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Xavier SP, da Silva AMC, Victor A. Antibiotic prescribing patterns in pediatric patients using the WHO access, watch, reserve (AWaRe) classification at a quaternary hospital in Nampula, Mozambique. Sci Rep 2024; 14:22719. [PMID: 39349590 PMCID: PMC11443130 DOI: 10.1038/s41598-024-72349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 09/05/2024] [Indexed: 10/04/2024] Open
Abstract
Antibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference. A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0-10 years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories. Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1-3 years and 28 days-12 months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria. 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection. All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy to combat AMR.
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Affiliation(s)
- Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso, Av. Fernando Correa da Costa, 2367 - Bairro Boa Esperança, Cuiabá, Mato Grosso, 78060-900, Brazil.
| | - Ageo Mario Cândido da Silva
- Institute of Collective Health, Federal University of Mato Grosso, Av. Fernando Correa da Costa, 2367 - Bairro Boa Esperança, Cuiabá, Mato Grosso, 78060-900, Brazil
| | - Audêncio Victor
- School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, 01246904, Brazil
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Almogbel Y, Mobark MA, Almutairi MS, Almogbel FS, Rabbani SI, Alhathloul S, Alamro S, Alatallah L. The Appropriateness of Empirical Uses of Antibiotics Based on Antimicrobial Susceptibility Results for Inpatients at a Tertiary Hospital in Saudi Arabia. Antibiotics (Basel) 2024; 13:824. [PMID: 39334998 PMCID: PMC11428488 DOI: 10.3390/antibiotics13090824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/24/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
The optimal use of antibiotics represents a cornerstone in controlling antibiotic resistance. Strategies such as antibiotic stewardship programs (ASPs) have been developed to influence the rational use of antibiotics. This study evaluated the appropriateness of the empirical use of antibiotics based on antibiotic susceptibility results with the aim of participating effectively in improving local ASPs. In a cross-sectional study conducted at a tertiary hospital in Saudi Arabia, 500 inpatients received empirical antibiotics, and their culture and sensitivity results were included. The appropriateness of the empirical use of antibiotics was determined based on their alignment with the culture and sensitivity results. More than half of the participants (56.4%) were men, and nearly half (43%) were over 61 years old. The empirical uses of antibiotics were appropriately prescribed in 58% of the patients. Ciprofloxacin and ceftriaxone were the most prescribed antibiotics, while vancomycin, piperacillin-tazobactam, and tigecycline were the most appropriately prescribed antibiotics. E. coli was the main microorganism isolated in the susceptibility results and was appropriately prescribed in 59% of the patients. The highest microbial sensitivity was observed for linezolid, vancomycin, and tigecycline. Antibiotics were appropriately prescribed empirically in more than half of the participants. Activating interventional ASP is crucial to fill the gap in prescribing antimicrobials. Considering the expected type of organisms and the local susceptibility pattern is likely to yield a more appropriate empirical use of antibiotics.
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Affiliation(s)
- Yasser Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Mugahid A Mobark
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Masaad S Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Faisal S Almogbel
- Family Medicine Academy, Qassim Health Cluster, Buraydah 52367, Saudi Arabia
- Preventive Medicine, King Fahd Specialist Hospital, Buraydah 52366, Saudi Arabia
| | - Syed I Rabbani
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Sultan Alhathloul
- PharmD Graduates, Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Shada Alamro
- PharmD Graduates, Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Lateefah Alatallah
- PharmD Graduates, Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
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Shanta AS, Islam N, Al Asad M, Akter K, Habib MB, Hossain MJ, Nahar S, Godman B, Islam S. Resistance and Co-Resistance of Metallo-Beta-Lactamase Genes in Diarrheal and Urinary-Tract Pathogens in Bangladesh. Microorganisms 2024; 12:1589. [PMID: 39203431 PMCID: PMC11356267 DOI: 10.3390/microorganisms12081589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/24/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024] Open
Abstract
Carbapenems are the antibiotics of choice for treating multidrug-resistant bacterial infections. Metallo-β-lactamases (MBLs) are carbapenemases capable of hydrolyzing nearly all therapeutically available beta-lactam antibiotics. Consequently, this research assessed the distribution of two MBL genes and three β-lactamases and their associated phenotypic resistance in diarrheal and urinary-tract infections (UTIs) to guide future policies. Samples were collected through a cross-sectional study, and β-lactamase genes were detected via PCR. A total of 228 diarrheal bacteria were isolated from 240 samples. The most predominant pathogens were Escherichia coli (32%) and Klebsiella spp. (7%). Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 50.4%, 65.6%, 66.8%, 80.5%, 54.4%, 41.6%, 25.7%, 41.2%, 37.2%, and 42.9%, respectively. A total of 142 UTI pathogens were identified from 150 urine samples. Klebsiella spp. (39%) and Escherichia coli (24%) were the major pathogens isolated. Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 93.7%, 75.0%, 91.5%, 93.7%, 88.0%, 72.5%, 13.6%, 44.4%, 71.1%, and 43%, respectively. Twenty-four diarrheal isolates carried blaNDM-1 or blaVIM genes. The overall MBL gene prevalence was 10.5%. Thirty-six UTI pathogens carried either blaNDM-1 or blaVIM genes (25.4%). Seven isolates carried both blaNDM-1 and blaVIM genes. MBL genes were strongly associated with phenotypic carbapenem and other β-lactam antibiotic resistance. blaOXA imparted significantly higher phenotypic resistance to β-lactam antibiotics. Active surveillance and stewardship programs are urgently needed to reduce carbapenem resistance in Bangladesh.
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Affiliation(s)
- Ayasha Siddique Shanta
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Nahidul Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Mamun Al Asad
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Kakoli Akter
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Marnusa Binte Habib
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Md. Jubayer Hossain
- Center for Health Innovation, Research, Action, and Learning—Bangladesh (CHIRAL Bangladesh), Dhaka 1205, Bangladesh;
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (A.S.S.); (N.I.); (M.A.A.); (K.A.); (M.B.H.); (S.N.)
- Faculty of Medicine and Health, School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
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Lambert M, Wonink A, Benko R, Plejdrup Hansen M, van Dijk L, Taxis K. Pharmacists combating antimicrobial resistance: A Delphi study on antibiotic dispensing. Res Social Adm Pharm 2024; 20:723-732. [PMID: 38702286 DOI: 10.1016/j.sapharm.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The daily work of community pharmacists includes dispensing antibiotics, but little is known about how this should be done to ensure quality use of antibiotics. OBJECTIVE To define specific tasks of the community pharmacist when dispensing antibiotics and to assess to what extent these tasks can be implemented in practice in Europe. METHODS A Delphi study with community pharmacist experts in the European Economic Area. Statements on potential tasks for pharmacists during the antibiotic dispensing process were based on a systematic literature review. Participants rated the statements for importance and feasibility of implementation in practice in 3 rounds on a scale from 1 to 9. Consensus of importance was defined as ≥ 80 % of experts rating a statement between 7 and 9. An online expert meeting was conducted between rounds 1 and 2. Scores for all statements were analysed descriptively. RESULTS Overall, 38 experts from 21 countries participated in the study. Experts reached consensus on 108 statements within 5 themes: 1) collaboration with prescribers, 2) checking prescriptions and dispensing, 3) counselling, 4) education, and 5) pharmacy services. Potential tasks included advising and collaborating with prescribers, performing safety checks, and having access to specific prescription information. Additionally, pharmacists should counsel patients related to the dispensed antibiotic and on antimicrobial resistance and infectious diseases. With few exceptions, pharmacists should not dispense antibiotics without prescriptions or prescribe antibiotics. Consensus on feasibility of implementation was only reached for statements in the categories "counselling patients" and "education". Barriers to changing practice included structure of the healthcare system, resistance to change from prescribers or pharmacy staff, lack of time and finances, legal barriers, and patient expectations. CONCLUSION Community pharmacists have an important role when dispensing antibiotics. This study provides important steps towards better community pharmacy antibiotic dispensing practices throughout the EEA.
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Affiliation(s)
- Maarten Lambert
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands.
| | - Anneloes Wonink
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
| | - Ria Benko
- Institute of Clinical Pharmacy and Albert Szent-Györgyi Medical Center, Central Pharmacy and Emergency Care Department, University of Szeged, 6720, Szeged, Hungary
| | | | - Liset van Dijk
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands; Nivel, Netherlands Institute for Health Services Research, 3513, CR, Utrecht, the Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, 9713, AV, Groningen, the Netherlands
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Semenova Y, Kassym L, Kussainova A, Aimurziyeva A, Makalkina L, Avdeyev A, Yessmagambetova A, Smagul M, Aubakirova B, Akhmetova Z, Yergaliyeva A, Lim L. Knowledge, Attitudes, and Practices towards Antibiotics, Antimicrobial Resistance, and Antibiotic Consumption in the Population of Kazakhstan. Antibiotics (Basel) 2024; 13:718. [PMID: 39200018 PMCID: PMC11350668 DOI: 10.3390/antibiotics13080718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024] Open
Abstract
During the COVID-19 pandemic, a ban on inspections of small businesses, including pharmacies, was imposed in Kazakhstan, which relaxed law enforcement efforts regarding the prohibition of over-the-counter antibiotic (AB) sales. This study aimed to investigate how this affected the knowledge, attitudes, and practices (KAP) related to AB and antimicrobial resistance (AMR), as well as to assess actual AB consumption at the community level. The study comprised two cross-sectional sub-studies: the first involved a KAP survey conducted in 2022 and 2024, utilizing the Special Eurobarometer questionnaire on AMR. The second sub-study analyzed AB consumption in 2021 and 2023, measured in defined daily doses per 1000 inhabitants. Results revealed an increase in the percentage of individuals reporting receipt of information about ABs and AMR in the past year (37.3% in 2022 vs. 52.9% in 2024, p < 0.001) and an increase in the percentage of individuals reporting AB use in the past year (49.0% in 2022 vs. 54.0% in 2024, p = 0.056). The most consumed ABs were from the Watch group, with azithromycin and ceftriaxone ranking highest. These findings support the hypothesis that the relaxation of law enforcement contributed to an increase in AB consumption and emphasize the need for public health policies to address this issue.
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Affiliation(s)
- Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (L.K.); (A.K.)
| | - Laura Kassym
- School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (L.K.); (A.K.)
| | - Assiya Kussainova
- School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan; (L.K.); (A.K.)
| | - Ainur Aimurziyeva
- School of Sciences and Humanities, Nazarbayev University, Astana 010000, Kazakhstan;
| | - Larissa Makalkina
- Department of Clinical Pharmacology, Astana Medical University, Astana 010000, Kazakhstan;
| | - Andrey Avdeyev
- Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana 010000, Kazakhstan;
| | - Aizhan Yessmagambetova
- Ministry of Health of the Republic of Kazakhstan, Astana 010000, Kazakhstan; (A.Y.); (Z.A.)
| | - Manar Smagul
- National Center of Public Healthcare, Astana 010000, Kazakhstan; (M.S.); (A.Y.)
| | | | - Zaure Akhmetova
- Ministry of Health of the Republic of Kazakhstan, Astana 010000, Kazakhstan; (A.Y.); (Z.A.)
| | - Ademi Yergaliyeva
- National Center of Public Healthcare, Astana 010000, Kazakhstan; (M.S.); (A.Y.)
| | - Lisa Lim
- Graduate School of Public Policy, Nazarbayev University Astana 010000, Kazakhstan;
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Nasehi MM, Effatpanah M, Gholamnezhad M, Karami H, Ghamkhar M, Armand N, Sohi YH, Mehrizi R, Ghamkhar L. Antibiotic prescription prevalence in Iranian outpatients: A focus on defined daily doses and the AWaRe classification system. Am J Infect Control 2024:S0196-6553(24)00607-2. [PMID: 39032834 DOI: 10.1016/j.ajic.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The inappropriate use and overprescription of antibiotics pose a global health threat, particularly contributing to antimicrobial resistance. This study aims to evaluate antibiotic prescription prevalence in Iranian outpatients using the defined daily doses (DDD) and Access, Watch, and Reserve classification systems. METHODS This retrospective study analyzed electronic prescriptions for systemic antibiotics in Tehran, Iran, from March 2022 to March 2023. The data were obtained from the Iranian Health Insurance Organization and processed using the Cross-Industry Standard Process. Descriptive statistics and DDD per 1,000 inhabitants per day were calculated. RESULTS A total of 817,178 antibiotic prescriptions were analyzed, with a sex distribution of 57.43% female and a median age of 48 years. On average, each patient received 1.89 antibiotics per prescription. Over 63% of antibiotics were classified in the "Watch" category, with Azithromycin being the most commonly prescribed (27.56%). The total DDD per 1,000 inhabitants per day was 4.99, with general practitioners accounting for 58.02% of the prescriptions, primarily prescribing Azithromycin. CONCLUSIONS The study emphasizes the high use of Watch group antibiotics, indicating a need for improved prescribing practices. Education on antibiotic stewardship and stricter guidelines are necessary to combat antimicrobial resistance. Continuous monitoring is crucial to optimize antibiotic use in outpatient settings in Iran.
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Affiliation(s)
- Mohammad Mahdi Nasehi
- Pediatric Neurology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran; Pediatric Neurology Department, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric Department, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, National Center for Health Insurance Research, Tehran, Tehran, Iran
| | - Mohammad Gholamnezhad
- Department of Infectious Diseases, Clinical Research Development Unit, Yasuj University of Medical Sciences, Yasuj, Kohgiluyeh and Boyer-Ahmad, Iran.
| | - Hossein Karami
- National Center for Health Insurance Research, Tehran, Tehran, Iran
| | - Maryam Ghamkhar
- Islamic Azad University Chalus Branch, Chalus, Mazandaran, Iran
| | - Nezam Armand
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karj, Alborz, Iran
| | | | - Reza Mehrizi
- National Center for Health Insurance Research, Tehran, Tehran, Iran
| | - Leila Ghamkhar
- National Center for Health Insurance Research, Tehran, Tehran, Iran.
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Li Q, Song M, Hu Z, Ding Y, Huang C, Liu J. Pediatric respiratory pathogen dynamics in Southern Sichuan, China: a retrospective analysis of gender, age, and seasonal trends. Front Pediatr 2024; 12:1374571. [PMID: 39086626 PMCID: PMC11288815 DOI: 10.3389/fped.2024.1374571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Objective To address the research gap in the epidemiology of pediatric respiratory tract infections (RTIs) in Luzhou, Southern Sichuan, China, by analyzing respiratory pathogens in a large pediatric cohort from 2018 to 2021, covering the pre- and during-COVID-19 periods. Methods This study conducted a retrospective analysis of children with RTIs in Luzhou from July 2018 to January 2021. Strict exclusion criteria were applied to ensure an accurate representation of the pediatric population. Pathogen detection included viruses, bacteria, and atypical agents. Results Pathogens were identified in 52.8% of 12,546 cases. Viruses accounted for 32.2% of infections, bacteria for 29.8%, and atypical agents for 29.7%, with significant findings of Staphylococcus aureus, Moraxella catarrhalis, and Mycoplasma pneumoniae. Age-related analysis indicated a higher incidence of bacterial infections in infants and viral infections in preschool-aged children, with atypical pathogens being most prevalent in 3-5-year-olds. Gender-based analysis, adjusted for age, revealed similar overall pathogen presence; however, females were more susceptible to viral infections, while males were more prone to Streptococcus pneumoniae. Notably, there was an unusual increase in pathogen cases during spring, potentially influenced by behavioral changes and public health measures related to COVID-19. Co-infections were identified as a significant risk factor for the development of pneumonia. Conclusion The study provides essential insights into the epidemiology of respiratory pathogens in pediatric populations, emphasizing the need for healthcare strategies tailored to age, gender, and seasonality. The findings highlight the impact of environmental and public health factors, including COVID-19 measures, on respiratory pathogen prevalence, underscoring the importance of targeted diagnostic and treatment protocols in pediatric respiratory infections.
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Affiliation(s)
- Qing Li
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Min Song
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhi Hu
- Department of Medical Laboratory, Southwest Medical University, Luzhou, China
| | - Yinhuan Ding
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chengliang Huang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinbo Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Province Engineering Technology Research Center of Molecular Diagnosis of Clinical Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Molecular Diagnosis of Clinical Diseases Key Laboratory of Luzhou, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Kurdi A, Al Mutairi N, Baker K, M-Amen K, Darweesh O, Karwi H, Seaton A, Sneddon J, Godman B. Impact of COVID-19 pandemic on the utilization and quality of antibiotic use in the primary care setting in England, March 2019-March 2023: a segmented interrupted time series analysis of over 53 million individuals. Expert Rev Anti Infect Ther 2024:1-12. [PMID: 38940069 DOI: 10.1080/14787210.2024.2368816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Amid the COVID-19 pandemic, we evaluated the short-term impact of COVID-19 on antibiotic use in primary care in England, focusing on both antibiotic quantity (overuse) and quality (misuse) of use. RESEARCH DESIGN AND METHODS A population-based segmented interrupted analysis was applied on monthly dispensed antibiotics prescriptions using the Prescription Cost Analysis dataset (March/2019-March/2023). The quantity was assessed using number of items dispensed per 1000 inhabitants (NTI) and defined daily doses per 1000 inhabitants per day (DID), while quality was evaluated using WHO's Access Watch Reserve (AWaRe) classification, the proportion of '4C' antibiotics and the percentage of broad- to narrow-spectrum antibiotics. RESULTS Findings indicate 8.6 (17.2%) and 0.4 (2.6%) increase in the NTI and DID, respectively, with a statistically significant uptick in trend noted after the second lockdown (β5) for 'total antibiotics' for NTI only (β5 = 1.6; 95% CI:0.17, 3.1). Quality assessment showed an increase in 'Access' antibiotics from 77% in March/2019 to 86% in March/2023; however, COVID-19 had no significant impact on WHO AWaRe classes. CONCLUSION COVID-19's impact on antibiotic use quality and quantity appeared to be minimal, though an increase in utilization post-second lockdown coincided with healthcare system recovery. This suggests a nuanced impact of the pandemic, highlighting the importance of continued antimicrobial stewardship.
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Affiliation(s)
- Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Regional Governorate, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Najla Al Mutairi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Kirmanj Baker
- Department of Surgery, College of Medicine, University of Kirkuk, Kirkuk, Iraq
| | - Karwan M-Amen
- Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
| | | | - Hardee Karwi
- Depatment of Clinical Pharmacy, Azadi Teaching Hospital, Kirkuk Health Directorate, Ministry of Health, Kirkuk, Iraq
| | - Andrew Seaton
- Department of Internal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow, UK
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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9
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Al Balushi H, Kurdi A, Almutairi N, Baker KI, Amen KM, Karwi H, Seaton A, Godman B. Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis. Expert Rev Anti Infect Ther 2024:1-11. [PMID: 38836493 DOI: 10.1080/14787210.2024.2363485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19's long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. RESEARCH DESIGN AND METHODS A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and "4C"-antibiotics. RESULTS Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of "4C" antibiotic reduced significantly after the second lockdown. CONCLUSIONS Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.
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Affiliation(s)
- Hayam Al Balushi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Directorate General of Pharmaceutical Affairs and Drug Control, Ministry of Health, Oman
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Kurdistan Regional Governorate, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Najla Almutairi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | | | - Karwan M Amen
- Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
| | - Hardee Karwi
- Azadi Teaching Hospital, Kirkuk Health Directorate, Ministry of Health, Kirkuk, Iraq
| | - Andrew Seaton
- Department of Internal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
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10
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Sarker S, Neeloy RM, Habib MB, Urmi UL, Al Asad M, Mosaddek ASM, Khan MRK, Nahar S, Godman B, Islam S. Mobile Colistin-Resistant Genes mcr-1, mcr-2, and mcr-3 Identified in Diarrheal Pathogens among Infants, Children, and Adults in Bangladesh: Implications for the Future. Antibiotics (Basel) 2024; 13:534. [PMID: 38927200 PMCID: PMC11200974 DOI: 10.3390/antibiotics13060534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Colistin is a last-resort antimicrobial for treating multidrug-resistant Gram-negative bacteria. Phenotypic colistin resistance is highly associated with plasmid-mediated mobile colistin resistance (mcr) genes. mcr-bearing Enterobacteriaceae have been detected in many countries, with the emergence of colistin-resistant pathogens a global concern. This study assessed the distribution of mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes with phenotypic colistin resistance in isolates from diarrheal infants and children in Bangladesh. Bacteria were identified using the API-20E biochemical panel and 16s rDNA gene sequencing. Polymerase chain reactions detected mcr gene variants in the isolates. Their susceptibilities to colistin were determined by agar dilution and E-test by minimal inhibitory concentration (MIC) measurements. Over 31.6% (71/225) of isolates showed colistin resistance according to agar dilution assessment (MIC > 2 μg/mL). Overall, 15.5% of isolates carried mcr genes (7, mcr-1; 17, mcr-2; 13, and mcr-3, with co-occurrence occurring in two isolates). Clinical breakout MIC values (≥4 μg/mL) were associated with 91.3% of mcr-positive isolates. The mcr-positive pathogens included twenty Escherichia spp., five Shigella flexneri, five Citrobacter spp., two Klebsiella pneumoniae, and three Pseudomonas parafulva. The mcr-genes appeared to be significantly associated with phenotypic colistin resistance phenomena (p = 0.000), with 100% colistin-resistant isolates showing MDR phenomena. The age and sex of patients showed no significant association with detected mcr variants. Overall, mcr-associated colistin-resistant bacteria have emerged in Bangladesh, which warrants further research to determine their spread and instigate activities to reduce resistance.
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Affiliation(s)
- Shafiuzzaman Sarker
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Reeashat Muhit Neeloy
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Marnusa Binte Habib
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Mamun Al Asad
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | | | | | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
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11
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Broom J, Broom A, Kenny K, Konecny P, Post JJ. Regulating antimicrobial use within hospitals: A qualitative study. Infect Dis Health 2024; 29:81-90. [PMID: 38216402 DOI: 10.1016/j.idh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To examine how regulatory structures and processes focused on antimicrobial stewardship and antimicrobial resistance are experienced by hospital managers and clinicians. METHODS Forty-two hospital managers and clinicians working within accreditation and antimicrobial stewardship teams in three Australian hospitals participated in individual in-depth interviews. Thematic analysis was performed. RESULTS Thematic analysis revealed participants' experiences of hospital antimicrobial regulation and their perceptions of what would be required for meaningful antimicrobial optimisation. Theme 1: Experience of regulation of antimicrobials within hospitals: Participants described an increased profile of antimicrobial resistance with inclusion in regulatory requirements, but also the risks of bureaucratic manoeuvring to meet standards rather than governance-inducing systemic changes. Theme 2: Growth of accreditation processes and hospitals over time: Both regulatory requirements and hospitals were described as evolving over time, each manoeuvring in response to each other (e.g. development of short notice accreditation). Theme 3: Perceived requirements for change: Participants perceived a need for top-down buy-in, resource prioritisation, complex understanding of power and influence on clinician behaviour, and a critical need for medical engagement. CONCLUSIONS This study around antimicrobials shows the tension and dynamic relationship between regulatory processes and hospital responses, bringing to light the enduring balance of a system that positions itself to meet regulatory requirements and emerging "demands", without necessarily addressing the key underlying concerns. Antimicrobial resistance-related solutions are perceived as likely to require further resourcing and buy-in across multiple levels, engagement across professional streams and require strategies that consider complex systems change in order for regulatory structures to have potency.
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Affiliation(s)
- Jennifer Broom
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia.
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia.
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Jeffrey J Post
- School of Clinical Medicine, University of New South Wales, Sydney, Australia; Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.
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12
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Moja L, Zanichelli V, Mertz D, Gandra S, Cappello B, Cooke GS, Chuki P, Harbarth S, Pulcini C, Mendelson M, Tacconelli E, Ombajo LA, Chitatanga R, Zeng M, Imi M, Elias C, Ashorn P, Marata A, Paulin S, Muller A, Aidara-Kane A, Wi TE, Were WM, Tayler E, Figueras A, Da Silva CP, Van Weezenbeek C, Magrini N, Sharland M, Huttner B, Loeb M. WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections. Clin Microbiol Infect 2024; 30 Suppl 2:S1-S51. [PMID: 38342438 DOI: 10.1016/j.cmi.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML have been reviewed and categorized into three groups: Access, Watch, and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance and the implications for their appropriate use. The 2023 AWaRe classification provides empirical guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe, focussing on the clinical evidence base that guided the selection of Access, Watch, or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimizing the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update national prescribing guidelines, and supervise antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment.
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Affiliation(s)
- Lorenzo Moja
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland.
| | - Veronica Zanichelli
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Bernadette Cappello
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Pem Chuki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland
| | - Celine Pulcini
- APEMAC, and Centre régional en antibiothérapie du Grand Est AntibioEst, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Evelina Tacconelli
- Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Loice Achieng Ombajo
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Ronald Chitatanga
- Antimicrobial Resistance National Coordinating Centre, Public Health Institute of Malawi, Blantyre, Malawi
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China
| | | | - Christelle Elias
- Service Hygiène et Epidémiologie, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Sarah Paulin
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Arno Muller
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | | | - Teodora Elvira Wi
- Department of Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | - Wilson Milton Were
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Elizabeth Tayler
- WHO Regional Office for the Eastern Mediterranean (EMRO), World Health Organisation, Cairo, Egypt
| | | | - Carmem Pessoa Da Silva
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nicola Magrini
- NHS Clinical Governance, Romagna Health Authority, Ravenna, Italy; World Health Organization Collaborating Centre for Evidence Synthesis and Guideline Development, Bologna, Italy
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infections, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Benedikt Huttner
- Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; World Health Organization Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Canada
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13
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Ul Mustafa Z, Batool A, Ibrar H, Salman M, Khan YH, Mallhi TH, Meyer JC, Godman B, Moore CE. Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications. Expert Rev Anti Infect Ther 2024; 22:229-240. [PMID: 38146949 DOI: 10.1080/14787210.2023.2299387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). METHODS Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. RESULTS A total of 284 patients were included, most were male (66.9%), aged 30-50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the 'Watch' category (90.8%) followed by the 'Reserve' category (4.8%), similar to previous COVID-19 waves. CONCLUSION There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Arfa Batool
- Department of Medicine, Sheikh Zaid Medical College, Rahim Yar Khan, Pakistan
| | - Hadia Ibrar
- Department of Medicine, Wah Medical College, Rawalpindi, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
| | - Catrin E Moore
- Centre for Neonatal and Pediatric Infection, St. George's University of London, London, UK
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14
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Alnezary FS, Alamri AR, Alrehaili RD, Alnizari DS, Alzahrani F, Mahmoud M, Almutairi MS, Kurdi A, Godman B. Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR. Front Pediatr 2024; 12:1342493. [PMID: 38562134 PMCID: PMC10982503 DOI: 10.3389/fped.2024.1342493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Method Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. Results 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. Conclusion A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.
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Affiliation(s)
- Faris S. Alnezary
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Amira R. Alamri
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Rafa D. Alrehaili
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Dina S. Alnizari
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Fahad Alzahrani
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Mansour Mahmoud
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Masaad S. Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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15
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Zhang J, Lin L, Lu G, Wu K, Tian D, Tang L, Ma X, Wang Y, Liu G, Li Y, Qian J, Wang P, Cao Q, Zhang W, Wu L, Si L, Wu Y, Zheng Y, Shen K, Deng J, Li D, Yang Y. Patterns of antibiotic administration in Chinese neonates: results from a multi-center, point prevalence survey. BMC Infect Dis 2024; 24:186. [PMID: 38347526 PMCID: PMC10863225 DOI: 10.1186/s12879-024-09077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES In this study, we describe the patterns of antibiotic prescription for neonates based on World Health Organization's (WHO) Essential Medicines List Access, Watch, and Reserve (AWaRe), and the Management of Antibiotic Classification (MAC) Guidelines in China. METHODS One-day point-prevalence surveys (PPS) on antimicrobial prescriptions were conducted on behalf of hospitalized neonates in China from September 1 and November 30, annually from 2017 to 2019. RESULTS Data was collected for a total of 2674 neonatal patients from 15 hospitals in 9 provinces across China of which 1520 were newborns who received at least one antibiotic agent. A total of 1943 antibiotic prescriptions were included in the analysis. The most commonly prescribed antibiotic was meropenem (11.8%). The most common reason for prescribing antibiotic to neonates was pneumonia (44.2%). There were 419 (21.6%), 1343 (69.1%) and 6 (0.3%) antibiotic prescriptions in the Access, Watch and Reserve groups, respectively. According to MAC Guidelines in China, there were 1090 (56.1%) antibiotic agents in the Restricted and 414 (21.3%) in the Special group. CONCLUSION Broad-spectrum antibiotics included in the Watch and Special groups were likely to be overused in Chinese neonates.
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Affiliation(s)
- Jiaosheng Zhang
- Department of Infectious diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Li Lin
- Department of Respiratory, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Keye Wu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Daiyin Tian
- Department of Respiratory, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lanfang Tang
- Department of Respiratory, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Ma
- Department of Respiratory, Children's Hospital Affiliated to Shandong University & Jinan Children's Hospital, Jinan, China
| | - Yajuan Wang
- Neonatal Department, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yanqi Li
- Department of Respiratory, Xi'an Children's Hospital, Xi'an, China
| | - Jing Qian
- Department of Respiratory, Children's Hospital Attached to the Capital Institute of Pediatrics, Beijing, China
| | - Ping Wang
- Neonatal Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenshuang Zhang
- Department of Respiratory, Tianjin Children's Hospital, Tianjin, China
| | - Lijuan Wu
- Clinical Laboratory, Bao'an Maternity & Child Health Hospital, Shenzhen, China
| | - Ligang Si
- Department of Pediatric, The sixth Hospital of Haerbin Medical University, Haerbin, China
| | - Yue Wu
- Department of Pharmacy, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuejie Zheng
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Kunling Shen
- Department of Internal Medicine, Shenzhen Children's Hospital, Shenzhen, China
- Department of Respiratory, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China.
| | - Defa Li
- Shenzhen Clinical College of Pediatrics, Shantou University Medical College, Shenzhen, China.
- Clinical laboratory, Shenzhen Children's Hospital, Shenzhen, China.
| | - Yonghong Yang
- Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China.
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16
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Baltas I, Kavallieros K, Konstantinou G, Koutoumanou E, Gibani MM, Gilchrist M, Davies F, Pavlu J. The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study. JAC Antimicrob Resist 2024; 6:dlae010. [PMID: 38304723 PMCID: PMC10833646 DOI: 10.1093/jacamr/dlae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Objectives Fluroquinolone prophylaxis during haematopoietic cell transplantation (HCT) remains contentious. We aimed to determine its effectiveness and association with exposure to treatment antimicrobials and antimicrobial resistance. Methods All admission episodes for HCT (N = 400 , 372 unique patients) in a tertiary centre between January 2020 and December 2022 were studied. Allogeneic HCT (allo-HCT) recipients received prophylaxis with ciprofloxacin during chemotherapy-induced neutropenia, while autologous HCT (auto-HCT) recipients did not. Results Allo-HCT was performed for 43.3% (173/400) of patients, auto-HCT for 56.7% (227/400). Allo-HCT was associated with an average of 1.01 fewer infection episodes per 100 admission days (95% CI 0.62-1.40, P < 0.001) compared with auto-HCT. In allo-HCT, the total exposure to all antimicrobials was higher [+24.8 days of therapy (DOT)/100 admission days, P < 0.001], as was exposure to ciprofloxacin (+40.5 DOT/100 admission days, P < 0.001). By contrast, exposure to meropenem (-4.5 DOT/100 admission days, P = 0.02), piperacillin/tazobactam (-5.2 DOT/100 admission days, P < 0.001), aminoglycosides (-4.5 DOT/100 admission days, P < 0.001) and glycopeptides (-6.4 DOT/100 admission days, P < 0.001) was reduced. Enterobacteriaceae isolated during allo-HCT were more resistant to ciprofloxacin (65.5%, 19/29 versus 6.1%, 2/33, P < 0001), ceftriaxone (65.5%, 19/29 versus 9.1%, 3/33, P < 0.001), other antimicrobial classes. Vancomycin-resistant enterococci were more common in allo-HCT recipients (11%, 19/173 versus 0.9%, 2/227, P < 0.001). Inpatient mortality during allo- and auto-HCT was 9.8% (17/173) and 0.4% (1/227). respectively (P < 0.001). Conclusions Ciprofloxacin prophylaxis in allo-HCT was associated with fewer infection episodes and reduced exposure to treatment antimicrobials. Mortality in auto-HCT remained low. A significant burden of antimicrobial resistance was detected in allo-HCT recipients.
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Affiliation(s)
- Ioannis Baltas
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Eirini Koutoumanou
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Malick M Gibani
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Mark Gilchrist
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Frances Davies
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Department of Infectious Disease, Imperial College NHS Healthcare Trust, St Mary's Hospital, London, UK
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Faculty of Medicine, Imperial College London, London, UK
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17
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Mudenda S, Chilimboyi R, Matafwali SK, Daka V, Mfune RL, Kemgne LAM, Bumbangi FN, Hangoma J, Chabalenge B, Mweetwa L, Godman B. Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC Antimicrob Resist 2024; 6:dlae023. [PMID: 38389802 PMCID: PMC10883698 DOI: 10.1093/jacamr/dlae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. Methods A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Robert Chilimboyi
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Department of Pharmacy, Saint Francis' Hospital, Private Bag 11, Katete, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | | | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, P.O. Box 30226, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, P.O. Box 31890, Lusaka, Zambia
| | - Larry Mweetwa
- Department of Science and Technology, Ministry of Technology and Science, Maxwell House, Los Angeles Boulevard, P. O. Box 50464, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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18
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Khan S, Bond SE, Lee-Milner J, Conway BR, Lattyak WJ, Aldeyab MA. Antimicrobial consumption in an acute NHS Trust during the COVID-19 pandemic: intervention time series analysis. JAC Antimicrob Resist 2024; 6:dlae013. [PMID: 38328263 PMCID: PMC10848649 DOI: 10.1093/jacamr/dlae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Objective To determine the impact of the COVID-19 pandemic on antimicrobial consumption and trends of therapeutic drugs for COVID-19 treatments, including corticosteroids, remdesivir and monoclonal antibodies (tocilizumab) from April 2017 to September 2022 in a secondary care NHS Trust in England. Methods A retrospective intervention time series analysis was conducted for April 2017 to September 2022 at the Mid Yorkshire Teaching NHS Trust. Data were retrieved from the pharmacy dispensing system as defined daily doses (DDDs) monthly and reported per 1000 occupied bed days (OBDs). Antimicrobial consumption and COVID-19 treatment options were measured. DDDs were calculated according to the classification of antimicrobials for systemic use (J01) and for other drugs classification. Trends for antimicrobial consumption and other therapeutic drugs for treating COVID-19 were also determined in each wave in England. Results During the pandemic: total antibiotic consumption decreased from 826.4 to 728.2 DDDs per 1000 OBDs (P = 0.0067); piperacillin/tazobactam use increased (P < 0.0001) and ciprofloxacin use decreased (P < 0.0001); there were no changes in Access, Watch, Reserve antibiotic use, and the proportion of antifungal consumption was consistent throughout the study. The use of total antibiotics (P = 0.024), levofloxacin (P = 0.0007), piperacillin/tazobactam (P = 0.0015) and co-amoxiclav (P = 0.0198) increased during wave one. Consumption of COVID-19 treatment drugs was highest during wave two, with 624.3 DDDs per 1000 OBDs for dexamethasone (P = 0.4441), 6.8 DDDs per 1000 OBDs for remdesivir (P < 0.0001) and 35.01 DDDs per 1000 OBDs for tocilizumab (P = 0.2544). Discussion This study determined the consumption of antimicrobials trends before and during the pandemic. The individual wave antimicrobial consumption indicates maximum consumption in the first wave, advocating for antimicrobial stewardship and preparedness for future pandemics.
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Affiliation(s)
- Sidra Khan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Stuart E Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Jade Lee-Milner
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - William J Lattyak
- Statistical Consulting Department, Scientific Computing Associates Corp., River Forest, IL 60305, USA
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
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19
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Ruckert A, Lake S, Van Katwyk SR. Developing a protocol on antimicrobial resistance through WHO's pandemic treaty will protect lives in future pandemics. Global Health 2024; 20:10. [PMID: 38297334 PMCID: PMC10829236 DOI: 10.1186/s12992-024-01015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024] Open
Abstract
Addressing antimicrobial resistance (AMR) through the pandemic treaty is a crucial aspect of pandemic prevention, preparedness, and response. At the moment, AMR-related provisions in the draft text do not go far enough and will likely lead countries to commit to the status-quo of AMR action. We suggest that the protocol mechanism of the treaty proposed under Article 31 offers an opportunity to develop a subsidiary agreement (or protocol) to further codify the specific obligations and enforcement mechanisms necessary to meet the treaty's AMR provisions. We also highlight experiences with previous treaty implementation that relied on protocols to inform design of a future AMR protocol.
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Affiliation(s)
- Arne Ruckert
- Global Strategy Lab, School of Global Health, York University, M3J 1P3, Toronto, ON, Canada.
| | - Shajoe Lake
- Global Strategy Lab, School of Global Health, York University, M3J 1P3, Toronto, ON, Canada
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20
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Massele A, Rogers AM, Gabriel D, Mayanda A, Magoma S, Cook A, Chigome A, Lorenzetti G, Meyer JC, Moore CE, Godman B, Minzi O. A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2195. [PMID: 38138298 PMCID: PMC10745081 DOI: 10.3390/medicina59122195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of 'Watch' antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.
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Affiliation(s)
- Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Anastasia Martin Rogers
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Deogratias Gabriel
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Ashura Mayanda
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Sarah Magoma
- Department of Infectious Diseases, Faculty of Medicine, University of Dodoma, Dodoma P.O. Box 582, Tanzania;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar Es Salaam P.O. Box 65013, Tanzania;
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21
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Teague E, Bezuidenhout S, Meyer JC, Godman B, Engler D. Knowledge and Perceptions of Final-Year Nursing Students Regarding Antimicrobials, Antimicrobial Resistance, and Antimicrobial Stewardship in South Africa: Findings and Implications to Reduce Resistance. Antibiotics (Basel) 2023; 12:1742. [PMID: 38136776 PMCID: PMC10740495 DOI: 10.3390/antibiotics12121742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Antimicrobial resistance (AMR) is being increasingly seen as the next pandemic due to high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final-year nursing students regarding antibiotic use, AMR, and antimicrobial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms® was undertaken among six universities in South Africa offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew that ceftazidime is not a fourth-generation cephalosporin, and only 16.1% knew that clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control, respectively, increase AMR. AMS was also not a well-known concept among final-year nurses. The lack of knowledge regarding antibiotics, AMR, and AMS among final-year nurses could have important repercussions in practice once these nurses are qualified. Consequently, this information gap needs to be urgently addressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa.
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Affiliation(s)
- Elisma Teague
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa;
| | - Selente Bezuidenhout
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa; (J.C.M.)
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa; (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa; (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Deirdré Engler
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa;
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22
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Alam M, Saleem Z, Haseeb A, Qamar MU, Sheikh A, Almarzoky Abuhussain SS, Iqbal MS, Raees F, Chigome A, Cook A, Moore CE, Mustafa ZU, Salman M, Saleh U, Shabbir S, Godman B. Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future. J Infect Public Health 2023; 16 Suppl 1:97-110. [PMID: 37973496 DOI: 10.1016/j.jiph.2023.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.
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Affiliation(s)
- Muniba Alam
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan; Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh EH16 4UX, UK
| | | | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London SW17 0RE, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London SW17 0RE, UK
| | - Zia-Ul- Mustafa
- Department of Pharmacy Services, District Headquarter Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Umar Saleh
- University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sana Shabbir
- University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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23
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Haseeb A, Abuhussain SSA, Alghamdi S, Bahshwan SM, Mahrous AJ, Alzahrani YA, Alzahrani AF, AlQarni A, AlGethamy M, Naji AS, Khogeer AAO, Iqbal MS, Godman B, Saleem Z. Point Prevalence Survey of Antimicrobial Use and Resistance during the COVID-19 Era among Hospitals in Saudi Arabia and the Implications. Antibiotics (Basel) 2023; 12:1609. [PMID: 37998811 PMCID: PMC10668720 DOI: 10.3390/antibiotics12111609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
The inappropriate prescribing of antimicrobials increases antimicrobial resistance (AMR), which poses an appreciable threat to public health, increasing morbidity and mortality. Inappropriate antimicrobial prescribing includes their prescribing in patients hospitalized with COVID-19, despite limited evidence of bacterial infections or coinfections. Knowledge of current antimicrobial utilization in Saudi Arabia is currently limited. Consequently, the objective of this study was to document current antimicrobial prescribing patterns among Saudi hospitals during the COVID-19 pandemic. This study included patients with or without COVID-19 who were admitted to five hospitals in Makkah, Saudi Arabia. Data were gathered using the Global PPS methodology and analyzed using descriptive statistics. Out of 897 hospitalized patients, 518 were treated with antibiotics (57.7%), with an average of 1.9 antibiotics per patient. There were 174 culture reports collected, representing 36.5% of all cases. The most common indication for antibiotics use was community-acquired infections, accounting for 61.4% of all cases. 'Watch' antibiotics were the most commonly prescribed antibiotics, with the cephalosporins and carbapenems representing 38.7% of all antibiotics prescribed, followed by the penicillins (23.2%). Notably, Piperacillin/Tazobactam and Azithromycin were prescribed at relatively higher rates for COVID-19 patients. These findings highlight the need for continuous efforts to optimize the rational use of antibiotics through instigating appropriate antimicrobial stewardship programs in hospitals and, as a result, reduce AMR in the country.
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Affiliation(s)
- Abdul Haseeb
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | | | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha 57911, Saudi Arabia
| | - Shahad M. Bahshwan
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Yazeed A. Alzahrani
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayte 62411, Saudi Arabia
| | - Albaraa Faraj Alzahrani
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Asem Saleh Naji
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Asim Abdulaziz Omar Khogeer
- Plan and Research Department, Ministry of Health (MOH), Makkah 12211, Saudi Arabia
- Medical Genetics Unit, Maternity & Children Hospital, Makkah Healthcare Cluster, Ministry of Health, Makkah 24382, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 16242, Saudi Arabia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
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Chiumia FK, Muula AS, Chimimba F, Nyirongo HM, Kampira E, Khuluza F. Effect of antibiotic medicines availability on adherence to standard treatment guidelines among hospitalized adult patients in southern Malawi. PLoS One 2023; 18:e0293562. [PMID: 37906554 PMCID: PMC10617696 DOI: 10.1371/journal.pone.0293562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Antibiotic resistance is a global public health problem. High and inappropriate use of antibiotic therapy exacerbate the risk of antibiotic resistance. We assessed the effect of availability of antibiotic medicines on adherence to standard treatment guidelines among hospitalized adult patients in Southern Malawi. METHODS A cross-sectional study was done to assess the availability of 16 antibiotics among the first-line recommended treatments for common bacterial infections in Malawi. Data for up to six-month duration was extracted from stock card records in Machinga and Nsanje District Hospitals and Zomba Central Hospital. This was complemented by a retrospective review of 322 patient management files from medical wards to assess adherence to the Malawi Standard Treatment Guidelines (MSTG). Investigators abstracted data such as patient demographics, diagnoses, and prescribed therapy using a data collection form that resulted in analyzing 304 patient files. Data was entered into Microsoft excel and analyzed using STATA 14.1. Point availability, stock-out duration and adherence to treatment guidelines were presented in terms of frequencies and percentages. Chi-square test or Fisher's exact test was applied to assess the association between variables and adherence to treatment guidelines. RESULTS Point availability of antibiotics was 81.5%, 87.7%, and 42.8% for Zomba Central, Machinga and Nsanje District Hospitals respectively. Over a period of six months, 12.5% of antibiotic medicines were stocked out for at least one day at Zomba (Median stock out days = 0, (IQR 0-0 days), while 64.3% were stocked out at Machinga (Median stock out days = 21, IQR 0-31 days) and 85.7% were stocked out at Nsanje District Hospital (Median stock out days = 66.5, IQR 18-113 days). Overall, adherence to MSTG was 79.6%, (95% CI, 73.3-84.9%). By facilities, adherence to guidelines at Zomba Central Hospital was 95.9% (95% CI, 89.7-98.9%) while at Nsanje and Machinga District Hospitals was 73.2% (95% CI, 59.7-84.2%) and 54.2% (95% CI, 39.2-68.6%) respectively. Adherence to treatment guidelines was associated with health facility, presence of laboratory test results, antibiotic spectrum, and WHO-AWaRe category of the medicine, p<0.005. Adherence was lower for antibiotics that were stocked out than antibiotics that were not stocked out during the study period (63.8%, 95% CI 48.5-77.3% vs 84.4%, 95% CI 77.7-89.8%), p< 0.002. CONCLUSION We found unstable availability of antibiotic medicines in hospitals which might contribute to the sub-optimal adherence to standard treatment guidelines. This is a setback to efforts aimed at curbing antibiotic resistance in Malawi.
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Affiliation(s)
- Francis Kachidza Chiumia
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Sinjani Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Frider Chimimba
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Happy Magwaza Nyirongo
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Kampira
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, Meyer JC. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1540. [PMID: 37887241 PMCID: PMC10604704 DOI: 10.3390/antibiotics12101540] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
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Affiliation(s)
- Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
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Kanan M, Ramadan M, Haif H, Abdullah B, Mubarak J, Ahmad W, Mari S, Hassan S, Eid R, Hasan M, Qahl M, Assiri A, Sultan M, Alrumaih F, Alenzi A. Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward. Antibiotics (Basel) 2023; 12:1504. [PMID: 37887205 PMCID: PMC10604829 DOI: 10.3390/antibiotics12101504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Antibiotic overuse poses a critical global health concern, especially in low- and middle-income countries (LMICs) where access to quality healthcare and effective regulatory frameworks often fall short. This issue necessitates a thorough examination of the factors contributing to antibiotic overuse in LMICs, including weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. To address these challenges, regulatory frameworks should be implemented to restrict non-prescription sales, and accessible point-of-care diagnostic tools must be emphasized. Furthermore, the establishment of effective stewardship programs, the expanded use of vaccines, and the promotion of health systems, hygiene, and sanitation are all crucial components in combating antibiotic overuse. A comprehensive approach that involves collaboration among healthcare professionals, policymakers, researchers, and educators is essential for success. Improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities are paramount. Equally important are education and awareness initiatives to promote responsible antibiotic use, the implementation of regulatory measures, the wider utilization of vaccines, and international cooperation to tackle the challenges of antibiotic overuse in LMICs.
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Affiliation(s)
- Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
| | - Maali Ramadan
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Hanan Haif
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Bashayr Abdullah
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Jawaher Mubarak
- Department of Pharmacy, Maternity and Children Hospital in Rafha, Rafha 76312, Saudi Arabia; (M.R.); (H.H.); (B.A.); (J.M.)
| | - Waad Ahmad
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Shahad Mari
- Department of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia; (W.A.); (S.M.)
| | - Samaher Hassan
- Department of Clinical Pharmacy, Jazan College of Pharmacy, Jazan 82726, Saudi Arabia;
| | - Rawan Eid
- Department of Pharmacy, Nahdi Company, Tabuk 47311, Saudi Arabia;
| | - Mohammed Hasan
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | - Mohammed Qahl
- Department of Pharmacy, Najran Armed Forces Hospital, Najran 66256, Saudi Arabia;
| | - Atheer Assiri
- Department of Pharmacy, Armed Forces Hospital Southern Region, Mushait 62562, Saudi Arabia; (M.H.); (A.A.)
| | | | - Faisal Alrumaih
- Department of Pharmacy, Northern Border University, Rafha 76313, Saudi Arabia;
| | - Areej Alenzi
- Department of Infection Control and Public Health, Regional Laboratory in Northern Border Region, Arar 73211, Saudi Arabia;
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Sefah IA, Nyamadi D, Kurdi A, Bugri AA, Kerr F, Yamoah P, Pichierri G, Godman B. Assessment of the quality of antimicrobial prescribing among hospitalized patients in a teaching hospital in Ghana: findings and implications. Hosp Pract (1995) 2023; 51:223-232. [PMID: 37489811 DOI: 10.1080/21548331.2023.2241344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/24/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE There is a need to assess the quality of antimicrobial prescribing in hospitals as a first step toward improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with Ghana's National Action Plan. METHODS A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical, and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of 'Watch' antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs). RESULTS Out of 217 patients' medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3%). Most of the antibiotics prescribed were in the WHO 'Watch' group (71.0%) followed by those in the 'Access' group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than 1 day, with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance with the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR = 0.013 CI 0.001-0.127, p-value = 0.001). CONCLUSION Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - David Nyamadi
- The School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | | | - Frances Kerr
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, Glasgow, UK
| | - Peter Yamoah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lawes Bridge Torbay Hospital, Torquay, UK
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
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Haseeb A, Saleem Z, Faidah HS, Saati AA, AlQarni A, Iqbal MS, Alghamdi S, Elrggal ME, AlGethamy M, Radwan RM, Mahrous AJ, Abuhussain SSA, Khayyat SM, Ibrahim K, Godman B, Sheikh A. Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:1299. [PMID: 37627718 PMCID: PMC10451798 DOI: 10.3390/antibiotics12081299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullmoin AlQarni
- Department of Infectious Diseases, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention & Control Program, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | | | - Sarah M. Khayyat
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Kiran Ibrahim
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG7 2QL, UK
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh EH16 4UX, UK
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Altaf U, Saleem Z, Akhtar MF, Altowayan WM, Alqasoumi AA, Alshammari MS, Haseeb A, Raees F, Imam MT, Batool N, Akhtar MM, Godman B. Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1237. [PMID: 37512049 PMCID: PMC10384799 DOI: 10.3390/medicina59071237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient's medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization's Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.
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Affiliation(s)
- Ummara Altaf
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore 54000, Pakistan; (U.A.); (M.F.A.)
- Department of Pharmaceutical Services, Ghurki Trust Teaching Hospital, Lahore 54000, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore 54000, Pakistan; (U.A.); (M.F.A.)
| | - Waleed Mohammad Altowayan
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (W.M.A.); (A.A.A.)
| | - Abdulmajeed A. Alqasoumi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (W.M.A.); (A.A.A.)
| | - Mohammed Salem Alshammari
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56215, Saudi Arabia;
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi Arabia;
| | - Narjis Batool
- Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia;
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK;
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Ngyedu EK, Acolatse J, Akafity G, Incoom R, Rauf A, Seaton RA, Sneddon J, Cameron E, Watson M, Wanat M, Godman B, Kurdi A. Selling antibiotics without prescriptions among community pharmacies and drug outlets: a simulated client study from Ghana. Expert Rev Anti Infect Ther 2023; 21:1373-1382. [PMID: 37975725 DOI: 10.1080/14787210.2023.2283037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Selling antibiotics without prescriptions is mostly illegal worldwide, including in Ghana, and promotes antimicrobial resistance. We evaluated the prevalence and practice of selling antibiotics without prescriptions among community pharmacies (CPs) and drug outlets, for the first time, in Ghana to quantify and characterize this issue to inform future interventions. RESEARCH DESIGN AND METHODS Two scenarios utilizing the Simulated Client Methodology were enacted: an upper respiratory tract infection of viral origin (scenario one); and pediatric diarrhea (scenario two). CPs/Outlets were selected by stratified proportional random sampling from four metropolitan cities (~14% of the total Ghanaian population). Selling of antibiotics was assessed at three demand levels and its overall prevalence was estimated, then stratified by the study variables. RESULTS Out of the 265 sampled CPs/outlets, the prevalence of selling antibiotic without prescription was 88.3% (n = 234/265), with variations not only across the four regions [92.5% (n = 123/133) in Kumasi, 87.5% (n = 14/16) in Cape Coast, 84.1% (n = 69/82) in Accra, and 82.4% (n = 28/34) in Tamale] but also across CPs [90% (n = 121/134)] and drug outlets [86% (n = 113/131)]. CONCLUSIONS A very high prevalence/sub-optimal practice of selling antibiotics without prescriptions was found. This highlights the need to increase compliance with antibiotic dispensing legislation through evidence-based interventions including education of key stakeholders.
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Affiliation(s)
- Eric Kofi Ngyedu
- Oral and Maxillofacial Surgery, Research Unit, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Joseph Acolatse
- Oral and Maxillofacial Surgery, Research Unit, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - George Akafity
- Oral and Maxillofacial Surgery, Research Unit, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Oral and Maxillofacial Surgery, Research Unit, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | | | - R Andrew Seaton
- Department is Infectious Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Elaine Cameron
- School of Psychology, University of Stirling, Stirling, UK
| | - Margaret Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
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Sulis G, Sayood S, Gandra S. How can we tackle the overuse of antibiotics in low- and middle-income countries? Expert Rev Anti Infect Ther 2023; 21:1189-1201. [PMID: 37746828 DOI: 10.1080/14787210.2023.2263643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Antibiotic overuse is a pressing global health concern, particularly in low- and middle-income countries (LMICs) where there is limited access to quality healthcare and insufficient regulation of antibiotic dispensation. This perspective piece highlights the challenges of antibiotic overuse in LMICs and provides insights into potential solutions to address this issue. AREAS COVERED This perspective explores key factors contributing to antibiotic overuse in LMICs, encompassing weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. It discusses regulatory frameworks to curb non-prescription sales, the role of accessible point-of-care diagnostic tools, challenges in implementing effective stewardship programs, the expanded use of vaccines, and the importance of health systems, hygiene, and sanitation. EXPERT OPINION In this article, we emphasize the need for a comprehensive approach involving collaboration among healthcare professionals, policymakers, researchers, and educators. We underscore the importance of improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities. The article also highlights the significance of education and awareness in promoting responsible antibiotic use, the role of regulatory measures, the expanded utilization of vaccines, and the need for international collaboration to address the challenges of antibiotic overuse in LMICs.
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Affiliation(s)
- Giorgia Sulis
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sena Sayood
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Hoxha I, Godman B, Malaj A, Meyer JC. 11-Year Trend in Antibiotic Consumption in a South-Eastern European Country; the Situation in Albania and the Implications for the Future. Antibiotics (Basel) 2023; 12:882. [PMID: 37237785 PMCID: PMC10215466 DOI: 10.3390/antibiotics12050882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
There are growing concerns with rising antimicrobial resistance (AMR) across countries. These concerns are enhanced by the increasing and inappropriate utilization of 'Watch' antibiotics with their greater resistance potential, AMR is further exacerbated by the increasing use of antibiotics to treat patients with COVID-19 despite little evidence of bacterial infections. Currently, little is known about antibiotic utilization patterns in Albania in recent years, including the pandemic years, the influence of an ageing population, as well as increasing GDP and greater healthcare governance. Consequently, total utilization patterns in the country were tracked from 2011 to 2021 alongside key indicators. Key indicators included total utilization as well as changes in the use of 'Watch' antibiotics. Antibiotic consumption fell from 27.4 DIDs (defined daily doses per 1000 inhabitants per day) in 2011 to 18.8 DIDs in 2019, which was assisted by an ageing population and improved infrastructures. However, there was an appreciable increase in the use of 'Watch' antibiotics during the study period. Their utilization rose from 10% of the total utilization among the top 10 most utilized antibiotics (DID basis) in 2011 to 70% by 2019. Antibiotic utilization subsequently rose after the pandemic to 25.1 DIDs in 2021, reversing previous downward trends. Alongside this, there was increasing use of 'Watch' antibiotics, which accounted for 82% (DID basis) of the top 10 antibiotics in 2021. In conclusion, educational activities and antimicrobial stewardship programs are urgently needed in Albania to reduce inappropriate utilization, including 'Watch' antibiotics, and hence AMR.
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Affiliation(s)
- Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1001 Tirana, Albania
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Admir Malaj
- Independent Researcher, 1001 Tirana, Albania
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
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Haseeb A, Saleem Z, Maqadmi AF, Allehyani RA, Mahrous AJ, Elrggal ME, Kamran SH, AlGethamy M, Naji AS, AlQarni A, Alhariqi KW, Khan MA, Ibrahim K, Raees F, Azmat A, Cook A, Campbell SM, Lorenzetti G, Meyer JC, Godman B, Moore CE. Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications. Antibiotics (Basel) 2023; 12:827. [PMID: 37237730 PMCID: PMC10215537 DOI: 10.3390/antibiotics12050827] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Aseel Fayk Maqadmi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Roaa Abdulrahman Allehyani
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
- Batterjee Medical College, Jeddah 21442, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Manal AlGethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia;
| | - Asem Saleh Naji
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Khalid W. Alhariqi
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | | | - Kiran Ibrahim
- Primary and Secondary Healthcare Department, DHQ Hospital Khushab, Khushab 41200, Pakistan;
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Stephen M. Campbell
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
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Saleem Z, Ahsan U, Haseeb A, Altaf U, Batool N, Rani H, Jaffer J, Shahid F, Hussain M, Amir A, Rehman IU, Saleh U, Shabbir S, Qamar MU, Altowayan WM, Raees F, Azmat A, Imam MT, Skosana PP, Godman B. Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications. Antibiotics (Basel) 2023; 12:678. [PMID: 37107040 PMCID: PMC10135394 DOI: 10.3390/antibiotics12040678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahuddin Zakaria University, Multan 60800, Pakistan
| | - Umar Ahsan
- Department of Infection Prevention and Control, Alnoor Specialist Hospital, Ministry of Health, Makkah 24241, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore 54000, Pakistan
| | - Narjis Batool
- Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia
| | - Hira Rani
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Javeria Jaffer
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Fatima Shahid
- Department of Pharmacy, Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Mujahid Hussain
- Department of Pharmacy, Indus Hospital and Health Network, Karachi 75190, Pakistan
| | - Afreenish Amir
- Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Umar Saleh
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Sana Shabbir
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Waleed Mohammad Altowayan
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj 11942, Saudi Arabia
| | - Phumzile P. Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Mustafa ZUI, Khan AH, Harun SN, Salman M, Godman B. Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications. Antibiotics (Basel) 2023; 12:646. [PMID: 37107008 PMCID: PMC10135218 DOI: 10.3390/antibiotics12040646] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being 'Watch' antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.
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Affiliation(s)
- Zia UI Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
| | - Sabariah Noor Harun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
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Mudenda S, Daka V, Matafwali SK. World Health Organization AWaRe framework for antibiotic stewardship: Where are we now and where do we need to go? An expert viewpoint. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e84. [PMID: 37179758 PMCID: PMC10173285 DOI: 10.1017/ash.2023.164] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/15/2023]
Abstract
The AWaRe classification categorizes antibiotics and is a tool for antimicrobial stewardship. To combat antimicrobial resistance, prescribers must adhere to the AWaRe framework, which promotes the rational use of antibiotics. Therefore, increasing political will, dedicating resources, building capacity, and improving awareness and sensitization campaigns may promote adherence to the framework.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Author for correspondence: Steward Mudenda, Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia. E-mail:
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Scott K. Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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