guidelines. CONCLUSION Prescription rates for Australian Aboriginal children in these communities are significantly higher than that reported nationally for non-Aboriginal Australians. Prescriptions predominantly aligned with treatment guidelines in this setting where there is a high burden of infectious disease.
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Tamhankar AJ, Nachimuthu R, Singh R, Harindran J, Meghwanshi GK, Kannan R, Senthil Kumar N, Negi V, Jacob L, Bhattacharyya S, Sahoo KC, Mahadik VK, Diwan V, Sharma M, Pathak A, Khedkar SU, Avhad D, Saxena S, Nerkar S, Venu V, Kumar S, Shandeepan G, Ranjit Singh K, Gashnga R, Kumar A. Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245141. [PMID: 31888272 PMCID: PMC6950494 DOI: 10.3390/ijerph16245141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Abstract
Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a ‘redline’ to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro–physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure—3000 Indian Rupees/day (US$~47), time for planning—1 day, program spread—4 days, program time—4 h, direct and indirect reach of the message—respectively 250 and 500 persons/event. A 2 min play entitled ‘Take antibiotics as prescribed by the doctor’ was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.
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Affiliation(s)
- Ashok J. Tamhankar
- Indian Initiative for Management of Antibiotic Resistance, 302, Aryans, Deonar, Mumbai 400088, India
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; (V.D.); (M.S.); (A.P.)
- Correspondence: or ; Tel.: +91-2225573179 or +91-9892465195
| | - Ramesh Nachimuthu
- Indian Initiative for Management of Antibiotic Resistance, Antibiotic Resistance and Phage Laboratory, Vellore Institute of Technology, Vellore 632014, India;
| | - Ravikant Singh
- Chief Functionary’s Office, Doctors For You, Lallubhai Compound, Mankhurd, Mumbai 400 043, India;
| | - Jyoti Harindran
- Departmentof Pharmaceutical Sciences, Centre for Professional and Advanced Studies, Cheruvandoor Campus, Ettumanoor, Kottayam, Kerala 686631, India;
| | - Gautam Kumar Meghwanshi
- Department of Microbiology, Maharaja Ganga Singh University, NH-15, Jaisalmer Road, Bikaner, Rajasthan 334 001, India;
| | - Rajesh Kannan
- Department of Microbiology, Bharathidhasan University, Thiruchirapalli, Tamilnadu 620024, India;
| | | | - Vikrant Negi
- Department of Microbiology, Dr. S.N. Medical College, Jodhpur, Rajasthan 342 001, India;
| | - Lijy Jacob
- Department of Biotechnology, St. Berchmans College, Changanassery, Kerala 686101, India;
| | - Sayan Bhattacharyya
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar 801507, India;
| | - Krushna Chandra Sahoo
- Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha 751023, India;
| | - Vijay Kumar Mahadik
- Department of Public Health and Environment, R.D Gardi Medical College, Ujjain, Madhya Preadesh 456006, India;
| | - Vishal Diwan
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; (V.D.); (M.S.); (A.P.)
- Medical Director’s office, Department of Public Health and Environment, R.D Gardi Medical College, Ujjain, Madhya Preadesh 456006, India
| | - Megha Sharma
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; (V.D.); (M.S.); (A.P.)
- Department of Pharmacology, R.D Gardi Medical College, Ujjain, Madhya Preadesh 456006, India
| | - Ashish Pathak
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; (V.D.); (M.S.); (A.P.)
- Department of Paediatrics, R.D Gardi Medical College, Ujjain, Madhya Preadesh 456006, India
| | - Smita U. Khedkar
- Bactest Laboratory and Dental College, Nashik, Maharashtra 422 005, India;
| | - Dnyaneshwar Avhad
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai 400088, India;
| | - Sonal Saxena
- Department of Microbiology, Lady Hardinge Medical College, Delhi 110 001, India;
| | - Sandeep Nerkar
- Chetana Laboratories, Nashik, Maharashtra 422009, India;
| | - Vaishali Venu
- Director-Health services’ offce, Doctors For You, Lallubhai Compound, Mankhurd, Mumbai, Maharashtra 400043, India;
| | | | - G. Shandeepan
- Doctors For You, Bandipore, Jammu and Kashmir 193502, India;
| | | | - Ridiamma Gashnga
- Doctors For You, Laitumkhrah Nongrim Road, Shillong, Meghalaya 793003, India;
| | - Arvind Kumar
- Doctors For You, A-58, Plot no. 7, Block A extension, Budh Vihar, Delhi, Budh Vihar, Delhi 110086, India;
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Farooqui HH, Mehta A, Selvaraj S. Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data. PLoS One 2019; 14:e0224848. [PMID: 31721809 PMCID: PMC6853304 DOI: 10.1371/journal.pone.0224848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health). We coded the diagnosis provided in the medical audit data to International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the prescribed antibiotics for the diagnosis to Anatomic Therapeutic Chemical (ATC) classification of World Health Organization (ATC index-2016). We calculated and reported antibiotic prescription rate per 1,000 persons per year, by age groups, antibiotic class and disease conditions. Our main findings are—approximately 519 million antibiotic prescriptions were dispensed in the private sector, which translates into 412 prescriptions per 1,000 persons per year. Majority of the antibiotic prescriptions were dispensed for acute upper respiratory infections (J06) (20.4%); unspecified acute lower respiratory infection (J22) (12.8%); disorders of urinary system (N39) (6.0%); cough (R05) (4.7%); and acute nasopharyngitis (J00) (4.6%) and highest antibiotic prescription rates were observed in the age group 0–4 years. To conclude our study reports first ever country level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-10 mapped disease conditions.
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Affiliation(s)
- Habib Hasan Farooqui
- Indian Institute of Public Health –Delhi, Public Health Foundation of India, Gurugram, Haryana, India
- * E-mail:
| | - Aashna Mehta
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
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Ranjalkar J, Chandy SJ. India's National Action Plan for antimicrobial resistance - An overview of the context, status, and way ahead. J Family Med Prim Care 2019; 8:1828-1834. [PMID: 31334140 PMCID: PMC6618210 DOI: 10.4103/jfmpc.jfmpc_275_19] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Antimicrobial resistance (AMR) is a multifaceted complex problem with momentous consequences for individuals as well as health-care systems. Understanding the gravity of the problem, the World Health Assembly has adopted the Global Action Plan on AMR in the year 2015 as a part of the tripartite collaboration with World Health Organization, Food and Agricultural Organization, and World Organization for Animal Health. India's National Action Plan (NAP) for AMR was released in April 2017 by the Union Ministry of Health and Family Welfare. The objectives of the NAP include improving awareness, enhancing surveillance measures, strengthening infection prevention and control, research and development, promoting investments, and collaborative activities to control AMR. On the basis of the NAP, various states have begun the process of initiating their State Action Plans. The aim of this article is to highlight some of the main components of the NAP and to make family physicians, general practitioners, and other stakeholders aware of the issue of AMR and its factors and what can be done. The article also discusses some of the challenges in implementation of NAP such as varied perceptions about antibiotic use and AMR among key stakeholders, inappropriate antibiotic use owing to a number of reasons, lack of diagnostic facilities, widespread use of antibiotics in various sectors, environmental contamination because of pharmaceutical industry, agricultural and hospital waste, gaps in infection prevention and control, and difficulty in enforcing regulations. Similar to other low-middle income countries (LMICs), lack of sufficient finances remains a major challenge in NAP implementation in India as well. Overall, a strong political will, inter-sectoral co-ordination between public and private sectors and comprehensive strengthening of the healthcare systems are necessary to achieve the desired forward momentum.
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Affiliation(s)
- Jaya Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sujith J Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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