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Miellet S, Byrne MK, Reynolds N, Sweetnam T. A confirmation of the predictive utility of the Antibiotic Use Questionnaire. BMC Public Health 2024; 24:1925. [PMID: 39026260 PMCID: PMC11256407 DOI: 10.1186/s12889-024-18901-3] [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: 05/29/2023] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The change in the efficacy of antimicrobial agents due to their misuse is implicated in extensive health and mortality related concerns. The Antibiotics Use Questionnaire (AUQ) is a theory driven measure based on the Theory of Planned Behaviour (TpB) factors that is designed to investigate drivers of antibiotic use behaviour. The objective of this study is to replicate the factor structure from the pilot study within a similar Australian confirmation cohort, and to extend this through investigating if the factor structure holds in a Chinese-identifying cohort. METHODS The AUQ was disseminated to two cohorts: a confirmation cohort similar to the original study, and a Chinese identifying cohort. Data analysis was completed on the two data sets independently, and on a combined data set. An orthogonal principal components analysis with varimax rotation was used to assess the factor structure, followed by general linear models to determine the influence of the TpB factors on reported antibiotic use. RESULTS 370 participant responses from the confirmation cohort, and 384 responses from the Chinese-identifying cohort were retained for analysis following review of the data. Results showed modest but acceptable levels of internal reliability across both cohorts. Social norms, and the interaction between attitudes and beliefs and knowledge were significant predictors of self-reported antibiotic use in both cohorts. In the confirmation cohort healthcare training was a significant predictor, and in the Chinese-identifying cohort education was a significant predictor. All other predictors tested produced a nonsignificant relationship with the outcome variable of self-reported antibiotic use. CONCLUSIONS This study successfully replicated the factor structure of the AUQ in a confirmation cohort, as well as a cohort that identified as culturally or legally Chinese, determining that the factor structure is retained when investigated across cultures. The research additionally highlights the need for a measure such as the AUQ, which can identify how differing social, cultural, and community factors can influence what predicts indiscriminate antibiotic use. Future research will be required to determine the full extent to which this tool can be used to guide bespoke community level interventions to assist in the management of antimicrobial resistance.
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Affiliation(s)
- Sebastien Miellet
- School of Psychology, University of Wollongong, Building 41, Northfields Ave, Wollongong, NSW, 2522, Australia.
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia.
| | - Mitchell K Byrne
- School of Psychology, University of Wollongong, Building 41, Northfields Ave, Wollongong, NSW, 2522, Australia
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia
| | - Nina Reynolds
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), Wollongong, NSW, Australia
- School of Business, University of Wollongong, Wollongong, NSW, Australia
| | - Taylor Sweetnam
- Faculty of Health, Charles Darwin University, Northern Territory, Australia
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Dulli L, Touré F, Mama AD, Evens E, Murray K, Djè NN, Koné S, Sadate-Ngatchou P, Bovary A, Eichleay M, Jean-Baptiste M, Méité A. Feasibility and acceptability of integrating mass distribution of azithromycin to children 1-11 months into a trachoma mass drug administration campaign to reduce child mortality in Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003426. [PMID: 38985785 PMCID: PMC11236188 DOI: 10.1371/journal.pgph.0003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
Evidence suggests that bi-annual mass drug administration (MDA) of single-dose azithromycin to 1-11 month-old children reduces child mortality in high child-mortality settings. Several countries conduct annual MDAs to distribute azithromycin to individuals ages 6 months and older to prevent trachoma infection. This study examined the feasibility and acceptability of reaching 1-11 months-old children during a trachoma MDA in Côte d'Ivoire by extending azithromycin distribution to infants 1-5 months old during the campaign. In November 2020, the study piloted single-dose azithromycin for 1-5 month-olds during a trachoma MDA in one health district. Monitoring data included the number of children reached and occurrences of adverse drug reactions. Feasibility, the extent to which the target population received the intervention (coverage), was assessed through a population-based, household survey with parents/caregivers of eligible children conducted after the MDA. Acceptability was explored through in-depth interviews (IDIs) with parents/caregivers of eligible children, focus group discussions (FGDs) with community drug distributors (CDDs), and IDIs with their supervisors. CDD FGDs and supervisor IDIs also documented implementation challenges and recommendations for scale-up. 1,735 1-5 month-olds received azithromycin during the pilot activity (estimated population coverage of 90.2%). Adverse drug reactions were reported for 1% (n = 18) infants; all were mild and self-limited. The post-MDA coverage survey interviewed 267 parents/caregivers; survey-based intervention coverage was 95.4% of 1-5 month-olds. Qualitative data revealed high intervention acceptability among parents, CDDs, and supervisors. Implementation challenges included the need to weigh babies to calculate dosage for 1-5 month-olds and the need to obtain written informed consent from parents to provide the drug to 1-5 month-olds. CDDs also indicated the need for more information on azithromycin and possible side effects during training. Delivering azithromycin to younger infants appears acceptable to parents and implementers; >90% coverage indicates feasibility to integrate into a trachoma MDA. (Clinicaltrials.gov ID number: NCT04617626).
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Affiliation(s)
- Lisa Dulli
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Fatoumata Touré
- Global Health and Population Business Unit, FHI 360, Abidjan, Côte d'Ivoire
| | - Adam Djima Mama
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Emily Evens
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Kate Murray
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Norbert N'goran Djè
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Stéphane Koné
- Global Health and Population Business Unit, FHI 360, Abidjan, Côte d'Ivoire
| | - Pat Sadate-Ngatchou
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Anoma Bovary
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
| | - Marga Eichleay
- Global Health and Population Business Unit, FHI 360, Durham, North Carolina, United States of America
| | - Milenka Jean-Baptiste
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Aboulaye Méité
- The Côte d'Ivoire National Neglected Tropical Diseases Program (Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive), Abidjan, Côte d'Ivoire
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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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Karnchanapandh K, Sanachai K, Poo-Arporn RP, Rungrotmongkol T. Enhancing bezlotoxumab binding to C. difficile toxin B2: insights from computational simulations and mutational analyses for antibody design. J Biomol Struct Dyn 2024:1-11. [PMID: 38511411 DOI: 10.1080/07391102.2024.2329785] [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: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
Clostridioides difficile infection (CDI) is a significant concern caused by widespread antibiotic use, resulting in diarrhea and inflammation from the gram-positive anaerobic bacterium C. difficile. Although bezlotoxumab (Bez), a monoclonal antibody (mAb), was developed to address CDI recurrences, the recurrence rate remains high, partly due to reduced neutralization efficiency against toxin B2. In this study, we aimed to enhance the binding of Bez to C. difficile toxin B2 by combining computational simulations and mutational analyses. We identified specific mutations in Bez, including S28R, S31W/K, Y32R, S56W and G103D/S in the heavy chain (Hc), and S32F/H/R/W/Y in the light chain (Lc), which significantly improved binding to toxin B2 and formed critical protein-protein interactions. Through molecular dynamics simulations, several single mutations, such as HcS28R, LcS32H, LcS32R, LcS32W and LcS32Y, exhibited superior binding affinities to toxin B2 compared to Bez wild-type (WT), primarily attributed to Coulombic interactions. Combining the HcS28R mutation with four different mutations at residue LcS32 led to even greater binding affinities in double mutants (MTs), particularly HcS28R/LcS32H, HcS28R/LcS32R and HcS28R/LcS32Y, reinforcing protein-protein binding. Analysis of per-residue decomposition free energy highlighted key residues contributing significantly to enhanced binding interactions, emphasizing the role of electrostatic interactions. These findings offer insights into rational Bez MT design for improved toxin B2 binding, providing a foundation for developing more effective antibodies to neutralize toxin B2 and combat-related infections.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Kun Karnchanapandh
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Kamonpan Sanachai
- Department of Biochemistry, Faculty of Science, Khon Kaen University, Khon Kaen, Thailand
| | - Rungtiva P Poo-Arporn
- Biological Engineering Program, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Thanyada Rungrotmongkol
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biocatalyst and Sustainable Biotechnology, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
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Shen Y, Luo J, Di Cesare A, Guo N, Zou S, Yang Y. Performance evaluation for the inactivation of multidrug-resistant bacteria in wastewater effluent by different disinfection technologies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 345:123427. [PMID: 38286262 DOI: 10.1016/j.envpol.2024.123427] [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: 06/24/2023] [Revised: 12/21/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
The escalating presence of antibiotic-resistant bacteria (ARB) in aquatic ecosystems underscores the critical role of wastewater treatment plants (WWTPs) in mitigating antibiotic resistance. Disinfection is the final, pivotal step in WWTPs, and it is essential to control the dissemination of ARB before water discharge. This study utilized both phenotypic analysis and transcriptome (RNA-seq) approach to investigate the efficiency and mechanisms of disinfection using chlorination, ultraviolet (UV), and peracetic acid (PAA) on multidrug-resistant bacteria (MRB). Our results demonstrated that the use of 100 mg min L-1 of chlorine, 8.19 mJ cm-2 of UV irradiation or 50 min mg L-1 of PAA significantly reduced the abundance of MRB. Intriguingly, RNA-seq clarified distinct mechanisms of chlorination and UV disinfection. UV radiation triggered the SOS response to cope with DNA damage, induced the expression of multi-drug resistance genes by increasing the expression of efflux pump transporters. UV radiation also promoted the absorption of iron through chelation and transportation to participate in various cell life processes. Chlorination, on the other hand, significantly up-regulated osmotic response elements, including the synthesis of glycine betaine, iron-sulfur clusters, and related transporters. Both chlorination and UV significantly down-regulated key metabolic pathways (P < 0.05), inhibiting the process of amino acid synthesis and energy metabolism. Imbalance in energy homeostasis was the most important factor leading to cytotoxicity. These results provide useful insights into optimizing the wastewater disinfection process in order to prevent the dissemination of ARB in aquatic environment.
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Affiliation(s)
- Yijing Shen
- School of Marine Sciences, Sun Yat-sen University, Zhuhai, 519082, China; Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, China; Guangdong Provincial Key Laboratory of Marine Resources and Coastal Engineering, Zhuhai, 519082, China
| | - Jieling Luo
- School of Marine Sciences, Sun Yat-sen University, Zhuhai, 519082, China
| | - Andrea Di Cesare
- National Research Council of Italy - Water Research Institute (CNR-IRSA) Molecular Ecology Group (MEG), Verbania, 28922, Italy
| | - Nairong Guo
- School of Marine Sciences, Sun Yat-sen University, Zhuhai, 519082, China; Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, China; Guangdong Provincial Key Laboratory of Marine Resources and Coastal Engineering, Zhuhai, 519082, China
| | - Shichun Zou
- School of Marine Sciences, Sun Yat-sen University, Zhuhai, 519082, China; Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, China; Guangdong Provincial Key Laboratory of Marine Resources and Coastal Engineering, Zhuhai, 519082, China
| | - Ying Yang
- School of Marine Sciences, Sun Yat-sen University, Zhuhai, 519082, China; Southern Marine Science and Engineering Guangdong Laboratory, Zhuhai, 519000, China; Guangdong Provincial Key Laboratory of Marine Resources and Coastal Engineering, Zhuhai, 519082, China.
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Ribeiro-do-Valle CC, Bonet M, Brizuela V, Abalos E, Baguiya A, Bellissimo-Rodrigues F, Budianu M, Puscasiu L, Knight M, Lissauer D, Dunlop C, Jacob ST, Shakoor S, Gadama L, Assarag B, Souza JP, Cecatti JG. Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort. Ann Clin Microbiol Antimicrob 2024; 23:21. [PMID: 38402175 PMCID: PMC10894467 DOI: 10.1186/s12941-024-00681-8] [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: 09/21/2023] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections. METHODS We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women. RESULTS We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries. CONCLUSIONS Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
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Affiliation(s)
- Carolina C Ribeiro-do-Valle
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Mihaela Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Lucian Puscasiu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - David Lissauer
- University of Liverpool, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | - Shevin T Jacob
- Walimu, Mbarara, Uganda
- Department of Clinical Services, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Microbiology, Aga Khan University, Karachi, Pakistan
| | - Luis Gadama
- Department of Obstetrics and Gynaecology, University of Malawi, Zomba, Malawi
| | | | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Jose G Cecatti
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Campinas, R. Alexander Fleming, 101, Campinas, São Paulo, CEP 13083-888, Brazil.
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Perez-Bou L, Gonzalez-Martinez A, Gonzalez-Lopez J, Correa-Galeote D. Promising bioprocesses for the efficient removal of antibiotics and antibiotic-resistance genes from urban and hospital wastewaters: Potentialities of aerobic granular systems. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 342:123115. [PMID: 38086508 DOI: 10.1016/j.envpol.2023.123115] [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: 03/16/2023] [Revised: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The use, overuse, and improper use of antibiotics have resulted in higher levels of antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs), which have profoundly disturbed the equilibrium of the environment. Furthermore, once antibiotic agents are excreted in urine and feces, these substances often can reach wastewater treatment plants (WWTPs), in which improper treatments have been highlighted as the main reason for stronger dissemination of antibiotics, ARB, and ARGs to the receiving bodies. Hence, achieving better antibiotic removal capacities in WWTPs is proposed as an adequate approach to limit the spread of antibiotics, ARB, and ARGs into the environment. In this review, we highlight hospital wastewater (WW) as a critical hotspot for the dissemination of antibiotic resistance due to its high level of antibiotics and pathogens. Hence, monitoring the composition and structure of the bacterial communities related to hospital WW is a key factor in controlling the spread of ARGs. In addition, we discuss the advantages and drawbacks of the current biological WW treatments regarding the antibiotic-resistance phenomenon. Widely used conventional activated sludge technology has proved to be ineffective in mitigating the dissemination of ARB and ARGs to the environment. However, aerobic granular sludge (AGS) technology is a promising technology-with broad adaptability and excellent performance-that could successfully reduce antibiotics, ARB, and ARGs in the generated effluents. We also outline the main operational parameters involved in mitigating antibiotics, ARB, and ARGs in WWTPs. In this regard, WW operation under long hydraulic and solid retention times allows better removal of antibiotics, ARB, and ARGs independently of the WW technology employed. Finally, we address the current knowledge of the adsorption and degradation of antibiotics and their importance in removing ARB and ARGs. Notably, AGS can enhance the removal of antibiotics, ARB, and ARGs due to the complex microbial metabolism within the granular biomass.
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Affiliation(s)
- Lizandra Perez-Bou
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain; Microbial Biotechnology Group, Microbiology and Virology Department, Faculty of Biology, University of Havana, Cuba
| | - Alejandro Gonzalez-Martinez
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain
| | - Jesus Gonzalez-Lopez
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain
| | - David Correa-Galeote
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain.
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Mittal N, Mittal R, Singh S, Godara S. The Availability of Essential Antimicrobials in Public and Private Sector Facilities: A Cross-Sectional Survey in a District of North India. Antibiotics (Basel) 2024; 13:131. [PMID: 38391517 PMCID: PMC10886159 DOI: 10.3390/antibiotics13020131] [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: 11/25/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
(1) Background: There is a need to assess the availability of essential antimicrobials, as the availability of an antimicrobial is a critical element of its rational use. We aimed to assess the availability of antimicrobials listed in the National List of Essential Medicines 2015, India (primary list), and a selected (secondary) list comprised of agents indicated for commonly encountered infectious illnesses in various healthcare settings and to identify the reasons for their non-availability. (2) Methods: A cross-sectional survey of 25 public, private, and other sector pharmacies was carried out in Rohtak, a district of the North Indian state of Haryana, from April to June 2022. (3) Results: Most of the antimicrobials surveyed were optimally available in various sector pharmacies with the exception of benzathine benzylpenicillin, benzylpenicillin, cloxacillin, cefazolin, cefuroxime, cefadroxil, amphotericin B, and antimalarials. The most frequent reasons for limited availability were low demand, no prescriptions, and the non-listing of drugs in the state's essential medicine list. (4) Conclusions: Enough evidence needs to be generated with respect to the status of availability of essential antimicrobials from different regions of India as well as other lower-middle-income countries to devise measures for ascertaining better availability of these agents, especially antibiotics at regional, national, and global scales.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Rakesh Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sukhbir Singh
- Department of Hospital Administration, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Sushila Godara
- Health Department, Government of Haryana, Panchkula 134109, Haryana, India
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Wieters I, Johnstone S, Makiala-Mandanda S, Poda A, Akoua-Koffi C, Abu Sin M, Eckmanns T, Galeone V, Kaboré FN, Kahwata F, Leendertz FH, Mputu B, Ouedraogo AS, Page N, Schink SB, Touré FS, Traoré A, Venter M, Vietor AC, Schubert G, Tomczyk S. Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa. Antimicrob Resist Infect Control 2024; 13:9. [PMID: 38273333 PMCID: PMC10809765 DOI: 10.1186/s13756-024-01365-w] [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: 09/08/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Exposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries. METHODS ANDEMIA included 12 urban and rural health facilities in Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification ("Access", "Watch", "Reserve", and "Not recommended" antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors. RESULTS Among 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d'Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics. CONCLUSIONS Reported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.
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Affiliation(s)
- Imke Wieters
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Siobhan Johnstone
- Center for Enteric Diseases, National Health Laboratory Service, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Sheila Makiala-Mandanda
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Chantal Akoua-Koffi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Ivory Coast
- Université Alassane Ouattara de Bouaké, Bouaké, Ivory Coast
| | - Muna Abu Sin
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | | | | | - François Kahwata
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Fabian H Leendertz
- Helmholtz Institute for One Health, Fleischmannstraße 42, 17489, Greifswald, Germany
| | - Benoit Mputu
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Nicola Page
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | | | | | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | - Grit Schubert
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Tomczyk
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
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10
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Ekuma A, Onukak A, Udoette S, Versporten A, Pauwels I, Oduyebo O, Goossens H. AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria. Pan Afr Med J 2023; 46:80. [PMID: 38282765 PMCID: PMC10819836 DOI: 10.11604/pamj.2023.46.80.33027] [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: 12/30/2021] [Accepted: 08/13/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction point prevalence surveys have been used as a standardized tool to monitor antibiotic consumption to inform antimicrobial stewardship interventions in many countries. The 2021 WHO model list of Essential Medicines has classified antibiotics into three groups: access, watch and reserve. The aim of this paper is to describe the antibiotics used within a space of three years between 2018 and 2021 at the University of Uyo Teaching Hospital based on WHO AWaRe classification. Methods three point-prevalence surveys were conducted in the wards in our 500-bed tertiary hospital in 2018, 2019 and 2021. Each ward was surveyed on a particular day within a four-week period. The wards were grouped into medical and surgical for comparison. Antibiotics were classified as access, watch, and reserve. Validated data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). Results a total of 526 patients were surveyed out of which 344 were on antimicrobial therapy with a total of 687 antibiotic prescriptions. The overall prevalence of patients who received at least one antimicrobial was 65.4% (62.4 -72.8%). The Access group of antibiotics made up 48.2% of prescriptions while the watch group made up 50.5% of prescriptions. More watch Antibiotics were prescribed by surgical wards (49.7%) than by medical wards (43.7%). Conclusion the use of Access group antibiotics in our hospital falls below the WHO target level in both medical and surgical wards. There is a need for strengthening antibiotic stewardship activities to reduce the use of watch group antibiotics and limit antimicrobial resistance.
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Affiliation(s)
- Agantem Ekuma
- Department of Medical Microbiology and Parasitology, University of Uyo, Uyo, Nigeria
| | - Asukwo Onukak
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Sylvanus Udoette
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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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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Aiken AM, Nyamwaya B, Madrid L, Edessa D, Labi AK, Obeng-Nkrumah N, Mwabaya W, Chimenya M, Cocker D, Iregbu KC, Princewill-Nwajiobi PIP, Dramowski A, Sonda T, Mmbaga BT, Ojok D, Fwoloshi S, Scott JAG, Whitelaw A. Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study. Gates Open Res 2023; 7:21. [PMID: 38532981 PMCID: PMC10963387 DOI: 10.12688/gatesopenres.14267.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/28/2024] Open
Abstract
Background: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study. Methods: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). Results: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients. Conclusions: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation.
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Affiliation(s)
- Alexander M. Aiken
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Nyamwaya
- KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Lola Madrid
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Dumessa Edessa
- School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
| | - William Mwabaya
- KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Mabvuto Chimenya
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Derek Cocker
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kenneth C. Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | | | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tolbert Sonda
- Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David Ojok
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia
| | - J Anthony G Scott
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Whitelaw
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - MBIRA study collaborators
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
- KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya
- School of Pharmacy, Haramaya University, Harar, Ethiopia
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Shrestha N, Manandhar S, Maharjan N, Twati D, Dongol S, Basnyat B, Baker S, Karkey A. Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal. PLoS One 2023; 18:e0285287. [PMID: 37134062 PMCID: PMC10156006 DOI: 10.1371/journal.pone.0285287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Unregulated antimicrobial use is common in both hospital and community settings of low- and middle-income countries (LMICs). However, discrete data regarding the use/misuse of antimicrobials at pharmacies in LMICs are limited. This study was conducted to understand knowledge, attitude, and practice of pharmacy employees on antimicrobial dispensing in Nepal. METHODS We conducted a cross-sectional survey using a structured questionnaire on 801 pharmacy employees working in community and hospital pharmacies located in Lalitpur metropolitan city (LMC) of Kathmandu, Nepal between April 2017 and March 2019. RESULTS A majority (92%) of respondents agreed that demand for non-prescription antimicrobials was common. Asking for prescription before dispensing was ranked as the first preference by majority (69%) of participants. Suspected respiratory tract infection was the most common reason demanding for non-prescription antimicrobials with the highest mean rank of 1.5. Azithromycin was the most commonly prescribed and sold antimicrobial, as reported by 46% and 48% of participants respectively. A majority (87%) of respondents agreed on antimicrobial resistance (AMR) to be a global public health threat; and misuse/overuse of antimicrobials was perceived as the most common cause of AMR with a mean rank of 1.93. CONCLUSION Our study revealed that unfounded dispensing and use of antimicrobials is prevalent among pharmacies in Kathmandu, Nepal. This over reliance on antimicrobials, notably azithromycin, may escalate burden of AMR. We identified several drivers of inappropriate antimicrobial dispensing practice in pharmacies, which will aid public health authorities in addressing these issues. Further studies considering role of other stakeholders, such as doctors, veterinarians, general public, and policy makers are required to obtain a more holistic perspectives on practices of antimicrobial use so to curb the extant AMR crisis.
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Affiliation(s)
- Nistha Shrestha
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Sulochana Manandhar
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
- Nuffield Department of Medicine, Medical Sciences Division, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nhukesh Maharjan
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Devina Twati
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Sabina Dongol
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
- Nuffield Department of Medicine, Medical Sciences Division, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
- Nuffield Department of Medicine, Medical Sciences Division, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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14
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Impact of Patient-Reported Penicillin Allergy on Antibiotic Prophylaxis and Surgical Site Infection Among Patients Undergoing Colorectal Surgery. Dis Colon Rectum 2022; 65:1397-1404. [PMID: 34856589 DOI: 10.1097/dcr.0000000000002190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgical site infections are a major preventable source of morbidity, mortality, and increased health care expenditures after colorectal surgery. Patients with penicillin allergy may not receive the recommended preoperative antibiotics, putting them at increased risk for surgical site infections. OBJECTIVE This study aimed to evaluate the impact of patient-reported penicillin allergy on preoperative antibiotic prophylaxis and surgical site infection rates among patients undergoing major colon and rectal procedures. DESIGN This is a retrospective observational study. SETTING This study was conducted at a tertiary teaching hospital in Dallas. PATIENTS Adults undergoing colectomy or proctectomy between July 2012 and July 2019 were included. MAIN OUTCOME MEASURES The primary outcomes measured were preoperative antibiotic choice and surgical site infection. RESULTS Among 2198 patients included in the study, 12.26% (n = 307) reported a penicillin allergy. Patients with penicillin allergy were more likely to be white (82%) and female (54%; p < 0.01). The most common type of allergic reaction reported was rash (36.5%), whereas 7.2% of patients reported anaphylaxis. Patients with self-reported penicillin allergy were less likely to receive beta-lactam antibiotics than patients who did not report a penicillin allergy (79.8% vs 96.7%, p < 0.001). Overall, 143 (6.5%) patients had surgical site infections. On multivariable logistic regression, there was no difference in rates of surgical site infection between patients with penicillin allergy vs those without penicillin allergy (adjusted OR 1.14; 95% CI, 0.71-1.82). LIMITATIONS A limitation of this study was its retrospective study design. CONCLUSIONS Self-reported penicillin allergy among patients undergoing colorectal surgery is common; however, only a small number of these patients report any serious adverse reactions. Patients with self-reported penicillin allergy are less likely to receive beta-lactam antibiotics and more likely to receive non-beta-lactam antibiotics. However, this does not affect the rate of surgical site infection among these patients, and these patients can be safely prescribed non-beta-lactam antibiotics without negatively impacting surgical site infection rates. See Video Abstract at http://links.lww.com/DCR/B838 .IMPACTO DE LA ALERGIA A LA PENICILINA INFORMADA POR EL PACIENTE EN LA PROFILAXIS ANTIBIÓTICA Y LA INFECCIÓN DEL SITIO OPERATORIO ENTRE PACIENTES DE CIRUGÍA COLORECTAL. ANTECEDENTES Las infecciones del sitio operatorio son una de las principales fuentes prevenibles de morbilidad, mortalidad y aumento del gasto sanitario después de cirugía colorrectal. Es posible que los pacientes con alergia a la penicilina no reciban los antibióticos preoperatorios recomendados, lo que los pone en mayor riesgo de infecciones en el sitio operatorio. OBJETIVO Este estudio tuvo como objetivo evaluar el impacto de la alergia a la penicilina informada por el paciente sobre la profilaxis antibiótica preoperatoria y las tasas de infección del sitio operatorio entre pacientes sometidos a procedimientos mayores de colon y recto. DISEO Estudio observacional retrospectivo. AJUSTE Hospital universitario terciario en Dallas. PACIENTES Adultos sometidos a colectomía o proctectomía entre julio de 2012 a julio de 2019. PRINCIPALES MEDIDAS DE DESENLACE Elección de antibióticos preoperatorios e infección del sitio operatorio. RESULTADOS Entre los 2198 pacientes incluidos en el estudio, el 12,26% (n = 307) informó alergia a la penicilina. Los pacientes con alergia a la penicilina tenían más probabilidades de ser blancos (82%) y mujeres (54%) ( p < 0,01). El tipo más común de reacción alérgica notificada fue erupción cutánea (36,5%), mientras que el 7,2% de los pacientes notificó anafilaxia. Los pacientes con alergia a la penicilina autoinformada tenían menos probabilidades de recibir antibióticos betalactámicos en comparación con los pacientes que no informaron alergia a la penicilina (79,8% frente a 96,7%, p < 0,001). En general, hubo 143 (6,5%) pacientes con infecciones del sitio operatorio. En la regresión logística multivariable no hubo diferencias en las tasas de infección del sitio operatorio entre los pacientes con alergia a la penicilina frente a los que no tenían alergia a la penicilina (razón de probabilidades ajustada 1,14; intervalo de confianza del 95%, 0,71-1,82). LIMITACIONES Diseño de estudio retrospectivo. CONCLUSIONES La alergia a la penicilina autoinformada entre los pacientes de cirugía colorrectal es común, sin embargo, solo un pequeño número de estos pacientes informan reacciones adversas graves. Los pacientes con alergia a la penicilina autoinformada tienen menos probabilidades de recibir antibióticos betalactámicos y más probabilidades de recibir antibióticos no betalactámicos. Sin embargo, esto no afecta la tasa de infección del sitio quirúrgico entre estos pacientes y se les puede recetar de forma segura con antibióticos no betalactámicos sin afectar negativamente las tasas de infección del sitio quirúrgico. Consulte Video Resumen en http://links.lww.com/DCR/B838 . (Traducción-Dr. Juan Carlos Reyes ).
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Allwell-Brown G, Namugambe JS, Ssanyu JN, Johansson EW, Hussain-Alkhateeb L, Strömdahl S, Mårtensson A, Kitutu FE. Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda. JAC Antimicrob Resist 2022; 4:dlac091. [PMID: 36072304 PMCID: PMC9444054 DOI: 10.1093/jacamr/dlac091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda.
Methods
We surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019–20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels.
Results
Antibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2–59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91–9.72) were significant contextual determinants of antibiotic prescribing.
Conclusions
We demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients.
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Affiliation(s)
- Gbemisola Allwell-Brown
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University , SE-751 85 Uppsala , Sweden
| | - Juliet Sanyu Namugambe
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology , PO Box 1410, Mbarara , Uganda
| | - Jacquellyn Nambi Ssanyu
- Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University , PO Box 7072, Kampala , Uganda
- School of Public Health, Makerere University , PO Box 7072, Kampala , Uganda
| | - Emily White Johansson
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University , SE-751 85 Uppsala , Sweden
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , SE-405 30 Gothenburg , Sweden
| | - Susanne Strömdahl
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University , SE-751 85 Uppsala , Sweden
| | - Andreas Mårtensson
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University , SE-751 85 Uppsala , Sweden
| | - Freddy Eric Kitutu
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University , SE-751 85 Uppsala , Sweden
- Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University , PO Box 7072, Kampala , Uganda
- School of Public Health, Makerere University , PO Box 7072, Kampala , Uganda
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Gough EK. The impact of mass drug administration of antibiotics on the gut microbiota of target populations. Infect Dis Poverty 2022; 11:76. [PMID: 35773678 PMCID: PMC9245274 DOI: 10.1186/s40249-022-00999-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022] Open
Abstract
Antibiotics have become a mainstay of healthcare in the past century due to their activity against pathogens. This manuscript reviews the impact of antibiotic use on the intestinal microbiota in the context of mass drug administration (MDA). The importance of the gut microbiota to human metabolism and physiology is now well established, and antibiotic exposure may impact host health via collateral effects on the microbiota and its functions. To gain further insight into how gut microbiota respond to antibiotic perturbation and the implications for public health, factors that influence the impact of antibiotic exposure on the microbiota, potential health outcomes of antibiotic-induced microbiota alterations, and strategies that have the potential to ameliorate these wider antibiotic-associated microbiota perturbations are also reviewed.
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Affiliation(s)
- Ethan K Gough
- Department of International Health, Human Nutrition Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gautham M, Miller R, Rego S, Goodman C. Availability, Prices and Affordability of Antibiotics Stocked by Informal Providers in Rural India: A Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11040523. [PMID: 35453278 PMCID: PMC9026796 DOI: 10.3390/antibiotics11040523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
Providers without formal training deliver healthcare and antibiotics across rural India, but little is known about the antibiotics that they stock. We conducted a cross-sectional survey of such informal providers (IPs) in two districts of West Bengal, and assessed the availability of the antibiotics, as well as their sales volumes, retail prices, percentage markups for IPs and affordability. Of the 196 IPs that stocked antibiotics, 85% stocked tablets, 74% stocked syrups/suspensions/drops and 18% stocked injections. Across all the IPs, 42 antibiotic active ingredients were stocked, which comprised 278 branded generics from 74 manufacturers. The top five active ingredients that were stocked were amoxicillin potassium clavulanate (52% of the IPs), cefixime (39%), amoxicillin (33%), azithromycin (25%) and ciprofloxacin (21%). By the WHO's AWaRe classification, 71% of the IPs stocked an ACCESS antibiotic and 84% stocked a WATCH antibiotic. The median prices were in line with the government ceiling prices, but with substantial variation between the lowest and highest priced brands. The most affordable among the top five tablets were ciprofloxacin, azithromycin, cefixime and amoxicillin (US$ 0.8, 0.9, 1.9 and 1.9 per course), and the most affordable among the syrups/suspensions/drops were azithromycin and ofloxacin (US$ 1.7 and 4.5 per course, respectively), which are mostly WATCH antibiotics. IPs are a key source of healthcare and antibiotics in rural communities; practical interventions that target IPs need to balance restricting WATCH antibiotics and expanding the basket of affordable ACCESS antibiotics.
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Gulleen EA, Lubwama M, Komakech A, Krantz EM, Liu C, Phipps W. Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e54. [PMID: 36483337 PMCID: PMC9726558 DOI: 10.1017/ash.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa. DESIGN Cross-sectional survey. SETTING The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda. PARTICIPANTS We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians. METHODS The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role. RESULTS All 60 respondents who answered the question had heard the term "antimicrobial resistance." Only 44 (73%) had heard the term "antimicrobial stewardship." Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures. CONCLUSIONS Although most recognized the term "antimicrobial resistance," fewer were familiar with the term "antimicrobial stewardship." Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.
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Affiliation(s)
- Elizabeth A. Gulleen
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
| | - Margaret Lubwama
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Alfred Komakech
- Department of Pharmacy, Uganda Cancer Institute, Kampala, Uganda
| | - Elizabeth M. Krantz
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Catherine Liu
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
| | - Warren Phipps
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, Washington, United States
- Seattle Cancer Care Alliance, Seattle, Washington, United States
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Holm M, Zellweger RM, Poudyal N, Smith KHT, Joh HS, Marks F. Measuring the Link Between Vaccines and Antimicrobial Resistance in Low Resource Settings – Limitations and Opportunities in Direct and Indirect Assessments and Implications for Impact Studies. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.805833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The importance of vaccines in combatting antimicrobial resistance (AMR) is commonly accepted. Although scientific reasoning supports the putative connection between vaccines and reduction of AMR, reliably measuring the magnitude and effect of vaccines on antimicrobial resistance is inherently challenging, especially in low resource settings. We review the intrinsic challenges in estimating the effect of vaccines on AMR and discuss the limitations and opportunities in current methods from the host, pathogen, and environment perspectives. We highlight advantages and pitfalls in different epidemiological study designs with a specific focus on impact studies in low resource settings and suggest how these perspectives could be considered in future research.
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D’Arcy N, Ashiru-Oredope D, Olaoye O, Afriyie D, Akello Z, Ankrah D, Asima DM, Banda DC, Barrett S, Brandish C, Brayson J, Benedict P, Dodoo CC, Garraghan F, Hoyelah J, Jani Y, Kitutu FE, Kizito IM, Labi AK, Mirfenderesky M, Murdan S, Murray C, Obeng-Nkrumah N, Olum WJ, Opintan JA, Panford-Quainoo E, Pauwels I, Sefah I, Sneddon J, St. Clair Jones A, Versporten A. Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented. Antibiotics (Basel) 2021; 10:antibiotics10091122. [PMID: 34572704 PMCID: PMC8469030 DOI: 10.3390/antibiotics10091122] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals globally. G-PPS was carried out at 17 hospitals across Ghana, Uganda, Zambia and Tanzania. The overall prevalence of antimicrobial use was 50% (30–57%), with most antibiotics prescribed belonging to the WHO ‘Access’ and ‘Watch’ categories. No ‘Reserve’ category of antibiotics was prescribed across the study sites while antimicrobials belonging to the ‘Not Recommended’ group were prescribed infrequently. Antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions across all countries. The most prescribed therapeutic subgroup of antimicrobials was ‘Antibacterials for systemic use’. As a result of the programme, PPS data are now readily available for the first time in the hospitals, strengthening the global commitment to improved antimicrobial surveillance. Antimicrobial stewardship interventions developed included the formation of AMS committees, the provision of training and the preparation of new AMS guidelines. Other common interventions included the presentation of findings to clinicians for increased awareness, and the promotion of a multi-disciplinary approach to successful AMS programmes. Repeat PPS would be necessary to continually monitor the impact of interventions implemented. Broader participation is also encouraged to strengthen the evidence base.
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Affiliation(s)
- Nikki D’Arcy
- Commonwealth Partnerships Programme on Antimicrobial Stewardship, Commonwealth Pharmacists Association, London E1W 1AW, UK; (N.D.); (O.O.)
| | - Diane Ashiru-Oredope
- Commonwealth Partnerships Programme on Antimicrobial Stewardship, Commonwealth Pharmacists Association, London E1W 1AW, UK; (N.D.); (O.O.)
- Correspondence: or
| | - Omotayo Olaoye
- Commonwealth Partnerships Programme on Antimicrobial Stewardship, Commonwealth Pharmacists Association, London E1W 1AW, UK; (N.D.); (O.O.)
| | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra P.O. Box CT104, Ghana;
| | - Zainab Akello
- Laro Division, Gulu Regional Referral Hospital, Gulu P.O. Box 166, Uganda;
| | - Daniel Ankrah
- Korle-Bu Teaching Hospital, Accra P.O. Box 77, Ghana;
| | | | - David C. Banda
- Department of Pharmacy, University Teaching Hospital, Lusaka P.O. Box 50001, Zambia;
| | - Scott Barrett
- Pharmacy Department, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields NE29 8NH, UK; (S.B.); (J.B.)
| | | | - Joseph Brayson
- Pharmacy Department, North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields NE29 8NH, UK; (S.B.); (J.B.)
| | - Peter Benedict
- Kilimanjaro Christian Medical Centre, Moshi P.O. Box 3010, Tanzania;
| | - Cornelius C. Dodoo
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana;
| | - Frances Garraghan
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK;
| | | | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK;
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | | | - Appiah-Korang Labi
- Medical Microbiology Department, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana; (A.-K.L.); (J.A.O.)
| | | | - Sudaxshina Murdan
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
| | | | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, Accra P.O. Box LG 25, Ghana;
| | | | - Japheth Awuletey Opintan
- Medical Microbiology Department, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana; (A.-K.L.); (J.A.O.)
| | | | - Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; (I.P.); (A.V.)
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Keta-Dzelukope P.O. Box WT82, Ghana;
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK;
| | | | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; (I.P.); (A.V.)
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Probst V, Islamovic F, Mirza A. Antimicrobial stewardship program in pediatric medicine. Pediatr Investig 2021; 5:229-238. [PMID: 34589677 PMCID: PMC8458720 DOI: 10.1002/ped4.12292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022] Open
Abstract
The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.
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Affiliation(s)
- Varvara Probst
- University of FloridaCollege of MedicineJacksonvilleFLUSA
| | | | - Ayesha Mirza
- University of FloridaCollege of MedicineJacksonvilleFLUSA
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Stalteri Mastrangelo R, Santesso N, Bognanni A, Darzi A, Karam S, Piggott T, Baldeh T, Schünemann F, Ventresca M, Morgano GP, Moja L, Loeb M, Schunemann H. Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey. BMJ Open 2021; 11:e046097. [PMID: 34330853 PMCID: PMC8327810 DOI: 10.1136/bmjopen-2020-046097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems. METHODS We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence. RESULTS We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines. DISCUSSION Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required. PROSPERO REGISTRATION NUMBER CRD42020145235.
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Affiliation(s)
- Rosa Stalteri Mastrangelo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Samer Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Adekoya I, Maraj D, Steiner L, Yaphe H, Moja L, Magrini N, Cooke G, Loeb M, Persaud N. Comparison of antibiotics included in national essential medicines lists of 138 countries using the WHO Access, Watch, Reserve (AWaRe) classification: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1429-1440. [PMID: 34332706 DOI: 10.1016/s1473-3099(20)30854-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/25/2020] [Accepted: 10/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The WHO Model List of Essential Medicines classified antibiotics into Access, Watch, and Reserve (AWaRe) categories for the treatment of 31 priority bacterial infections as a tool to facilitate antibiotic stewardship and optimal use. We compared the listing of antibiotics on national essential medicines lists (NEMLs) to those in the 2019 WHO Model List and the AWaRe classification database to determine the degree to which NEMLs are in alignment with the AWaRe classification framework recommended by WHO. METHODS In this cross-sectional study, we obtained up-to-date (data after 2017) NEMLs from our Global Essential Medicines (GEM) database, WHO online resources, and individual countries' websites. From the 2019 WHO Model List we extracted, as a reference standard, a list of 37 antibiotics (44 unique antibiotics after accounting for combination drugs or therapeutically equivalent drugs as specified by WHO) that were considered essential in treating 31 of the most common and severe clinical infectious syndromes (priority infections). From the WHO AWaRe Classification Database, which contains commonly used antibiotics globally, we extracted a list of 122 AWaRe antibiotics listed by at least one country in the GEM database. We then assessed individual countries' NEMLs for listing of the 44 essential and 122 commonly used antibiotics, overall and according to AWaRe classification group. We also evaluated and summarised the listing of both first-choice and second-choice treatments for the 31 priority infections. A total coverage score was calculated for each country by assigning a treatment score of 0-3 for each priority infection on the basis of whether first-choice and second-choice treatments, according to the 2019 WHO Model List, were included in the country's NEML. Coverage scores were then compared against the score of the 2019 WHO Model List and across World Bank income groups and WHO regions. FINDINGS As of July 7, 2020, we had up-to-date NEMLs for 138 countries. Of the 44 unique essential antibiotics, 24 were Access, 15 were Watch, and five were Reserve. The median number of total essential antibiotics listed across the 138 NEMLs was 26 (IQR 21-32). 102 (74%) countries listed at least 22 (50%) of the 44 essential antibiotics. The median number of total AWaRe antibiotics listed by the 138 countries was 35 (IQR 29-46), of Access antibiotics was 18 (16-21), of Watch antibiotics was 16 (11-22), and of Reserve antibiotics was one (0-2). 56 (41%) countries did not list any essential Reserve antibiotics. 131 (95%) countries had coverage scores of at least 60, equivalent to at least 75% of the score of the 2019 WHO Model List, which was 80. Nine (7%) countries listed fewer than 12 of 24 essential Access antibiotics, and seven (5%) did not list sufficient first-choice and second-choice treatments for priority infections (ie, they had coverage scores lower than 60). Of the 31 priority infections, acute neonatal meningitis and high-risk febrile neutropenia did not have enough listed treatments, with 82 (59%) countries listing no treatment for acute neonatal meningitis and 84 (61%) countries listing only a first-choice treatment, only a second-choice treatment, or no treatment for high-risk febrile neutropenia. Coverage scores differed between countries on the basis of World Bank income groups (p=0·025). INTERPRETATION Our findings highlight potential changes to the antibiotics included in NEMLs that would increase adherence to international guidance aimed at effectively treating infectious diseases while addressing antimicrobial resistance. FUNDING Canadian Institutes of Health Research and Ontario Strategy for Patient Oriented Research Support Unit.
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Affiliation(s)
- Itunuoluwa Adekoya
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Liane Steiner
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Hannah Yaphe
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland
| | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
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Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries. J Antimicrob Chemother 2021; 76:1614-1624. [PMID: 33822971 PMCID: PMC8120336 DOI: 10.1093/jac/dkab050] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives The WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population. Methods The Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed. Results Regional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use. Conclusions We observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.
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Affiliation(s)
- Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Corresponding author. E-mail:
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nico Drapier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Erika Vlieghe
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Antwerp, Belgium
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Gulleen EA, Adams SV, Chang BH, Falk L, Hazard R, Kabukye J, Scala J, Liu C, Phipps W, Abrahams O, Moore CC. Factors and Outcomes Related to the Use of Guideline-Recommended Antibiotics in Patients With Neutropenic Fever at the Uganda Cancer Institute. Open Forum Infect Dis 2021; 8:ofab307. [PMID: 34262989 PMCID: PMC8275883 DOI: 10.1093/ofid/ofab307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background Neutropenic fever (NF) is associated with significant morbidity and mortality for patients receiving cancer treatment in sub-Saharan Africa (sSA). However, the antibiotic management of NF in sub-Saharan Africa has not been well described. We evaluated the timing and selection of antibiotics for patients with NF at the Uganda Cancer Institute (UCI). Methods We conducted a retrospective chart review of adults with acute leukemia admitted to UCI from 1 January 2016 to 31 May 2017, who developed NF. For each NF event, we evaluated the association of clinical presentation and demographics with antibiotic selection as well as time to both initial and guideline-recommended antibiotics. We also evaluated the association between ordered antibiotics and the in-hospital case fatality ratio (CFR). Results Forty-nine NF events occurred among 39 patients. The time to initial antibiotic order was <1 day. Guideline-recommended antibiotics were ordered for 37 (75%) NF events. The median time to guideline-recommended antibiotics was 3 days. Fever at admission, a documented physical examination, and abdominal abnormalities were associated with a shorter time to initial and guideline-recommended antibiotics. The in-hospital CFR was 43%. There was no difference in in-hospital mortality when guideline-recommended antibiotics were ordered as compared to when non-guideline or no antibiotics were ordered (hazard ratio, 0.51 [95% confidence interval {CI}, .10-2.64] and 0.78 [95% CI, .20-2.96], respectively). Conclusions Patients with acute leukemia and NF had delayed initiation of guideline-recommended antibiotics and a high CFR. Prospective studies are needed to determine optimal NF management in sub-Saharan Africa, including choice of antibiotics and timing of antibiotic initiation.
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Affiliation(s)
- Elizabeth A Gulleen
- Vaccine and Infectious Diseases Divison, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Scott V Adams
- Vaccine and Infectious Diseases Divison, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bickey H Chang
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren Falk
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois, USA
| | - Riley Hazard
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Jackie Scala
- Department of Internal Medicine, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Catherine Liu
- Vaccine and Infectious Diseases Divison, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Warren Phipps
- Vaccine and Infectious Diseases Divison, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Christopher C Moore
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Hicks JP, Latham SM, Huque R, Das M, Newell J, Abdullah SM, Al Azdi Z, Jahan I, Rassi C, Hamade P, Shafique M, Islam MS, King R. Antibiotic practices among household members and their domestic animals within rural communities in Cumilla district, Bangladesh: a cross-sectional survey. BMC Public Health 2021; 21:406. [PMID: 33632193 PMCID: PMC7908663 DOI: 10.1186/s12889-021-10457-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Antibiotic resistance is a global threat to human health, and inappropriate use of antibiotics in humans and animals is widely considered to be a key driver of antibiotic resistant infections. Antibiotic use in humans and animals is growing rapidly in low- and, particularly, middle-income countries. However, there is little detailed understanding about practices related to the use of antibiotics in humans and animals within community settings in such countries. Here we aimed to understand the antibiotic practices of rural households across Cumilla district, Bangladesh, in relation to household members and their domestic animals. Methods In 2018 we conducted a cross-sectional survey using representative cluster sampling methods. We collected self-reported information from 682 female and 620 male household heads, with women also asked about their children’s antibiotic practices. Results Only 48% (95% CI: 40, 56%) of women and men had heard of antibiotics, and among those women and men who were aware of antibiotics and the children of those women 70% (95% CI: 64, 76%) reported having previously taken antibiotics, while among these individuals who reported previously taking antibiotics 21% (95% CI: 18, 25%) said they had done so most recently within the last month. Risky/inappropriate antibiotic practices in humans and animals were often reported. For example, among women and men who were aware of antibiotics and the children of those women 52% (95% CI: 40, 63%) reported previously taking antibiotics for a “cough/cold”, despite antibiotics being typically inappropriate for use against viral upper respiratory tract infections. Among poultry-owning respondents who were aware of antibiotics 11% (95% CI: 8, 15%) reported previously giving healthy poultry antibiotics, mainly for growth/prophylaxis, while among cattle-owning respondents who were aware of antibiotics and reported previously giving their cattle feed 20% (95% CI: 9, 37%) said the feed had contained antibiotics at least sometimes. Conclusions Our results highlight the need for context-adapted interventions at both the community level and the health systems level to reduce inappropriate antibiotic use among humans and domestic animals in rural Bangladesh. Successfully reducing inappropriate use of antibiotics among humans and animals is a required and critical step in tackling antimicrobial resistance. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10457-w.
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Affiliation(s)
- Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK.
| | - Sophia M Latham
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Cheshire, CH64 7TE, UK
| | - Rumana Huque
- ARK Foundation, Suite C-3 & C-4, House # 06, Road # 109, Gulshan-2, Dhaka, 1212, Bangladesh.,Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Mahua Das
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK
| | - Jane Newell
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - S M Abdullah
- ARK Foundation, Suite C-3 & C-4, House # 06, Road # 109, Gulshan-2, Dhaka, 1212, Bangladesh.,Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Zunayed Al Azdi
- ARK Foundation, Suite C-3 & C-4, House # 06, Road # 109, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Ishrat Jahan
- ARK Foundation, Suite C-3 & C-4, House # 06, Road # 109, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Christian Rassi
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Prudence Hamade
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Muhammad Shafique
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Mohammad Saiful Islam
- Faculty of Surgery and Professor of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, LS2 9JT, UK
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Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0236060. [PMID: 32649710 PMCID: PMC7351160 DOI: 10.1371/journal.pone.0236060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023] Open
Abstract
Background There are concerns about the quality of medicines available in low- and middle-income countries (LMIC) to manage hemorrhage, pre-eclampsia/eclampsia and sepsis. We aimed to identify, critically appraise, and synthesize the findings of studies on the quality of these three types of medicines available in LMIC. Methods This systematic review searched Medline, EMBASE and LILACS (from inception to 25 May 2020) for studies on the quality of selected medicines available in LMIC that provided at least the amount of active pharmaceutical ingredient. We contacted study authors for additional information. We excluded simulation studies. We used the MEDQUARG tool to assess study quality. The main outcome was the prevalence of failed samples. Findings We identified 9699 unique citations and included 34 studies (3159 samples from 40 countries) in the review. Most studies (65%) had low quality (scores <6/12). Overall, 48.9% of 1890 uterotonic samples (19 studies) failed quality tests; failures rates were 75% for ergometrine and nearly 40% each for oxytocin and misoprostol. The overall prevalence of failed injectable antibiotics (1090 samples, 18 studies) was 13.4%, ranging from 2.9% for injectable metronidazole (34 samples, 3 studies) to 16.0% for cefazolin (449 samples, 2 studies). The prevalence of low quality magnesium sulphate (179 samples, 2 studies) was 3.4%. We did not find any studies on the quality of carbetocin, tranexamic acid, or clindamycin. Conclusions There is a widespread problem with the quality of medicines used to manage life-threatening maternal conditions in LMIC. This can be a contributing factor to high maternal mortality rates in these regions.
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Fanelli U, Chiné V, Pappalardo M, Gismondi P, Esposito S. Improving the Quality of Hospital Antibiotic Use: Impact on Multidrug-Resistant Bacterial Infections in Children. Front Pharmacol 2020; 11:745. [PMID: 32499712 PMCID: PMC7243475 DOI: 10.3389/fphar.2020.00745] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Abstract
Antimicrobial resistance (AMR) is considered a rapidly growing global public health emergency. Neonates and children are among patients for whom antibiotics are largely prescribed and for whom the risk of AMR development is high. The phenomenon of increasing AMR has led to the need to develop measures aimed at the rational and effective use of the available drugs also in children and antimicrobial stewardship (AS), which is one of the measures that in adults has showed the highest efficacy in reducing antibiotic abuse and misuse, appears as an attractive approach. The aim of this manuscript is to analyze the basic principles and strategies of pediatric AS. To this end, we searched in PubMed articles published in years 2000 to 2019 containing "antimicrobial resistance," "antibiotic use," "antimicrobial stewardship," and "children" or "pediatric" as keywords. Our review showed that the balance between multi-resistant organisms and new antimicrobials is extremely precarious. The AS tools are the most important weapon at our disposal to stem the phenomenon. Careful monitoring of prescriptions, continuous training of prescribing physicians and collaboration with highly qualified multidisciplinary staff, creation of local and national guidelines, use of rapid diagnostic tests, technological means of support, and research activities by testing new broad-spectrum antibiotics are mandatory. However, all of these measures must be supported by adequate investment by national and international health organizations. Only by making AS daily practice, through the use of financial resources and dedicated staff, we can fight AMR to ensure safe and effective care for our young patients.
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Affiliation(s)
| | | | | | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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29
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Li G, Jackson C, Bielicki J, Ellis S, Hsia Y, Sharland M. Global sales of oral antibiotics formulated for children. Bull World Health Organ 2020; 98:458-466. [PMID: 32742031 PMCID: PMC7375212 DOI: 10.2471/blt.19.235309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate international consumption patterns of child-appropriate oral formulations of antibiotics by formulation type, with a focus on dispersible tablets, using data from a global sales database. Method Antibiotic sales data for 2015 covering 74 countries and regional country groups were obtained from the MIDAS® pharmaceutical sales database, which includes samples of pharmacy wholesalers and retailers. The focus was on sales of child-appropriate oral formulations of Access antibiotics in the 2017 World Health Organization's WHO Model list of essential medicines for children. Sales volumes are expressed using a standard unit (i.e. one tablet, capsule, ampoule or vial or 5 mL of liquid). Sales were analysed by antibiotic, WHO region and antibiotic formulation. Findings Globally, 17.7 billion standard units of child-appropriate oral antibiotic formulations were sold in 2015, representing 24% of total antibiotic sales of 74.4 billion units (both oral and parenteral) in the database. The top five child-appropriate Access antibiotics by sales volume were amoxicillin, amoxicillin with clavulanic acid, trimethoprim-sulfamethoxazole, cefalexin and ampicillin. The proportion of the top five sold for use as a syrup varied between 42% and 99%. Dispersible tablets represented only 22% of all child-appropriate oral formulation sales and made up only 15% of sales of 10 selected Access antibiotics on the model list for children. Conclusion Globally most child-appropriate oral antibiotics were not sold as dispersible tablets in 2015, as recommended by WHO. There is a clear need for novel solid forms of antibiotics suitable for use in children.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Charlotte Jackson
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
| | - Sally Ellis
- Global Antibiotic Research & Development Partnership, Geneva, Switzerland
| | - Yingfen Hsia
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0QT, England
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