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Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1615. [PMID: 38004480 PMCID: PMC10675245 DOI: 10.3390/ph16111615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Antibiotics have revolutionized medicine, saving countless lives since their discovery in the early 20th century. However, the origin of antibiotics is now overshadowed by the alarming rise in antibiotic resistance. This global crisis stems from the relentless adaptability of microorganisms, driven by misuse and overuse of antibiotics. This article explores the origin of antibiotics and the subsequent emergence of antibiotic resistance. It delves into the mechanisms employed by bacteria to develop resistance, highlighting the dire consequences of drug resistance, including compromised patient care, increased mortality rates, and escalating healthcare costs. The article elucidates the latest strategies against drug-resistant microorganisms, encompassing innovative approaches such as phage therapy, CRISPR-Cas9 technology, and the exploration of natural compounds. Moreover, it examines the profound impact of antibiotic resistance on drug development, rendering the pursuit of new antibiotics economically challenging. The limitations and challenges in developing novel antibiotics are discussed, along with hurdles in the regulatory process that hinder progress in this critical field. Proposals for modifying the regulatory process to facilitate antibiotic development are presented. The withdrawal of major pharmaceutical firms from antibiotic research is examined, along with potential strategies to re-engage their interest. The article also outlines initiatives to overcome economic challenges and incentivize antibiotic development, emphasizing international collaborations and partnerships. Finally, the article sheds light on government-led initiatives against antibiotic resistance, with a specific focus on the Middle East. It discusses the proactive measures taken by governments in the region, such as Saudi Arabia and the United Arab Emirates, to combat this global threat. In the face of antibiotic resistance, a multifaceted approach is imperative. This article provides valuable insights into the complex landscape of antibiotic development, regulatory challenges, and collaborative efforts required to ensure a future where antibiotics remain effective tools in safeguarding public health.
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Affiliation(s)
- Ghazala Muteeb
- Department of Nursing, College of Applied Medical Science, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Md Tabish Rehman
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11437, Saudi Arabia;
- Center for Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates;
| | - Moayad Shahwan
- Center for Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates;
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates
| | - Mohammad Aatif
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
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Nabidda S, Ssennyonjo R, Atwaru J, Kanyike AM, Baryayaka S, Pangholi K, Tusiimire J. Antimicrobial resistance and rational prescription practices: knowledge, perceptions and confidence of health profession interns in Uganda. JAC Antimicrob Resist 2023; 5:dlad105. [PMID: 37795426 PMCID: PMC10546811 DOI: 10.1093/jacamr/dlad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision. Objectives This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices. Methods This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and multivariable logistic regression were performed. P < 0.05 was considered statistically significant. Results We recruited 281 participants with a mean age of 27 ± 3.8 years, of which few (n = 53; 19%) had good knowledge about AMR and rational prescription. The use of professional organization guidelines as a source of information was significantly associated with good knowledge (adjusted OR = 1.9; 95% CI: 1.0-3.5; P = 0.046). Nurses had the least knowledge compared with doctors and pharmacists. Continuous medical education (99%) and availability of clinical guidelines (98%) were identified as the most helpful intervention to improve knowledge. Most participants were confident about accurately diagnosing infections and sepsis and selecting appropriate antimicrobials. Conclusions Continuous medical education and availability of clinical and professional organization guidelines should be leveraged to improve the knowledge of AMR and rational prescription among health profession interns. Their high confidence in rational prescription practices should be pivotal to the fight against AMR.
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Affiliation(s)
- Shamim Nabidda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Aga Khan University, Kampala, Uganda
| | | | - Joseph Atwaru
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Marvin Kanyike
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Shiellah Baryayaka
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Jonans Tusiimire
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Jung L, Kiwanuka J, Mbabazi L, Nakate V, Musaazi J, Nabajja H, Kajumbula H, Lübbert C, Mwaka E, Nsibirwa S, von Braun A. A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001880. [PMID: 37582103 PMCID: PMC10427013 DOI: 10.1371/journal.pgph.0001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.
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Affiliation(s)
- Laura Jung
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - James Kiwanuka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Leah Mbabazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hawah Nabajja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Christoph Lübbert
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - Erisa Mwaka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Sara Nsibirwa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amrei von Braun
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
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Pérez-Delgado O, Espinoza-Culupú AO, López-López E. Antimicrobial Activity of Apis mellifera Bee Venom Collected in Northern Peru. Antibiotics (Basel) 2023; 12:antibiotics12040779. [PMID: 37107142 PMCID: PMC10135115 DOI: 10.3390/antibiotics12040779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Due to the emergence of microorganisms resistant to antibiotics and the failure of antibiotic therapies, there is an urgent need to search for new therapeutic options, as well as new molecules with antimicrobial potential. The objective of the present study was to evaluate the in vitro antibacterial activity of Apis mellifera venom collected in the beekeeping areas of the city of Lambayeque in northern Peru against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Bee venom extraction was performed by electrical impulses and separated using the Amicon ultra centrifugal filter. Subsequently, the fractions were quantified by spectrometric 280 nm and evaluated under denaturant conditions in SDS-PAGE. The fractions were pitted against Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 29213, and Pseudomonas aeruginosa ATCC 27853. A purified fraction (PF) of the venom of A. mellifera and three low molecular weight bands of 7 KDa, 6 KDa, and 5 KDa were identified that showed activity against E. coli with a MIC of 6.88 µg/mL, while for P. aeruginosa and S. aureus, it did not present a MIC. No hemolytic activity at a concentration lower than 15.6 µg/mL and no antioxidant activity. The venom of A. mellifera contains a potential presence of peptides and a predilection of antibacterial activity against E. coli.
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Affiliation(s)
- Orlando Pérez-Delgado
- Health Science Research Laboratory, Universidad Señor de Sipán, Chiclayo 14001, Peru
| | | | - Elmer López-López
- Faculty of Health Sciences, Universidad Señor de Sipán, Chiclayo 14001, Peru
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Bacterial infections epidemiology and factors associated with multidrug resistance in the northern region of Ghana. Sci Rep 2022; 12:22069. [PMID: 36543904 PMCID: PMC9772187 DOI: 10.1038/s41598-022-26547-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial infections caused by multidrug resistant organisms are a major global threat. There is still a knowledge gap on this situation in the Northern Region of Ghana. This study determined the prevalence and resistance profile of bacterial infections. It also identified factors associated with multidrug resistance in the study area. This was a retrospective cross-sectional design and it analyzed data from the samples received at the Tamale Zonal Public Health Reference Laboratory from June 2018 to May 2022. The data were analyzed using the R software version 4.2.0. Univariate and multivariable binary logistic regression analyses were used to determine the factors associated with multidrug resistance. The samples included all specimen types possible. The specimens were collected for the purpose of clinical bacteriology diagnostics. Overall a total of 1222 isolates were obtained. The three (3) main bacteria responsible for infections were: Klebsiella spp. (27%), Moraxella spp. (22%), Escherichia spp. (16%). High resistance levels were found against the tested antibiotics and about 41.60% of the bacterial strains isolated were multidrug resistant. Hospitalization was associated with multidrug resistance in univariate (COR 1.96; 95% CI 1.43-2.71; P-value < 0.001) and multivariable analyses (AOR 1.78; 95% CI 1.28-2.49; P-value < 0.001). There is the need for further research on the molecular epidemiology of antibiotic resistance genes in the study area to effectively control the spread of multidrug resistant pathogens. In addition, efforts to build the capacity of health professionals on infection prevention and control as well as diagnostic and antimicrobial stewardship needs urgent attention.
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Kanyike AM, Olum R, Kajjimu J, Owembabazi S, Ojilong D, Nassozi DR, Amongin JF, Atulinda L, Agaba K, Agira D, Wamala NK, Buule R, Nabukeera G, Kyomuhendo R, Luwano R, Owobusingye W, Matovu D, Musoke P, Bongomin F, Kiyimba K. Antimicrobial resistance and rational use of medicine: knowledge, perceptions, and training of clinical health professions students in Uganda. Antimicrob Resist Infect Control 2022; 11:145. [PMID: 36434685 PMCID: PMC9700951 DOI: 10.1186/s13756-022-01186-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an important global health concern, projected to contribute to significant mortality, particularly in developing countries. This study aimed to determine the knowledge, perceptions of clinical health professions students towards antimicrobial resistance and rational use of medicine and confidence level to prescribe antimicrobials. METHODS An online descriptive cross-sectional survey was conducted among clinical health professions students across 9 medical schools in Uganda. A semi-structured questionnaire using Kobo Toolbox form was shared among participants via WhatsApp Messenger (Meta, California, USA). Knowledge was categorized using modified Bloom's cut-off. One-way ANOVA, Chi-square or Fisher's exact test, and logistic regression were used to assess the association between dependent and independent variables. A p < 0.05 was considered statistically significant. RESULTS We surveyed 681 participants, most were pursuing a Bachelor of Medicine and Surgery degree (n = 433, 63.6%), with a mean age of 24 (standard deviation: 3.6) years. Most participants (n = 596, 87.5%) had sufficient knowledge about antimicrobial resistance with a mean score of 85 ± 14.2%. There was a significant difference in mean knowledge scores of year 4 (86.6%) compared to year 3 (82.4%) (p = 0.002) and year 5 (88.0%) compared to year 3 (82.4%) (p < 0.001). Most participants (n = 456, 66.9%), were confident on making an accurate diagnosis of infection, and choosing the correct antimicrobial agent to use (n = 484, 71.1%). CONCLUSION Health profession students exhibited good knowledge on antimicrobial resistance and high self-perceived confidence that should be leveraged to foster better future antimicrobial prescription practices. However, they still agreed that a separated course unit on AMR is necessary which responsible authorities should consider to consolidate the efforts.
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Affiliation(s)
- Andrew Marvin Kanyike
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ronald Olum
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Kajjimu
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Shebah Owembabazi
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Daniel Ojilong
- grid.448602.c0000 0004 0367 1045Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Dianah Rhoda Nassozi
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Linda Atulinda
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kenneth Agaba
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Drake Agira
- grid.449527.90000 0004 0534 1218School of Medicine, Kabale University, Kabale, Uganda
| | - Nicholas Kisaakye Wamala
- grid.440478.b0000 0004 0648 1247Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka-Bushenyi, Uganda
| | - Richard Buule
- grid.440478.b0000 0004 0648 1247Faculty of Clinical Medicine and Dentistry, Kampala International University, Ishaka-Bushenyi, Uganda
| | - Germinah Nabukeera
- grid.449527.90000 0004 0534 1218School of Medicine, Kabale University, Kabale, Uganda
| | - Robert Kyomuhendo
- grid.442626.00000 0001 0750 0866Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rehema Luwano
- grid.442655.40000 0001 0042 4901Faculty of Medicine, Islamic University in Uganda, Mbale, Uganda
| | - Whitney Owobusingye
- grid.448548.10000 0004 0466 5982Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Dissan Matovu
- Faculty of Biology, Medicine and Health, King Ceaser University, Kampala, Uganda
| | - Philip Musoke
- grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Kenedy Kiyimba
- grid.448602.c0000 0004 0367 1045Department of Pharmacology and Therapeutics, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Plant Spices as a Source of Antimicrobial Synergic Molecules to Treat Bacterial and Viral Co-Infections. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27238210. [PMID: 36500303 PMCID: PMC9737474 DOI: 10.3390/molecules27238210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic exposed the lack of antiviral agents available for human use, while the complexity of the physiological changes caused by coronavirus (SARS-CoV-2) imposed the prescription of multidrug pharmacotherapy to treat infected patients. In a significant number of cases, it was necessary to add antibiotics to the prescription to decrease the risk of co-infections, preventing the worsening of the patient's condition. However, the precautionary use of antibiotics corroborated to increase bacterial resistance. Since the development of vaccines for COVID-19, the pandemic scenario has changed, but the development of new antiviral drugs is still a major challenge. Research for new drugs with synergistic activity against virus and resistant bacteria can produce drug leads to be used in the treatment of mild cases of COVID-19 and to fight other viruses and new viral diseases. Following the repurposing approach, plant spices have been searched for antiviral lead compounds, since the toxic effects of plants that are traditionally consumed are already known, speeding up the drug discovery process. The need for effective drugs in the context of viral diseases is discussed in this review, with special focus on plant-based spices with antiviral and antibiotic activity. The activity of plants against resistant bacteria, the diversity of the components present in plant extracts and the synergistic interaction of these metabolites and industrialized antibiotics are discussed, with the aim of contributing to the development of antiviral and antibiotic drugs. A literature search was performed in electronic databases such as Science Direct; SciELO (Scientific Electronic Library Online); LILACS (Latin American and Caribbean Literature on Health Sciences); Elsevier, SpringerLink; and Google Scholar, using the descriptors: antiviral plants, antibacterial plants, coronavirus treatment, morbidities and COVID-19, bacterial resistance, resistant antibiotics, hospital-acquired infections, spices of plant origin, coronaviruses and foods, spices with antiviral effect, drug prescriptions and COVID-19, and plant synergism. Articles published in English in the period from 2020 to 2022 and relevant to the topic were used as the main inclusion criteria.
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Hopp LJ, Clementinah A, Verdick CJ, Napyo A. Annual burden of disease in Nakaale, Karamoja: A descriptive, cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000222. [PMID: 36962152 PMCID: PMC10021429 DOI: 10.1371/journal.pgph.0000222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022]
Abstract
Even with global Sustainable Development Goals aimed at reducing poverty by reaching those furthest behind first and reducing inequalities within countries, regions like Karamoja continue to score low on many health indices. To understand the Karamoja context, we aimed to systematically describe the burden of disease in Nakaale, which is a hard-to-reach parish in Nakapiripirit District, through disaggregated data. This descriptive, cross-sectional study was conducted between January and December 2019. We relied on secondary data collected from all clients seen at Akisyon a Yesu Presbyterian Clinic's outpatient department in Nakaale. Data was extracted from Uganda's Health Management Information System records using Excel and exported to Stata for analysis. We labelled, categorised, and estimated frequencies and proportions for the variables. We estimated the means and medians for normally distributed or skewed variables respectively. A total of 14,685 observations, different diagnoses (n = 163) and residential locations or villages (n = 189) were extracted and included in the analysis. Nearly half (48.9%) of the clients were under the age of five years. Infectious diseases (42%), respiratory diseases (19%), and gastrointestinal and hepatic diseases (17%) were most commonly reported. While many clients (42%) reside in the sub-county where the health facility is located, a larger proportion (58%) came from further away, including 15% from outside of the local district. In conclusion, Akiyson a Yesu Presbyterian Clinic serves a very young population in a catchment area well beyond what is expected of a Health Centre II, in breadth of diagnoses, geographically, and in sheer numbers. Data gathered in this study will inform policy at the clinic, subcounty, and district levels enabling accurate health service delivery for the local context.
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Affiliation(s)
- Leah J Hopp
- Orthodox Presbyterian Uganda Mission, Akisyon a Yesu Presbyterian Clinic, Nakaale, Nakapiripirit, Uganda
| | | | - Christopher J Verdick
- Orthodox Presbyterian Uganda Mission, Akisyon a Yesu Presbyterian Clinic, Nakaale, Nakapiripirit, Uganda
| | - Agnes Napyo
- Department of Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Karasneh RA, Al-Azzam SI, Ababneh M, Al-Azzeh O, Al-Batayneh OB, Muflih SM, Khasawneh M, Khassawneh ARM, Khader YS, Conway BR, Aldeyab MA. Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan. Antibiotics (Basel) 2021; 10:antibiotics10070858. [PMID: 34356779 PMCID: PMC8300611 DOI: 10.3390/antibiotics10070858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.
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Affiliation(s)
- Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Sayer I. Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Mera Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Ola Al-Azzeh
- Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
| | - Ola B. Al-Batayneh
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Suhaib M. Muflih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.I.A.-A.); (M.A.); (S.M.M.)
| | - Mohammad Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | | | - Yousef S. Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD13DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK;
- Correspondence: ; Tel.: +44-01484-472825
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Namugambe JS, Delamou A, Moses F, Ali E, Hermans V, Takarinda K, Thekkur P, Nanyonga SM, Koroma Z, Mwoga JN, Akello H, Imi M, Kitutu FE. National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda. Trop Med Infect Dis 2021; 6:83. [PMID: 34069434 PMCID: PMC8163196 DOI: 10.3390/tropicalmed6020083] [Citation(s) in RCA: 6] [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: 04/06/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.
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Affiliation(s)
- Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, P.O. Box 1410 Mbarara, Uganda
| | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Nasser, Conakry, PB: 4099 Maferinyah, Guinea;
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099 Maferinyah, Guinea
| | - Francis Moses
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, 00232 Freetown, Sierra Leone
| | - Engy Ali
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Veerle Hermans
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Kudakwashe Takarinda
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, P.O. Box 7072 Kampala, Uganda;
| | - Zikan Koroma
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
| | - Joseph Ngobi Mwoga
- World Health Organisation County Office, P.O. Box 24578 Kampala, Uganda;
| | - Harriet Akello
- Ministry of Health Uganda, P.O. Box 7272 Kampala, Uganda;
| | - Monica Imi
- Enabel, The Belgian Development Agency, P.O. Box 40131 Kampala, Uganda;
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;
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