Awareness of antibiotic resistance: a tool for measurement among human and animal health care professionals in LMICs and UMICs

Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications

INTRODUCTION

Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries.

AREAS COVERED

This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics.

EXPERT OPINION

There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics.

CONCLUSIONS

There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

Impact of educational intervention on knowledge of antimicrobial resistance and antibiotic use patterns among healthcare students: a pre- and post-intervention study

BACKGROUND

Antimicrobial resistance (AMR) is a growing global health threat, partly driven by inappropriate antibiotic use. Healthcare students, as future practitioners, must have a good understanding of AMR to contribute to antimicrobial stewardship. This study aimed to evaluate the impact of an educational intervention on healthcare students' knowledge of AMR and to assess patterns of antibiotic use prior to the intervention.

METHODS

A quasi-experimental pre-and-post study design was conducted with unpaired groups of healthcare students. An educational intervention was carried out comprising of two 20-minute PowerPoint lectures, as well as question and answer sessions focused on understanding the spread, impact, and prevention of AMR. A self-administered questionnaire was given as a pre-test and repeated as a post-test immediately after the training. Students' knowledge of AMR and patterns of antibiotic use was assessed pre-intervention while knowledge of AMR was assessed post-intervention. The knowledge was categorised into domains (Understanding Antibiotic and Antimicrobial Resistance; Spread and Impact of Antibiotic/Antimicrobial Resistance; Prevention of Antibiotic/Antimicrobial Resistance). The total score for each domain of knowledge tested was categorized into good knowledge (≥ 80%) and poor knowledge (< 50%).

RESULTS

The number of participants in the pre- and post-intervention were 185 and 157 students with average age of 17.7 years and 17.8 years respectively. Post-intervention, there was a significant increase in students' AMR knowledge, with correct responses regarding spread and impact of AMR increasing from 40.5% pre-intervention to 62.4% post-intervention (p < 0.001; φ (effect size = 0.218). The proportion of students demonstrating good overall knowledge increased from 28.1 to 44.6% (p = 0.001; φ (effect size = 0.171). Misconceptions, such as misunderstanding that antibiotic resistance does not result from the body becoming resistant to antibiotics, persisted but not statistically significant (24.9-17.2%, p = 0.055). Pre-intervention also revealed varied antibiotic use patterns, including the inappropriate use of antibiotics for malaria (51.7%, (n = 76)), and common cold (25.2% (n = 37)).

CONCLUSIONS

The study findings indicate that educational interventions can effectively improve healthcare students' knowledge of AMR, though persistent misconceptions underscore the need for more targeted educational efforts. Incorporating structured AMR content into healthcare curricula could help the students contribute to antimicrobial stewardship. Future research should evaluate knowledge retention and behaviour changes to optimize the long-term impact of AMR education.

Perception of phage therapy and research across selected professional and social groups in Poland

There is no doubt that in the last 15 years phage therapy has re-emerged from the shadow of antibiotics, from the perspective of both scientists and various patient advocacy groups. Despite some important progress, there is little to no data on phage therapy perceptions in key groups, i.e., patients and their relatives, physicians and anyone who could potentially become infected with antibiotic-resistant bacteria. To the best of our knowledge, with 1,098 collected questionnaires, this article constitutes the first large-scale analysis on phage therapy perceptions, interest and knowledge among ordinary people in a country with a long, internationally recognized, tradition of treating patients with phages. In addition to 36 general questions addressed to everyone (including lay people), representatives of the health care sector and science and research sector received individually selected questions. Further, each participant had a chance to take part in a short quiz (consisting of 12 questions) verifying their basic knowledge about bacteriophages, their history, biology and therapeutic connotations. Awareness of antibiotic resistance was very high (above 90%) but contradicted the low level of knowledge about associated risks (12%). Consciousness of phage therapy varied between 8.9% (people taking care of household chores as their primary activity) to 37.7% (people with higher education) and 39.7% (inhabitants of large cities) while the readiness to use such treatments was very high (84.4%) despite the need to pay for it. The level of awareness of bacteriophages and phage therapy was clearly correlated with the acceptance of this type of treatment and the social acceptance to allocate further funds for the development of phage research. Interestingly, physicians were quite reluctant to deepen their knowledge in the field of phage therapy with just over one third (37.5%) ready to do so. With the COVID-19 pandemic in the background, we also explored how the pandemic influenced the interest in experimental therapies in general, which makes this article a potential universal compendium on perceptions of experimental therapies in the coming years.

Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study

Background

Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia.

Methods

A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0.

Results

Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics.

Conclusion

This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of 'Watch' antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.

Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review

This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.