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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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2
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Antibiotic Utilization during COVID-19: Are We Over-Prescribing? Antibiotics (Basel) 2023; 12:antibiotics12020308. [PMID: 36830218 PMCID: PMC9952319 DOI: 10.3390/antibiotics12020308] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
The aims of this study were to analyze the utilization of antibiotics before (2018, 2019) and during the COVID-19 pandemic (2020) and the practice of prescribing antibiotics in outpatient settings for COVID-19 patients during the 2020-2022 period. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose methodology was used for the analysis of outpatient antibiotic utilization in the Republic of Srpska. The data was expressed in DDD/1000 inhabitants/day. The rate of antibiotics prescribed to COVID-19 outpatients was analyzed using medical record data from 16,565 patients registered with B34.2, U07.1, and U07.2 World Health Organization International Classification of Diseases 10th revision codes. During 2020, outpatient antibiotic utilization increased by 53.80% compared to 2019. At least one antibiotic was prescribed for 91.04%, 83.05%, and 73.52% of COVID-19 outpatients during 2020, 2021, and the first half of 2022, respectively. On a monthly basis, at least one antibiotic was prescribed for more than 55% of COVID-19 outpatients. The three most commonly prescribed antibiotics were azithromycin, amoxicillin/clavulanic acid, and doxycycline. The trend of repurposing antibiotics for COVID-19 and other diseases treatment might be a double-edged sword. The long-term effect of this practice might be an increase in antimicrobial resistance and a loss of antibiotic effectiveness.
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3
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications. Hosp Pract (1995) 2022; 50:306-317. [PMID: 35980901 DOI: 10.1080/21548331.2022.2114251] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. METHODS A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. RESULTS The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files. CONCLUSIONS It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.
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Affiliation(s)
- Phumzile P Skosana
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Danie Kruger
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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4
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Sharma A, Singh A, Dar MA, Kaur RJ, Charan J, Iskandar K, Haque M, Murti K, Ravichandiran V, Dhingra S. Menace of antimicrobial resistance in LMICs: Current surveillance practices and control measures to tackle hostility. J Infect Public Health 2021; 15:172-181. [PMID: 34972026 DOI: 10.1016/j.jiph.2021.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial Resistance (AMR) is significant challenge humanity faces today, with many patients losing their lives every year due to AMR. It is more widespread and has shown a higher prevalence in low- and middle-income countries (LMICs) due to lack of awareness and other associated reasons. WHO has suggested some crucial guidelines and specific strategies such as antimicrobial stewardship programs taken at the institutional level to combat AMR. Creating awareness at the grassroots level can help to reduce the AMR and promote safe and effective use of antimicrobials. Control strategies in curbing AMR also comprise hygiene and sanitation as microbes travel from contaminated surroundings to the human body surface. As resistance to multiple drugs increases, vaccines can play a significant role in curbing the menace of AMR. This article summarizes the current surveillance practices and applied control measures to tackle the hostility in these countries with particular reference to the role of antimicrobial stewardship programs and the responsibilities of regulatory authorities in managing the situation.
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Affiliation(s)
- Ayush Sharma
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Akanksha Singh
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Mukhtar Ahmad Dar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Rimple Jeet Kaur
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Katia Iskandar
- Lebanese University, School of Pharmacy, Beirut, Lebanon; INSPECT-LB: Institute National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon; Universite Paul Sabatier UT3, INSERM, UMR1295, Toulouse, France
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, Malaysia
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - V Ravichandiran
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India; Department of Natural Products, National Institute of Pharmaceutical Education and Research, Kolkata, West Bengal, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India.
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5
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Saleem Z, Faller EM, Godman B, Malik MSA, Iftikhar A, Iqbal S, Akbar A, Hashim M, Amin A, Javeed S, Amir A, Zafar A, Sabih F, Hashmi FK, Hassali MA. Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211064714. [PMID: 36204499 PMCID: PMC9413637 DOI: 10.1177/23992026211064714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antibiotics are losing their effectiveness because of the rapid emergence of
resistant bacteria. Unnecessary antimicrobial use increases antimicrobial
resistance (AMR). There are currently no published data on antibiotic
consumption in Pakistan at the community level. This is a concern given high
levels of self-purchasing of antibiotics in Pakistan and variable knowledge
regarding antibiotics and AMR among physicians and pharmacists. Objective: The objective of this repeated prevalence survey was to assess the pattern of
antibiotic consumption data among different community pharmacies to provide
a baseline for developing future pertinent initiatives. Methods: A multicenter repeated prevalence survey conducted among community pharmacies
in Lahore, a metropolitan city with a population of approximately 10 million
people, from October to December 2017 using the World Health Organization
(WHO) methodology for a global program on surveillance of antimicrobial
consumption. Results: The total number of defined daily doses (DDDs) dispensed per patient ranged
from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from
pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a
total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin
with a total number of 486.6 DDDs and azithromycin with a total number of
472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime,
amikacin, and ofloxacin, with overall consumption highest in December. Conclusion: The study indicated high antibiotic usage among community pharmacies in
Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly
dispensed inappropriately. The National action plan of Pakistan on AMR
should be implemented by policymakers including restrictions on the
dispensing of antimicrobials.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | | | - Aqsa Iftikhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sonia Iqbal
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aroosa Akbar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Mahnoor Hashim
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aneeqa Amin
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sidra Javeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Afreenish Amir
- National University of Medical Sciences, Rawalpindi, Pakistan
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6
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction. Antibiotics (Basel) 2021; 10:antibiotics10080996. [PMID: 34439046 PMCID: PMC8388942 DOI: 10.3390/antibiotics10080996] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.
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Affiliation(s)
- Deirdré Engler
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Correspondence:
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Arcadia 0007, South Africa;
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- School of Pharmaceutical Sciences, University Sains Malaysia, George Town 118000, PNG, Malaysia
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7
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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8
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Saleem Z, Godman B, Azhar F, Kalungia AC, Fadare J, Opanga S, Markovic-Pekovic V, Hoxha I, Saeed A, Al-Gethamy M, Haseeb A, Salman M, Khan AA, Nadeem MU, Rehman IU, Qamar MU, Amir A, Ikram A, Hassali MA. Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications. Expert Rev Anti Infect Ther 2021; 20:71-93. [PMID: 34038294 DOI: 10.1080/14787210.2021.1935238] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan's national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan.Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR.Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town Malaysia
| | - Faiza Azhar
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Amna Saeed
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Manal Al-Gethamy
- Alnoor Specialist Hospital Makkah, Department of Infection Prevention & Control Program, Makkah, Kingdom of Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Kingdom of Saudi Arabia
| | - Muhammad Salman
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ayaz Ali Khan
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Muhammad Umer Nadeem
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inaam Ur Rehman
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Muhammad Usman Qamar
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
| | - Aamer Ikram
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
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9
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- 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;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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10
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Alkhaldi SM, Yaseen NA, Bataineh EA, Al-Rawashdeh B, Albadaineh MA, Mubarak SM, Jaras RE, Taha HA. Patterns of antibiotic prescribing and appropriateness for respiratory tract infections in a teaching hospital in Jordan. Int J Clin Pract 2021; 75:e14113. [PMID: 33629481 DOI: 10.1111/ijcp.14113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Inappropriate use of antibiotics is a public health concern that promotes antibiotic resistance globally. This study aimed to investigate the patterns of antibiotic prescribing for respiratory tract infections (RTIs) in Jordan to encourage judicious antibiotic prescribing. METHODS The researchers conducted a retrospective secondary analysis of oral antibiotics prescribed in the family medicine clinics in a teaching university hospital in Jordan in 2017. Antibiotic prescribing rates and the types of antibiotics prescribed were analysed. Patients' age, gender, type of insurance, and the RTIs diagnosis were investigated as possible factors that could be associated with inappropriate antibiotic prescribing for RTIs. RESULTS Our findings revealed that 20 133 prescriptions, (27.3%) of all the prescriptions issued in the family medicine clinics included an antibiotic. Penicillins accounted for 52.7% of all the antibiotics prescribed, followed by macrolides (21.6%) and cephalosporins (16.4%). The most common indication for prescribing the antibiotics was RTIs (51.1%). The majority of antibiotics prescribed for respiratory diagnosis were for upper RTIs (URTI) (61.5%), followed by otitis media (16.9%) and tonsillitis (15.4%). Only 28.8% of all the antibiotics prescribed were appropriate and indicated. Older patients were significantly more likely to be prescribed an antibiotic compared to the younger (P < .001). Also, hospital employees and university employees were significantly more likely to be prescribed an antibiotic compared to the Ministry of Health employees (P < .001). CONCLUSIONS Antibiotics were inappropriately prescribed, and their prescribing rate was high in the outpatient setting in the family medicine clinics studied in Jordan. This calls for policy-level interventions to promote judicious antibiotic prescribing to minimise the avoidable burden of microbial resistance and unnecessary expenditure.
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Affiliation(s)
- Sireen M Alkhaldi
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Nada A Yaseen
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Baeth Al-Rawashdeh
- Department of Special Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Sura M Mubarak
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Razan E Jaras
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Hana A Taha
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
- Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
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11
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications. Expert Rev Anti Infect Ther 2021; 19:1353-1366. [PMID: 33724147 DOI: 10.1080/14787210.2021.1898946] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Antimicrobial use is growing, driven mainly by rising demands in developing countries. Knowing how antimicrobials are prescribed is important. Consequently, we undertook a point prevalence survey (PPS) quantifying antimicrobial consumption among 18 public sector hospitals across South Africa.Method: A purpose-built web-based application was used to collect PPS data.Results: Out of 4407 adult patients surveyed, 33.6% were treated with an antimicrobial. The most frequently prescribed groups were a combination of penicillins including β-lactamase inhibitors. Amoxicillin combined with an enzyme inhibitor accounted for 21.4% total DDDs. In the medical and surgical wards, Access antimicrobials (54.1%) were mostly used, while in the ICU, Watch antimicrobials (51.5%) were mostly used. Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%; however, concerns with extended use of antimicrobials for surgical prophylaxis (73.2% of patients).Conclusion: The web-based PPS tool was easy to use and successful in capturing PPS data since the results were comparable to other PPS studies across Africa. High use of amoxicillin combined with an enzyme inhibitor, possibly because it was among the broad-spectrum antimicrobials in the Access group. The findings will assist with future targets to improve antimicrobial prescribing among public sector hospitals in South Africa.
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Affiliation(s)
- P P Skosana
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - N Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Kurdi
- 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
| | - M Bennie
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
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12
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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13
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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14
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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15
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Alrasheedy AA, Alsalloum MA, Almuqbil FA, Almuzaini MA, Aba Alkhayl BS, Albishri AS, Alharbi FF, Alharbi SR, Alodhayb AK, Alfadl AA, Godman B, Hill R, Anaam MS. The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia. Expert Rev Anti Infect Ther 2019; 18:87-97. [PMID: 31834825 DOI: 10.1080/14787210.2020.1705156] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes.Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios.Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively.Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.
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Affiliation(s)
| | - Muath A Alsalloum
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Feras A Almuqbil
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | | | - Ahmed S Albishri
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Faisal F Alharbi
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Saleh R Alharbi
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Abubakr A Alfadl
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ruaraidh Hill
- Evidence synthesis, Health Services Research, University of Liverpool, Liverpool, UK
| | - Mohammed S Anaam
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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16
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Jacobs TG, Robertson J, van den Ham HA, Iwamoto K, Bak Pedersen H, Mantel-Teeuwisse AK. Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review. BMC Health Serv Res 2019; 19:536. [PMID: 31366363 PMCID: PMC6670201 DOI: 10.1186/s12913-019-4359-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses. METHODS Both PubMed and Embase were systematically searched for studies reporting on impact measurement in moving towards prescription only access to antibiotics in LMICs. The PRISMA methodological review framework was used to ensure systematic data collection and analysis of literature. Narrative data synthesis was used due to heterogeneity of study designs. RESULTS In total, 15 studies were included that assessed policy impact in 10 different countries. Strategies employed to enforce regulations prohibiting OTC sales of systemic antibiotics included retention of prescriptions for antibiotics by pharmacies, government inspections, engaging pharmacists in the design of interventions, media campaigns for the general public and educational activities for health care workers. A variety of outcomes was used to assess the policy impact; changes in antimicrobial resistance rates, changes in levels of antibiotic use, changes in trends of antibiotic use, changes in OTC supply of antibiotics, and changes in reported practices and knowledge of pharmacists, medicine sellers and the general public. Differences in methodological approaches and outcome assessment made it difficult to compare the effectiveness of law enforcement activities. Most effective appeared to be multifaceted approaches that involved all stakeholders. Monitoring of the impact on total sales of antibiotics by means of an interrupted time series (ITS) analysis and analysis of pharmacies selling antibiotics OTC using mystery clients were the methodologically strongest designs used. CONCLUSIONS The published literature describing activities to enforce prescription-only access to antibiotics in LMICs is sparse and offers limited guidance. Most likely to be effective are comprehensive multifaceted interventions targeting all stakeholders with regular reinforcement of messages. Policy evaluation should be planned as part of implementation to assess the impact and effectiveness of intervention strategies and to identify targets for further activities. Robust study designs such as ITS analyses and mystery client surveys should be used to monitor policy impact.
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Affiliation(s)
- Tom G. Jacobs
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Jane Robertson
- World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
- University of Newcastle Calvary Mater Hospital, Edith St & Platt St, Waratah NSW, Newcastle, 2298 Australia
| | - Hendrika A. van den Ham
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Kotoji Iwamoto
- World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Hanne Bak Pedersen
- World Health Organization (WHO) Regional Office for Europe, UN City, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Aukje K. Mantel-Teeuwisse
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, David de Wied building, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
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17
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Robertson J, Iwamoto K, Hoxha I, Ghazaryan L, Abilova V, Cvijanovic A, Pyshnik H, Darakhvelidze M, Makalkina L, Jakupi A, Dzhakubekova A, Carp A, Cizmovic L, Rachina S, Radonjic V, Yusufi S, Aksoy M, Ibragimova M, Godman B, Kluge H, Pedersen HB. Antimicrobial Medicines Consumption in Eastern Europeand Central Asia - An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action. Front Pharmacol 2019; 9:1156. [PMID: 30890943 PMCID: PMC6411709 DOI: 10.3389/fphar.2018.01156] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.
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Affiliation(s)
- Jane Robertson
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
- Department of Clinical Pharmacology, The University of Newcastle, Callaghan, NSW, Australia
| | - Kotoji Iwamoto
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Iris Hoxha
- Department of Pharmacy, University of Medicine, Tirana, Tirana, Albania
| | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise, Ministry of Health, Yerevan, Armenia
| | - Vafa Abilova
- Department of Import Medicines and Medical Devices, Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan
| | - Ana Cvijanovic
- Sector for Providing Information on Drugs and Medical Products, Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Halina Pyshnik
- Department of Pharmaceutical Inspection and Organization of Medicinal Supply, Ministry of Health of the Republic of Belarus, Minsk, Belarus
| | - Marina Darakhvelidze
- Health Care Department, Ministry of IDPs, Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - Larissa Makalkina
- Department of Cardiology and Internal Medicine with a Course of Clinical Pharmacology and Pharmacy Astana Medical University, Astana, Kazakhstan
| | - Arianit Jakupi
- A2 – Pharmaceutical Consulting and UBT – Higher Education Institution, Pristina, Kosovo†
| | - Aigul Dzhakubekova
- Specialized Expertise of Medicines Unit, Department of Drug Provision and Medical Devices, Ministry of Health, Bishkek, Kyrgyzstan
| | - Angela Carp
- P.I. Coordination, Implementation and Monitoring Unit of the Health System Projects, Chişinãu, Moldova
| | - Lidija Cizmovic
- Department for Establishing Maximum Prices and Monitoring Consumption of Medicines, Agency for Medicines and Medical Devices, Podgorica, Montenegro
| | - Svetlana Rachina
- Internal Medicine Department with Cardiology and Functional Diagnostics Course, Russian Friendship University, Moscow, Russia
| | - Vesela Radonjic
- National Centre for Information on Medicines and Medical Device, Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Salomudin Yusufi
- Vice-Rector for Science, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Department of Rational Use of Medicines, Ministry of Health, Ankara, Turkey
| | - Muhabbat Ibragimova
- Head of the Information and Analytical Department, The State Center for Expertise and Standardization of Medicines, Medical Devices and Medical Equipment of the Agency for the Development of the Pharmaceutical Industry under the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hans Kluge
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Hanne Bak Pedersen
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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18
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Wojkowska-Mach J, Godman B, Glassman A, Kurdi A, Pilc A, Rozanska A, Skoczyński S, Wałaszek M, Bochenek T. Antibiotic consumption and antimicrobial resistance in Poland; findings and implications. Antimicrob Resist Infect Control 2018; 7:136. [PMID: 30473786 PMCID: PMC6238284 DOI: 10.1186/s13756-018-0428-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background The problem of inappropriate use of antibiotics and the resulting growth in antimicrobial resistance (AMR) has implications for Poland and the world. The objective of this paper was to compare and contrast antibiotic resistance and antibiotic utilisation in Poland in recent years versus other European countries, including agreed quality indicators, alongside current AMR patterns and ongoing policies and initiatives in Poland to influence and improve antibiotic prescribing. Methods A quantitative ten-year analysis (2007–2016) of the use of antibiotics based on European Centre for Disease Prevention and Control (ECDC) data combined with a literature review on AMR rates and antimicrobial stewardship initiatives. Results The system of monitoring AMR and appropriate strategies to address AMR rates remain underdeveloped in Poland. The role of microbiological diagnostics and efforts to prevent infections is currently underestimated by physicians. Overall, Poland had one of the highest rates of total consumption of antibiotics in the analysed European countries. Total consumption of antibacterials for systemic use and relative consumption of beta-lactamase sensitive penicillins were characterized by small but statistically significant average annual increases between 2007 and 2016 (from 22.2 DIDs to 23.9 DIDs and from 0.8 to 1.3%, respectively). Conclusions The integrated activities around appropriate antibiotic prescribing in the pre- and post-graduate training of physicians and dentists seem to be particularly important, as well as changes in policies on prescribing antibiotics within ambulatory care. AMR and appropriate prescribing of antibiotics should be the focus of health policy actions in Poland.
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Affiliation(s)
- Jadwiga Wojkowska-Mach
- 1Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Str., 31-121, Krakow, Poland
| | - Brian Godman
- 2Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, G4 ORE, Glasgow, UK.,3Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool, UK.,4Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.,5Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Amanda Glassman
- 6Center for Global Development, 2055 L Street NW, Washington, DC 20036 USA
| | - Amanj Kurdi
- 2Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, G4 ORE, Glasgow, UK.,7Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Andrzej Pilc
- 8Department of Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,9Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka 20 Str., 31-531, Krakow, Poland
| | - Anna Rozanska
- 1Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Str., 31-121, Krakow, Poland
| | - Szymon Skoczyński
- 10Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marta Wałaszek
- 11Department of Nursing, Institute of Health Sciences, State Higher Vocational School in Tarnów, Tarnów, Poland
| | - Tomasz Bochenek
- 9Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegorzecka 20 Str., 31-531, Krakow, Poland
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19
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Bojanić L, Marković-Peković V, Škrbić R, Stojaković N, Ðermanović M, Bojanić J, Fürst J, Kurdi AB, Godman B. Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications. Front Pharmacol 2018; 9:442. [PMID: 29896100 PMCID: PMC5987173 DOI: 10.3389/fphar.2018.00442] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.
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Affiliation(s)
- Ljubica Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ranko Škrbić
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Stojaković
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Mirjana Ðermanović
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Janja Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Epidemiology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Jurij Fürst
- Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Amanj B. Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of pharmacology and toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics Centre, Liverpool University, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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20
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Mukokinya MMA, Opanga S, Oluka M, Godman B. Dispensing of Antimicrobials in Kenya: A Cross-sectional Pilot Study and Its Implications. J Res Pharm Pract 2018; 7:77-82. [PMID: 30050960 PMCID: PMC6036869 DOI: 10.4103/jrpp.jrpp_17_88] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: The objective of this study was to evaluate the extent of self-medication of antibiotics and dispensing practices in Kenya. Methods: A cross-sectional study was carried out at three selected pharmacies in Nairobi (Kenya), between January and March 2017, targeting principally antibiotic prescriptions for systemic use issued and dispensed as well as antibiotics sold over-the-counter without a prescription. The quality of antibiotics prescribed and dispensed was assessed against key WHO and other criteria. Benchmarking was used to assess the quality of antibiotics prescribed as there are no predetermined levels, just guidance and the rationale. Key indicators included: utilization of penicillins, percentage utilization of third-and fourth-generation of cephalosporins versus first and second generation, utilization of macrolides including lincosamides and utilization of quinolones as a percent of total systemic antibiotic use. Findings: There was a low level of dispensing of antibiotics without a prescription with over 90% (94.1%) of antibiotics dispensed with a valid prescription. The most common antibiotics dispensed were the penicillins at just over 50% of all antibiotics, the cephalosporins at over 12% (12.6%) and the fluoroquinolones at just under 12% (11.7%). There were concerns with high use of third and fourth generation cephalosporins versus first- and second-generation as well as co-amoxiclav versus other penicillins. Conclusion: Low levels of self-medication of antibiotics and high adherence to quality standards for dispensing are encouraging and provide direction to other countries. Educational initiatives are needed though to address high levels of co-amoxiclav prescribing.
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Affiliation(s)
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, Kenya
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool University, Liverpool, UK
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