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Singh A, Rani PS, Bandsode V, Nyambero M, Qumar S, Ahmed N. Drivers of virulence and antimicrobial resistance in Gram-negative bacteria in different settings: A genomic perspective. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 124:105666. [PMID: 39242067 DOI: 10.1016/j.meegid.2024.105666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/13/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
The human gut presents a complex ecosystem harboring trillions of microorganisms living in close association with each other and the host body. Any perturbation or imbalance of the normal gut microbiota may prove detrimental to human health. Enteric infections and treatment with antibiotics pose major threats to gut microbiota health. Recent genomics-driven research has provided insights into the transmission and evolutionary dynamics of major enteric pathogens such as Escherichia coli, Klebsiella pneumoniae, Vibrio cholerae, Helicobacter pylori and Salmonella spp. Studies entailing the identification of various dominant lineages of some of these organisms based on artificial intelligence and machine learning point to the possibility of a system for prediction of antimicrobial resistance (AMR) as some lineages have a higher propensity to acquire virulence and fitness advantages. This is pertinent in the light of emerging AMR being one of the immediate threats posed by pathogenic bacteria in the form of a multi-layered fitness manifesting as phenotypic drug resistance at the level of clinics and field settings. To develop a holistic or systems-level understanding of such devastating traits, present methodologies need to be advanced with the high throughput techniques integrating community and ecosystem/niche level data across different omics platforms. The next major challenge for public health epidemiologists is understanding the interactions and functioning of these pathogens at the community level, both in the gut and outside. This would provide new insights into the dimensions of enteric bacteria in different environments and niches and would have a plausible impact on infection control strategies in terms of tackling AMR. Hence, the aim of this review is to discuss virulence and AMR in Gram-negative pathogens, the spillover of AMR and methodological advancements aimed at addressing it through a unified One Health framework applicable to the farms, the environment, different clinical settings and the human gut.
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Affiliation(s)
- Anuradha Singh
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India
| | - Pittu Sandhya Rani
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India
| | - Viraj Bandsode
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India
| | - Mahanga Nyambero
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India
| | - Shamsul Qumar
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India
| | - Niyaz Ahmed
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, Telangana, India.
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Keck JM, Viteri A, Schultz J, Fong R, Whitman C, Poush M, Martin M. New Agents Are Coming, and So Is the Resistance. Antibiotics (Basel) 2024; 13:648. [PMID: 39061330 PMCID: PMC11273847 DOI: 10.3390/antibiotics13070648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alina Viteri
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Rebecca Fong
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Charles Whitman
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Madeline Poush
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Marlee Martin
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Alqahtani NS, Bilal MM, Al Margan AM, Albaghrah FA, Al Sharyan AM, Alyami ASM. Assessment of Physicians' Practice in Implementing Antibiotic Stewardship Program in Najran City, Saudi Arabia: A Cross-Sectional Study. PHARMACY 2024; 12:24. [PMID: 38392931 PMCID: PMC10892749 DOI: 10.3390/pharmacy12010024] [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: 11/14/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION One of the main causes of illness, mortality, and rising medical costs is antimicrobial resistance, which is a global healthcare concern. OBJECTIVES This study explores the practice of physicians toward the effective implementation of Antibiotic Stewardship Programs (ASPs) in Najran city, Saudi Arabia. METHODOLOGY This cross-sectional study was conducted among physicians working at primary care setting in Najran city, Saudi Arabia, between May and August 2023. A self-administered questionnaire was distributed among the physicians composed of three parts: socio-demographic data, a questionnaire about physicians' practice in the efficacy of ASP, and a questionnaire about physicians' practice regarding prescribing antibiotics. RESULTS Of the 128 physicians who participated in the study, 60.2% were males, and 43.8% were aged between 36 and 45 years. Among the practices in implementing the ASP effectively, controlling the source of infection domain received the highest score (mean score: 4.83). Every practice domain mean score was greater than 3, indicating that study participants possessed a moderate level of ASP practice and implementation skills. The overall mean practice score in the effective implementation of ASP was 154.9 ± 25.5 out of 185 points, with good, moderate, and poor practices constituting 67.2%, 28.1%, and 4.7%, respectively. CONCLUSIONS The physicians showed a moderate level of practice for the effective implementation of ASPs in Najran city. The factors significantly associated with increased practice score include older age, male gender, Saudi nationality, handling five or fewer infection cases daily, and infection-initiated antibiotic prescribing treatment managed per day. These findings suggest the need for targeted interventions and educational programs to enhance physicians' adherence to ASP guidelines and promote appropriate antibiotic prescribing practices, ultimately contributing to global efforts in combating antimicrobial resistance and improving patient outcomes.
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Affiliation(s)
- Nasser Saeed Alqahtani
- Department of Family and Community Medicine, College of Medicine, Najran University, Najran 66462, Saudi Arabia
| | - Maha Mohammed Bilal
- Department of Family and Community Medicine, College of Medicine, Najran University, Najran 66462, Saudi Arabia
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Alsamara I, Ogilvie L, Sudbrak R, Brand A. One Health Lens for Antimicrobial Resistance Research and Funding: A Systematic Review. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:570-580. [PMID: 37851996 DOI: 10.1089/omi.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
One Health (OH) offers conceptual and applied prospects to advance planetary health and integrative biology in the 21st century. For example, The World Health Organization (WHO) has declared antimicrobial resistance (AMR) one of humanity's top 10 health threats worldwide (AMR). The AMR research, as seen through the OH lens, recognizes the interdependence and the coproduction of the health of humans, nonhuman animals, and the environment (the OH triad). Moreover, research and development (R&D) is required to generate potential solutions to prevent, diagnose, and treat infections and control the spread and emergence of AMR. However, it is still unclear how well the OH approach is integrated into current AMR R&D. In this study, we present a systematic review on the OH funding landscape for cross-sectoral AMR R&D, and its alignment/gaps with the current global strategic agenda on AMR. A systematic literature review was conducted using public databases covering the period between January 2015 and May 2022. We included the studies and reviews on AMR encompassing more than one sector of the OH triad. Out of the 777 included studies, 475 (61%) encompassed the three OH sectors. A key finding of the present systematic review is that the environment was the most neglected sector in the OH triad. AMR surveillance, transmission, and interventions are the most commonly studied priority topics. In addition, both cross-sectoral AMR literature and investments have been increasing since 2017. The operational aspect of AMR is the most researched and funded area. However, certain priority topics in the strategic research and innovation agenda of the Joint Programming Initiative on AMR are underrepresented in OH AMR research, such as diagnosis and therapeutics. To the best of authors' knowledge, this is the first study that systematically reviews the cross-sectoral literature on AMR, classifies it, and aligns and contextualizes it in regard to the funding landscape of AMR. This systematic review identifies neglected areas in AMR R&D and could serve as critical information for policymaking so as to realize the objectives of the Global Action Plan on AMR. Going forward, more cross-sectoral AMR research and funding are needed. As integrative biology and omics systems science are poised to benefit from a rapprochement with the OH lens, the present article highlights the AMR research and funding landscapes.
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Affiliation(s)
- Issam Alsamara
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lesley Ogilvie
- Director of the Global AMR R&D Hub Secretariat, Global Antimicrobial Resistance Research and Development Hub, Berlin, Germany
| | - Ralf Sudbrak
- Deputy Director of the Global AMR R&D Hub Secretariat, Global Antimicrobial Resistance Research and Development Hub, Berlin, Germany
| | - Angela Brand
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel) 2023; 12:1496. [PMID: 37887197 DOI: 10.3390/antibiotics12101496] [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: 08/26/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad 121004, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rashmi Sharma
- Department of Community Medicine, GMERS Medical College Sola, Ahmedabad 380060, India
| | - Bhola Nath
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli 229405, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342001, India
| | | | - Rakesh Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kahkasha Kahkasha
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar 814152, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Raman P Priyadarshini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur 174037, India
| | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong 793018, India
| | - Suneel Kumar Rohilla
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Jyoti Kaushal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal
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Tomic T, Henman M, Tadic I, Antic Stankovic J, Santric Milicevic M, Maksimovic N, Odalovic M. Antimicrobial utilization and resistance in Pseudomonas aeruginosa using segmented regression analysis: a comparative study between Serbia and eight European Countries. Int J Clin Pharm 2023; 45:989-998. [PMID: 37284904 PMCID: PMC10246517 DOI: 10.1007/s11096-023-01603-y] [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: 11/17/2022] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND In Europe, Serbia occupies a high position in antibiotic utilization and antimicrobial resistance (AMR). AIM The aim was to analyse utilization trends of meropenem, ceftazidime, aminoglycosides, piperacillin/tazobactam and fluoroquinolones (2006-2020), and the reported AMR in Pseudomonas aeruginosa (2013-2020) in Serbia and to compare with data from eight European countries (2015-2020). METHOD Joinpoint regression was used to analyse antibiotic utilization data (2006-2020) and the reported AMR in Pseudomonas aeruginosa (2013-2020). Data sources were relevant national and international institutions. Antibiotic utilization and AMR in Pseudomonas aeruginosa data in Serbia were compared with eight European countries. RESULTS There was a significantly increased trend for ceftazidime utilization and reported resistance in Pseudomonas aeruginosa, Serbia (p < 0.05) (2018-2020). For ceftazidime, piperacillin/tazobactam, and fluoroquinolones resistances in Pseudomonas aeruginosa an increased trend was observed, Serbia (2013-2020). A decrease in both the utilization of aminoglycosides, Serbia (p < 0.05) (2006-2018) and contemporaneous Pseudomonas aeruginosa resistance (p > 0.05) was detected. Fluoroquinolone utilization (2015-2020) was highest in Serbia compared to Netherlands and Finland, 310 and 305% higher, similar compared to Romania, and 2% less compared to Montenegro. Aminoglycosides (2015-2020) were 2550 and 783% more used in Serbia compared to Finland and Netherlands, and 38% less regarding Montenegro. The highest percentage of Pseudomonas aeruginosa resistance was in Romania and Serbia (2015-2020). CONCLUSION The use of piperacillin/tazobactam, ceftazidime and fluoroquinolones should be carefully monitored in clinical practice due to increased Pseudomonas aeruginosa resistance. The level of utilization and AMR in Pseudomonas aeruginosa is still high in Serbia compared to other European countries.
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Affiliation(s)
- Tanja Tomic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia.
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Ivana Tadic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia
| | | | | | | | - Marina Odalovic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia
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Mittal N, Mittal R, Goel N, Parmar A, Bahl A, Kaur S, Gudibanda KR, Dudhraj V, Singh SK. WHO-Point Prevalence Survey of Antibiotic Use Among Inpatients at a Core National Antimicrobial Consumption Network Site in North India: Findings and Implications. Microb Drug Resist 2023; 29:1-9. [PMID: 36656989 DOI: 10.1089/mdr.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Data on Point Prevalence Surveys (PPSs) in India are limited yet. We report findings of a PPS conducted in a core "National Antimicrobial Consumption Network site" under National Centre for Disease Control - WHO project "Point prevalence survey of antimicrobial consumption at healthcare facilities." A cross-sectional survey was conducted as per the "WHO methodology for PPS on antibiotic use in hospitals" in a tertiary care hospital in India in December 2021. Data were collected using predesigned and pretested questionnaire in separate hospital, ward, and patient forms. Eight hundred two inpatients (excluding ICUs) were covered out of whom 299 (37.3%) were on antibiotics with 11.7% receiving 3 or more antibiotics. Surgical prophylaxis (SP) (42.5%) and community acquired infections (32.8%) were the most common indications for antibiotic use. Of the patients, 92.5% received SP for more than 24 hrs. Most commonly prescribed antibiotics were penicillins with beta-lactamase inhibitors (22.3%). Of the total antibiotic prescriptions, 81.5% were from WHO essential medicines list and 12% from "not recommended" WHO AWaRe classification. Of the antibiotic prescriptions, 84.6% were parenteral. Few prescriptions complied with standard treatment guidelines (1.9%), documented indication for antibiotic use (11.6%), and stop/review date (4.4%) in notes. Double anaerobic cover accounted for 6.8% of the total prescriptions. Some identified areas for improvement were: formulation of hospital antibiotic guidelines, promoting culture of sending cultures, improvement in surgical antibiotic prophylaxis, decreasing use of antibiotic combinations and double anaerobic cover, fostering IV to oral switch of antibiotics, and ensuring effective communication among health care workers by documenting adequate information in medical notes.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Rakesh Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Nidhi Goel
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Aparna Parmar
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Arti Bahl
- National Center for Disease Control (NCDC), New Delhi, India
| | - Suneet Kaur
- National Center for Disease Control (NCDC), New Delhi, India
| | | | - Vibhor Dudhraj
- National Center for Disease Control (NCDC), New Delhi, India
| | - Sujeet K Singh
- National Center for Disease Control (NCDC), New Delhi, India
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications. Hosp Pract (1995) 2022; 50:306-317. [PMID: 35980901 DOI: 10.1080/21548331.2022.2114251] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. METHODS A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. RESULTS The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files. CONCLUSIONS It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.
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Affiliation(s)
- Phumzile P Skosana
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Danie Kruger
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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9
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Rahman MM, Alam Tumpa MA, Zehravi M, Sarker MT, Yamin M, Islam MR, Harun-Or-Rashid M, Ahmed M, Ramproshad S, Mondal B, Dey A, Damiri F, Berrada M, Rahman MH, Cavalu S. An Overview of Antimicrobial Stewardship Optimization: The Use of Antibiotics in Humans and Animals to Prevent Resistance. Antibiotics (Basel) 2022; 11:667. [PMID: 35625311 PMCID: PMC9137991 DOI: 10.3390/antibiotics11050667] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Antimicrobials are a type of agent widely used to prevent various microbial infections in humans and animals. Antimicrobial resistance is a major cause of clinical antimicrobial therapy failure, and it has become a major public health concern around the world. Increasing the development of multiple antimicrobials has become available for humans and animals with no appropriate guidance. As a result, inappropriate use of antimicrobials has significantly produced antimicrobial resistance. However, an increasing number of infections such as sepsis are untreatable due to this antimicrobial resistance. In either case, life-saving drugs are rendered ineffective in most cases. The actual causes of antimicrobial resistance are complex and versatile. A lack of adequate health services, unoptimized use of antimicrobials in humans and animals, poor water and sanitation systems, wide gaps in access and research and development in healthcare technologies, and environmental pollution have vital impacts on antimicrobial resistance. This current review will highlight the natural history and basics of the development of antimicrobials, the relationship between antimicrobial use in humans and antimicrobial use in animals, the simplistic pathways, and mechanisms of antimicrobial resistance, and how to control the spread of this resistance.
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Affiliation(s)
- Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mst. Afroza Alam Tumpa
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj 11942, Saudi Arabia;
| | - Md. Taslim Sarker
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Yamin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Sarker Ramproshad
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Banani Mondal
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India;
| | - Fouad Damiri
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Mohammed Berrada
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Md. Habibur Rahman
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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10
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Cameron A, Esiovwa R, Connolly J, Hursthouse A, Henriquez F. Antimicrobial Resistance as a Global Health Threat: The Need to Learn Lessons from the COVID-19 Pandemic. GLOBAL POLICY 2022; 13:179-192. [PMID: 35601654 PMCID: PMC9111155 DOI: 10.1111/1758-5899.13049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 06/10/2023]
Abstract
The global COVID-19 pandemic has exacerbated existing health, social, and economic challenges and threatened progress towards achieving the UN sustainable development goals. We discuss lessons learned from the COVID-19 pandemic for global policymaking for health security governance, with a particular focus on antimicrobial resistance. We identify One Health as the primary foundation of public health risk management owing to the collaborative, multidisciplinary, and multisectoral efforts that underpin the One Health approach and that enhance understanding of the complex interactions at the human-animal-environment interface. We discuss the narrow human-centric focus of the One Health approach, highlight the underrepresentation of the environmental sector in One Health networks, and encourage greater representation from the environmental sector. Furthermore, we highlight the importance of the social sciences for health security research and the need for effective communication and trust. Finally, we underscore the importance of strengthened and collaborative health, social care, and disaster management systems. The application of these lessons will facilitate holistic, multisectoral, collaborative, and ethical actions on antimicrobial resistance.
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11
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Saleem Z, Faller EM, Godman B, Malik MSA, Iftikhar A, Iqbal S, Akbar A, Hashim M, Amin A, Javeed S, Amir A, Zafar A, Sabih F, Hashmi FK, Hassali MA. Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211064714. [PMID: 36204499 PMCID: PMC9413637 DOI: 10.1177/23992026211064714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antibiotics are losing their effectiveness because of the rapid emergence of
resistant bacteria. Unnecessary antimicrobial use increases antimicrobial
resistance (AMR). There are currently no published data on antibiotic
consumption in Pakistan at the community level. This is a concern given high
levels of self-purchasing of antibiotics in Pakistan and variable knowledge
regarding antibiotics and AMR among physicians and pharmacists. Objective: The objective of this repeated prevalence survey was to assess the pattern of
antibiotic consumption data among different community pharmacies to provide
a baseline for developing future pertinent initiatives. Methods: A multicenter repeated prevalence survey conducted among community pharmacies
in Lahore, a metropolitan city with a population of approximately 10 million
people, from October to December 2017 using the World Health Organization
(WHO) methodology for a global program on surveillance of antimicrobial
consumption. Results: The total number of defined daily doses (DDDs) dispensed per patient ranged
from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from
pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a
total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin
with a total number of 486.6 DDDs and azithromycin with a total number of
472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime,
amikacin, and ofloxacin, with overall consumption highest in December. Conclusion: The study indicated high antibiotic usage among community pharmacies in
Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly
dispensed inappropriately. The National action plan of Pakistan on AMR
should be implemented by policymakers including restrictions on the
dispensing of antimicrobials.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | | | - Aqsa Iftikhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sonia Iqbal
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aroosa Akbar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Mahnoor Hashim
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aneeqa Amin
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sidra Javeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Afreenish Amir
- National University of Medical Sciences, Rawalpindi, Pakistan
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12
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Ogunleye OO, Oyawole MR, Odunuga PT, Kalejaye F, Yinka-Ogunleye AF, Olalekan A, Ogundele SO, Ebruke BE, Kalada Richard A, Anand Paramadhas BD, Kurdi A, Sneddon J, Seaton A, Godman B. A multicentre point prevalence study of antibiotics utilization in hospitalized patients in an urban secondary and a tertiary healthcare facilities in Nigeria: findings and implications. Expert Rev Anti Infect Ther 2021; 20:297-306. [PMID: 34128756 DOI: 10.1080/14787210.2021.1941870] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The understanding of antimicrobial utilization patterns is pertinent to successful implementation of the National Action Plans on Antimicrobial Resistance (AMR). There is, however, limited information on antibiotics utilization in Nigeria. This study was undertaken to build on existing information and provide direction for appropriate interventions including Antibiotics Stewardship Programs (ASP). METHOD A Point Prevalence Study (PPS) was conducted in two public urban health facilities in Lagos, Nigeria using a design adapted from the European Center for Disease Prevention and Control (ECDC) and Global-PPS surveys. RESULTS The prevalence of antibiotics use was 80.6% administered mostly parenterally (83.1% of total prescriptions) with concerns with extended surgical antibiotics prophylaxis. The mostly used antibiotics in the secondary hospital were parenteral metronidazole (32.4%), ceftriaxone (27.5%), and amoxicillin + clavulanate (8.2%) while the mostly used in the tertiary hospital were ceftriaxone (25.3%), parenteral metronidazole (19.1%), and amoxicillin + clavulanate (9.3%). There was an appreciable lack of specific functional capacities, policies, and processes to promote appropriate antimicrobial use in both hospitals. CONCLUSIONS There is high rate of antibiotics utilization in these facilities with lack of institutional frameworks and processes for ensuring appropriate antibiotic use. The study provides the information needed to improve future antimicrobial use in hospitals and reduce AMR.
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Affiliation(s)
- Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Modupe R Oyawole
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Patricia T Odunuga
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Folasade Kalejaye
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adesola F Yinka-Ogunleye
- Nigerian Centre for Disease Control, Federal Capital Territory, Abuja, Nigeria.,Institute of Global Health, University College, London, UK
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos, Nigeria.,Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos, Nigeria
| | - Sunday O Ogundele
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Diseases In Nigeria (IFAIN), Abuja, Nigeria
| | | | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Andrew Seaton
- Healthcare Improvement Scotland, Delta House, Glasgow, UK.,Queen Elizabeth University Hospital, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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13
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Sefah IA, Essah DO, Kurdi A, Sneddon J, Alalbila TM, Kordorwu H, Godman B. Assessment of adherence to pneumonia guidelines and its determinants in an ambulatory care clinic in Ghana: findings and implications for the future. JAC Antimicrob Resist 2021; 3:dlab080. [PMID: 34223139 PMCID: PMC8210001 DOI: 10.1093/jacamr/dlab080] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/12/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Adherence to local standard guidelines is seen as a pragmatic way to measure and improve the quality of future prescribing in ambulatory care to reduce morbidity, mortality and healthcare costs. OBJECTIVES To evaluate adherence to the Ghana Standard Treatment Guidelines (STGs) for the empirical antibiotic treatment of ambulatory care patients with community-acquired pneumonia (CAP) in a region in Ghana and factors associated with it. METHODS A cross-sectional survey was conducted using a checklist to collect data from the hospital electronic database, which included sociodemographic details, payment type and clinical information of all ambulatory patients attending Keta Municipal Hospital, diagnosed and managed for CAP from September 2018 to January 2019. Prescriptions were assessed for adherence to the Ghana STG based on choice of antibiotics. A χ2 test and multiple logistic regression were subsequently conducted. RESULTS A total of 1929 patient records with diagnosis of CAP within the study period at the ambulatory clinic were identified. The overall rate of adherence to the Ghana STG was 32.50% (n = 627). From the patient records collected, 62.50% were female, 41.84% were children (0-12 years), and 97.15% had a valid national health insurance status. Adherence was associated with the duration of antibiotic prescribing, number of additional antibiotics prescribed and some patients' clinical characteristics. CONCLUSIONS The rate of adherence to Ghana STG among the study population was low. Efforts must be made to train and encourage prescribers to follow empirical guidelines to reduce inappropriate selection of antibiotics in the ambulatory care settings.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Darius Obeng Essah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G12NP, UK
| | - Thelma Mpoku Alalbila
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Hope Kordorwu
- Nursing Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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14
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications. Expert Rev Anti Infect Ther 2021; 19:1353-1366. [PMID: 33724147 DOI: 10.1080/14787210.2021.1898946] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Antimicrobial use is growing, driven mainly by rising demands in developing countries. Knowing how antimicrobials are prescribed is important. Consequently, we undertook a point prevalence survey (PPS) quantifying antimicrobial consumption among 18 public sector hospitals across South Africa.Method: A purpose-built web-based application was used to collect PPS data.Results: Out of 4407 adult patients surveyed, 33.6% were treated with an antimicrobial. The most frequently prescribed groups were a combination of penicillins including β-lactamase inhibitors. Amoxicillin combined with an enzyme inhibitor accounted for 21.4% total DDDs. In the medical and surgical wards, Access antimicrobials (54.1%) were mostly used, while in the ICU, Watch antimicrobials (51.5%) were mostly used. Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%; however, concerns with extended use of antimicrobials for surgical prophylaxis (73.2% of patients).Conclusion: The web-based PPS tool was easy to use and successful in capturing PPS data since the results were comparable to other PPS studies across Africa. High use of amoxicillin combined with an enzyme inhibitor, possibly because it was among the broad-spectrum antimicrobials in the Access group. The findings will assist with future targets to improve antimicrobial prescribing among public sector hospitals in South Africa.
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Affiliation(s)
- P P Skosana
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - N Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - M Bennie
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Gauteng, South Africa
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15
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Atif M, Ihsan B, Malik I, Ahmad N, Saleem Z, Sehar A, Babar ZUD. Antibiotic stewardship program in Pakistan: a multicenter qualitative study exploring medical doctors' knowledge, perception and practices. BMC Infect Dis 2021; 21:374. [PMID: 33882843 PMCID: PMC8059254 DOI: 10.1186/s12879-021-06043-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The emerging threat of antibiotic resistance is growing exponentially and antibiotic stewardship programs are cornerstone to fight against this global threat. The study aimed to explore the knowledge, perspectives and practices of physicians regarding various aspects of antibiotic stewardship program including antibiotic stewardship activities, rational use of antibiotics, antibiotic resistance, prescribing practices and factors associated with these practices. METHODS In this qualitative study, a total of 17 semi-structured, in-depth interviews with doctors of three tertiary care public sector hospitals in Bahawalpur and Rahim Yar Khan were conducted. The convenient sampling method was adopted to collect the data and the saturation point criterion was applied to determine the sample size. Thematic analysis approach was used to draw conclusions from the data. RESULTS The analysis of data yielded five themes, 12 subthemes and 26 categories. The themes included, (i) perception about antibiotic use and antibiotic stewardship, (ii) antibiotic prescription practices, (iii) antibiotic resistance, (iv) limited strategies adopted by hospital administration to ensure quality and safe distribution of antibiotics, (v) implementation of antibiotic stewardship program: barriers, suggestion and future benefits. Doctors had misconceptions about the rational use of antibiotics. The perception regarding antibiotic stewardship programs was poor. Moreover, very few activities related to ASP existed. The participants gave many suggestions for successful implementation of ASP in order to reduce the burden of antibiotic resistance, including development of guidelines for the use of antibiotics, strict legislation regarding use of antibiotics, active participation of healthcare professionals and awareness program among general public about the use of antibiotics. CONCLUSION This study concluded that poor knowledge of doctors regarding ASP, non-existence of antibiogram of hospital and lack of rules for the safe use of antibiotics were the main driving factors associated with irrational antibiotic prescription practices and development of AR.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Beenish Ihsan
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Zikria Saleem
- Department of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Azka Sehar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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16
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Tomas A, Pavlović N, Stilinović N, Horvat O, Paut-Kusturica M, Dugandžija T, Tomić Z, Sabo A. Increase and Change in the Pattern of Antibiotic Use in Serbia (2010-2019). Antibiotics (Basel) 2021; 10:397. [PMID: 33916896 PMCID: PMC8067575 DOI: 10.3390/antibiotics10040397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010-2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.
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Affiliation(s)
- Ana Tomas
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Nebojša Pavlović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Nebojša Stilinović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Olga Horvat
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Milica Paut-Kusturica
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Tihomir Dugandžija
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Oncology Institute of Vojvodina, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Zdenko Tomić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
| | - Ana Sabo
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (N.S.); (O.H.); (M.P.-K.); (Z.T.); (A.S.)
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17
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Kruger D, Dlamini NN, Meyer JC, Godman B, Kurdi A, Lennon M, Bennie M, Schellack N. Development of a web-based application to improve data collection of antimicrobial utilization in the public health care system in South Africa. Hosp Pract (1995) 2021; 49:184-193. [PMID: 33566710 PMCID: PMC8315208 DOI: 10.1080/21548331.2021.1889213] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper-based systems. A web-based application (APP) was developed in South Africa to address this, building on a recent point prevalence survey (PPS) using a paper-based system. Consequently, there was a need to test and evaluate the ease of use of a newly developed app and potential time saving versus paper-based methods for PPS. The findings can be used to further refine the APP. Methods The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use. Results 181 patient’s files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings. Conclusions All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.
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Affiliation(s)
- D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Pharmacy, Private Hospital, Pretoria, South Africa
| | - N N Dlamini
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - M Lennon
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - M Bennie
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - N Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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18
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Taheri Y, Joković N, Vitorović J, Grundmann O, Maroyi A, Calina D. The Burden of the Serious and Difficult-to-Treat Infections and a New Antibiotic Available: Cefiderocol. Front Pharmacol 2021; 11:578823. [PMID: 33628170 PMCID: PMC7898678 DOI: 10.3389/fphar.2020.578823] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Infection is a disease that can occur due to the entrance of a virus, bacteria, and other infectious agents. Cefiderocol is innovative cephalosporin drug that belongs to a special class of antibiotics, sideromycins, which are taken up by bacterial cells through active transport. The unique cell entry and stability to β-lactamases allow cefiderocol to overcome the most common resistance mechanisms in Gram-negative bacteria. Objective: This article aims to highlight the therapeutic efficacy, safety and tolerability of cefiderocol, with a focus on the FDA label. Methods: The pharmacological properties of cefiderocol are also summarized. In this review, we conducted literature research on the PubMed database using the following keywords: "antimicrobial treatment", "new antibiotic", "cefiderocol", "siderophore cephalosporin"; "multidrug-resistant", "Gram-negative bacilli", "critically ill patients"; "severe bacterial infections". Results: There were identified the most relevant data about the pathophysiology of serious bacterial infections, antibacterial mechanism of action, microbiology, mechanisms of resistance, pharmacokinetic and pharmacodynamic properties of cefiderocol. Conclusion: The results highlighted there appeared to be clinical benefit from cefiderocol in the treatment of infections caused by Gram-negative aerobic microorganisms in adult patients with severe infections and limited treatment options.
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Affiliation(s)
- Yasaman Taheri
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nataša Joković
- The Faculty of Science and Mathematics, University of Niš, Niš, Serbia
| | - Jelena Vitorović
- The Faculty of Science and Mathematics, University of Niš, Niš, Serbia
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Alfred Maroyi
- Department of Botany, University of Fort Hare, Alice, South Africa
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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19
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Gallaher JR, Banda W, Lachiewicz AM, Krysiak R, Purcell LN, Charles AG. Predictors of multi-drug resistance in burn wound colonization following burn injury in a resource-limited setting. Burns 2020; 47:1308-1313. [PMID: 33371978 DOI: 10.1016/j.burns.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Bacterial resistance to antibiotics is growing dramatically worldwide due to several contributing factors, including inappropriate antibiotic utilization in the clinical setting and widespread use in the food production industry. Consequently, it is imperative to characterize antibiotic resistance in high-risk populations, such as burn patients, particularly in resource-limited settings where prevention strategies may be high-yield and new antibiotics are not readily available. We therefore sought to characterize and identify predictors of multi-drug resistant (MDR) bacteria colonization in burn patients at our center in Malawi. METHODS This is a prospective analysis of burn patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi within 72 h of burn injury. A swab of each patient's primary wound was collected at admission and each subsequent week. The primary aim was to determine predictors of colonization in burn wounds with multi-drug resistant bacteria using modified Poisson regression modeling. RESULTS 99 patients were enrolled and analyzed. The median age was 4 years (IQR 2-12) with a median % total burn surface area (TBSA) of 14% (IQR 9-25). The most common burn injury type was scald (n = 61, 61.6%), followed by flame (n = 37, 37.4%). Overall, 54 patients (54.6%) were colonized with MDR bacteria at some point during their hospitalization, with increases each week. For flame burns, the predictors of MDR bacterial colonization were each 1% increase of %TBSA (RR 1.01, 95% CI 1.00, 1.03, p = 0.038) and the use of operative intervention for burn treatment (RR 1.90, 95% CI 1.17, 3.09, p = 0.010). No variables were predictive of MDR wound colonization in scald burns. CONCLUSION Our study identified that almost half of the patients in a Malawian burn unit had MDR bacteria colonizing burn wounds after only a week in the hospital. This increased to almost 70% during hospitalization. We also found that for patients with flame burns, increasing %TBSA, and operative intervention put patients at greater risk of MDR colonization. Interventions such as isolation of burn patients, consistent disinfection and sterilization of wards and operating rooms, and optimization of wound care management are imperative to decrease spread of MDR bacteria and to improve burn-associated clinical outcomes in resource-limited environments.
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Affiliation(s)
- Jared R Gallaher
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Wone Banda
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
| | - Anne M Lachiewicz
- Department of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Robert Krysiak
- Department of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Laura N Purcell
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Anthony G Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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20
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Babatola AO, Fadare JO, Olatunya OS, Obiako R, Enwere O, Kalungia A, Ojo TO, Sunmonu TA, Desalu O, Godman B. Addressing antimicrobial resistance in Nigerian hospitals: exploring physicians prescribing behavior, knowledge, and perception of antimicrobial resistance and stewardship programs. Expert Rev Anti Infect Ther 2020; 19:537-546. [PMID: 32990480 DOI: 10.1080/14787210.2021.1829474] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assessed the knowledge of, attitude toward antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. METHODS A descriptive cross-sectional questionnaire-based study explored the physicians' self-reported practice of antibiotic prescribing, knowledge, attitude, and practice of AMR and components of ASPs. RESULTS The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents, respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19-45)out of 45while that for ASP was 46.0(32-57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p < 0.0001). CONCLUSION Respondents in this study were more knowledgeable about AMR than AMS and its core components.
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Affiliation(s)
- Adefunke O Babatola
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladele S Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Reginald Obiako
- Department of Clinical Pharmacology, Ahmadu Bello University, Zaria, Nigeria.,Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Okezie Enwere
- Department of Medicine, Imo State University, Orlu, Nigeria
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Temitope O Ojo
- Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olufemi Desalu
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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21
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Abu Hammour K, AL-Heyari E, Allan A, Versporten A, Goossens H, Abu Hammour G, Manaseer Q. Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey. Antibiotics (Basel) 2020; 9:antibiotics9090598. [PMID: 32933115 PMCID: PMC7559208 DOI: 10.3390/antibiotics9090598] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/19/2023] Open
Abstract
Background: The Global Point Prevalence Survey (Global-PPS) provides a standardised method to conduct surveillance of antimicrobial prescribing and resistance at hospital level. The aim of the present study was to assess antimicrobial consumption and resistance in a Jordan teaching hospital as part of the Global-PPS network. Methods: Detailed antimicrobial prescription data were collected according to the Global Point Prevalence Survey protocol. The internet-based survey included all inpatients present at 8:00 am on a specific day in June–July 2018. Resistance data were based on microbiological results available on the day of the PPS. Results: Data were collected for 380 patients admitted to adult wards, 72 admitted children, and 36 admitted neonates. The overall prevalence of antimicrobial use in adult, paediatric, and neonatal wards was 45.3%, 30.6%, and 22.2% respectively. Overall, 36 patients (7.4%) were treated for at least one healthcare-associated infection (HAI). The most frequent reason for antimicrobial treatment was pneumonia. Cephalosporins and carbapenems were most frequent prescribed among adult (50.6%) and paediatric/neonatal wards (39.6%). Overall resistance rates among patients treated for a community or healthcare-associated infection was high (26.0%). Analysis of antibiotic quality indicators by activity revealed good adherence to treatment guidelines but poor documentation of the reason for prescription and a stop/review date in the notes. Conclusion: The present study has established baseline data in a teaching hospital regarding the quantity and quality of prescribed antibiotics in the hospital. The study should encourage the establishment of tailor-made antimicrobial stewardship interventions and support educational programs to enhance appropriate antibiotic prescribing.
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Affiliation(s)
- Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11942, Jordan
- Correspondence: ; Tel.: +962-6-5355-000; Fax: +962-6-5353-217
| | - Esraa AL-Heyari
- Clinical Pharmacist Pharmacy Department—Jordan University Hospital, The University of Jordan, Amman 11942, Jordan; (E.A.-H.); (A.A.); (G.A.H.)
| | - Aya Allan
- Clinical Pharmacist Pharmacy Department—Jordan University Hospital, The University of Jordan, Amman 11942, Jordan; (E.A.-H.); (A.A.); (G.A.H.)
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, 2000 Antwerpen, Belgium; (A.V.); (H.G.)
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, 2000 Antwerpen, Belgium; (A.V.); (H.G.)
| | - Ghayda’ Abu Hammour
- Clinical Pharmacist Pharmacy Department—Jordan University Hospital, The University of Jordan, Amman 11942, Jordan; (E.A.-H.); (A.A.); (G.A.H.)
| | - Qusai Manaseer
- Faculty of Medicine, The University of Jordan, Amman 11942, Jordan;
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22
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Saleem Z, Hassali MA, Godman B, Fatima M, Ahmad Z, Sajid A, Rehman IU, Nadeem MU, Javaid Z, Malik M, Hussain A. Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study. J Pharm Policy Pract 2020; 13:26. [PMID: 32774870 PMCID: PMC7397594 DOI: 10.1186/s40545-020-00233-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies. Aims Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan. Methodology A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit. Results Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history. Conclusion Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia.,The University of Lahore, Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Brian Godman
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia.,Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Munazzah Fatima
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Zeenia Ahmad
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Areeba Sajid
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inaam Ur Rehman
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Zaida Javaid
- Punjab Institute of Cardiology, Lahore, Pakistan
| | - Madeeha Malik
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | - Azhar Hussain
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
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23
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Compliance with South Africa's Antimicrobial Resistance National Strategy Framework: are we there yet? J Chemother 2020; 33:21-31. [PMID: 32693710 DOI: 10.1080/1120009x.2020.1789389] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework. METHODS Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate. RESULTS Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant. CONCLUSION Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.
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Affiliation(s)
- Deirdré Engler
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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24
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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25
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Nisabwe L, Brice H, Umuhire MC, Gwira O, Harelimana JDD, Nzeyimana Z, Sebatunzi OR, Rusingiza EK, Hahirwa I, Muvunyi CM. Knowledge and attitudes towards antibiotic use and resistance among undergraduate healthcare students at University of Rwanda. J Pharm Policy Pract 2020; 13:7. [PMID: 32337049 PMCID: PMC7175502 DOI: 10.1186/s40545-020-00207-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an imminent threat to modern medicine. As the efficacy of treatment regimens is reduced, mortality and morbidity attributed to infectious diseases is expected to rise dramatically across the globe. Antimicrobial stewardship and good prescription practices are critical to conserving available therapeutics; it is appropriate, therefore, to appraise our attitudes and knowledge of antimicrobial resistance, particularly for the future healthcare practitioners. Methods This is a descriptive cross-sectional study that was conducted among 282 medicals, dental and pharmacy students from the University of Rwanda. Questionnaires were used to collect data from the 4th to 29th March 2017. Results Students from Level 3 to level 6 have demonstrated a good knowledge on antibiotics and antimicrobial resistance. Generally, 95% (n = 218) agreed that the inappropriate use of antibiotics could lead to antibiotic resistance. It was found that 96% (n = 220) of the respondents had heard about AMR outside their degree courses. 49% (n = 112) of the participants reported that they are able to purchase antibiotics without a prescription. 96% (n = 220) agreed that it was important for healthcare students to be knowledgeable about antimicrobial resistance. Perhaps most surprisingly, it was found that 83% (n = 191) of participants were unfamiliar with the concept of antimicrobial stewardship and 49% (n = 21) had not yet discussed antimicrobial resistance as part of their education, albeit only 1% (n = 3) was completely unfamiliar with the term. Furthermore, 38% (n = 86) did not support that the antibiotics were overused in Rwanda, 23% (n = 10) did not agree that inappropriate antimicrobial use contributed to antimicrobial resistance, and 50% (n = 22) of participants agreed that antibiotics were indicated in the treatment of pain and inflammation. Conclusions The present study reports a moderate knowledge on AMR among the healthcare students. The gaps in the current formal training of healthcare individuals have been identified as well. We highlight the necessity to enhance educational approaches to introduce the key concepts of AMR and antimicrobial stewardship to the curriculum of healthcare students.
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Affiliation(s)
- Lyduine Nisabwe
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Hirwa Brice
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Marie Christine Umuhire
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Olivia Gwira
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean De Dieu Harelimana
- 2Department of Biomedical Laboratory Science, School of Health Science, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Zephanie Nzeyimana
- Department of Medical Laboratory Sciences, Mount Kenya University, Kigali, Rwanda
| | - Osee Rurambya Sebatunzi
- 4Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and health Sciences, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Kamanzi Rusingiza
- 5Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and health Sciences, University of Rwanda, Kigali, Rwanda
| | - Innocent Hahirwa
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- 6Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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26
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Afriyie DK, Sefah IA, Sneddon J, Malcolm W, McKinney R, Cooper L, Kurdi A, Godman B, Seaton RA. Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship. JAC Antimicrob Resist 2020; 2:dlaa001. [PMID: 34222959 PMCID: PMC8210261 DOI: 10.1093/jacamr/dlaa001] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improved knowledge regarding antimicrobial use in Ghana is needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPSs) in hospitals. Objectives were to: (i) provide baseline data in two hospitals [Keta Municipal Hospital (KMH) and Ghana Police Hospital (GPH)] and identify priorities for improvement; (ii) assess the feasibility of conducting PPSs; and (iii) compare results with other studies. METHODS Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included: rationale for use; stop/review dates; and guideline compliance. RESULTS Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other β-lactam antibiotics were the most frequently prescribed in both hospitals, with third-generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously, duration was generally short with timely oral switching and infections were mainly community acquired. Encouragingly, there was good documentation of the indications for antibiotic use in both hospitals and 50.0%-66.7% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there were no missed doses. The duration of use for surgical prophylaxis was generally more than 1 day (69.0% in GPH and 77.0% in KMH). CONCLUSIONS These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible, relatively rapid and achieved with limited training. Targets for improvement identified included reduction of broad-spectrum antibiotics and duration of treatment.
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Affiliation(s)
| | - Israel A Sefah
- Department of Pharmacy, Keta Municipal Hospital, Keta-Dzelukope, Volta Region, Ghana
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - William Malcolm
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Rachel McKinney
- NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, UK
| | - Lesley Cooper
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - R Andrew Seaton
- Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
- University of Glasgow, Glasgow, UK
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27
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Godman B, Grobler C, Van-De-Lisle M, Wale J, Barbosa WB, Massele A, Opondo P, Petrova G, Tachkov K, Sefah I, Abdulsalim S, Alrasheedy AA, Unnikrishnan MK, Garuoliene K, Bamitale K, Kibuule D, Kalemeera F, Fadare J, Khan TA, Hussain S, Bochenek T, Kalungia AC, Mwanza J, Martin AP, Hill R, Barbui C. Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opin Pharmacother 2020; 20:2237-2255. [PMID: 31762343 DOI: 10.1080/14656566.2019.1684473] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Christoffel Grobler
- Elizabeth Donkin Hospital, Port Elizabeth, South Africa.,Walter Sisulu University, East London, South Africa.,Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Philip Opondo
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Buraidah Saudi Arabia
| | | | | | - Kristina Garuoliene
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Lithuania and Ministry of Health, Vilnius, Lithuania
| | - Kayode Bamitale
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - James Mwanza
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,HCD Economics, The Innovation Centre, Daresbury, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Whelan Building, Liverpool University, Liverpool, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona Italy
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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Alrasheedy AA, Alsalloum MA, Almuqbil FA, Almuzaini MA, Aba Alkhayl BS, Albishri AS, Alharbi FF, Alharbi SR, Alodhayb AK, Alfadl AA, Godman B, Hill R, Anaam MS. The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia. Expert Rev Anti Infect Ther 2019; 18:87-97. [PMID: 31834825 DOI: 10.1080/14787210.2020.1705156] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes.Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios.Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively.Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.
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Affiliation(s)
| | - Muath A Alsalloum
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Feras A Almuqbil
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | | | - Ahmed S Albishri
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Faisal F Alharbi
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Saleh R Alharbi
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Abubakr A Alfadl
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ruaraidh Hill
- Evidence synthesis, Health Services Research, University of Liverpool, Liverpool, UK
| | - Mohammed S Anaam
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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Chigome AK, Matlala M, Godman B, Meyer JC. Availability and Use of Therapeutic Interchange Policies in Managing Antimicrobial Shortages among South African Public Sector Hospitals; Findings and Implications. Antibiotics (Basel) 2019; 9:antibiotics9010004. [PMID: 31861923 PMCID: PMC7168338 DOI: 10.3390/antibiotics9010004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/22/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
Abstract: Background: Therapeutic interchange policies in hospitals are useful in dealing with antimicrobial shortages and minimising resistance rates. The extent of antimicrobial shortages and availability of therapeutic interchange policies is unknown among public sector hospitals in South Africa. This study aimed to ascertain the extent of and rationale for dealing with antimicrobial shortages, describe policies or guidelines available, and the role of pharmacists in the process. METHODS A quantitative and descriptive study was conducted with a target population of 403 public sector hospitals. Data were collected from hospital pharmacists using an electronic questionnaire via SurveyMonkeyTM. RESULTS The response rate was 33.5% and most (83.3%) hospitals had experienced shortages in the previous six months. Antimicrobials commonly reported as out of stock included cloxacillin (54.3%), benzathine benzylpenicillin (54.2%), and erythromycin (39.6%). Reasons for shortages included pharmaceutical companies with supply constraints (85.3%) and an inefficient supply system. Only 42.4% had therapeutic interchange policies, and 88.9% contacted the prescriber, when present, for substitution. CONCLUSIONS Antimicrobial shortages are prevalent in South African public sector hospitals with the most affected being penicillins and cephalosporins. Therapeutic interchange policies are not available at most hospitals. Effective strategies are required to improve communication between pharmacists and prescribers to ensure that safe, appropriate, and therapeutically equivalent alternatives are available.
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Affiliation(s)
- Audrey K. Chigome
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (A.K.C.); (J.C.M.)
| | - Moliehi Matlala
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (A.K.C.); (J.C.M.)
- Correspondence: or ; Tel.: +27-825697954/+27-125214741
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (A.K.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 ORE, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool L69 7ZH, UK
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; (A.K.C.); (J.C.M.)
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31
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Momanyi L, Opanga S, Nyamu D, Oluka M, Kurdi A, Godman B. Antibiotic Prescribing Patterns at a Leading Referral Hospital in Kenya: A Point Prevalence Survey. J Res Pharm Pract 2019; 8:149-154. [PMID: 31728346 PMCID: PMC6830017 DOI: 10.4103/jrpp.jrpp_18_68] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/27/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: Antibiotics are essential with inappropriate use leading to antimicrobial resistance (AMR). Currently, little is known about antibiotic use among hospitals in Kenya, which is essential to tackle as part of the recent national action plan addressing rising AMR rates. Consequently, the objective was to overcome this gap in a leading referral hospital in Kenya. The findings will subsequently be used to develop quality improvement programs for this and other hospitals in Kenya. Methods: This was a point prevalence survey. Data on antibiotic use were abstracted from patient medical records by a pharmacy team. Findings: The prevalence of antibiotic prescribing was 54.7%, highest in the intensive care unit and isolation wards. Most antibiotics were for treatment (75.4%) rather than prophylaxis (29.0%). The majority of patients on surgical prophylaxis were on prolonged duration (>1 day), with only 9.6% on a single dose as per current guidelines. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. The indication for antibiotic use was documented in only 37.3% of encounters. Generic prescribing was 62.5% and empiric prescribing was seen in 82.6% of encounters. Guideline compliance was 45.8%. Conclusion: Several areas for improvement were identified including addressing prolonged duration for prophylaxis, extensive prescribing of broad-spectrum antibiotics, high rates of empiric prescribing, and lack of documenting the indication for antimicrobials. Initiatives are ongoing to address this with pharmacists playing a key role.
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Affiliation(s)
- Lydia Momanyi
- Department of Pharmacy, Rift Valley Provincial General Hospital, Nakuru, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - David Nyamu
- Department of Pharmaceutics and Pharmacy Practice, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, Kenya
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Public Health Pharmacy and Management, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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32
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Tiroyakgosi C, Matome M, Kgatlwane J, Anand Paramadhas BD, Malone B, Mpinda-Joseph P, Rwegerera GM, Maika K, Mashalla Y, Godman B, Massele A. Antimicrobial utilization research and activities in Botswana, the past, present and the future. Expert Rev Anti Infect Ther 2019; 17:759-762. [PMID: 31524534 DOI: 10.1080/14787210.2019.1668777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A number of activities are ongoing to reduce AMR in Botswana by improving antimicrobial utilization across all sectors. However, there is a need to share experiences. With the objective of sharing these, the second one day symposium was held in the University of Botswana in October 2018 involving both private and public hospitals. In Lenmed Bokamoso hospital, ESKAPE organisms were associated with 50-90% of clinical infections; however, there was no correlation between healthcare associated infections (HAIs) and admission swab positivity with ESKAPE or ESBL isolates. Hang times, the time between a prescription and IV administration, were also discussed. At Nyangabwe Hospital, the prevalence of HAIs was 13.54%, 48.9% were laboratory confirmed of which 8.5% were blood stream infections (BSIs). The prevalence of different bacteria causing neonatal BSIs was also investigated. At Princess Marina Hospital, positive cultures were seen in 22.4% of blood cultures with contaminants comprising the majority. Several activities are ongoing in Botswana across sectors as a result of the findings and will be periodically reported to further improve antibiotic utilization.
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Affiliation(s)
| | | | - Joyce Kgatlwane
- School of Pharmacy, University of Botswana , Gaborone , Botswana
| | | | | | - Pinkie Mpinda-Joseph
- Infection Prevention and Control Coordinator, Nyangabgwe Hospital , Francistown , Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana , Gaborone , Botswana.,Department of Medicine, Princess Marina Hospital , Gaborone , Botswana
| | | | - Yohana Mashalla
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana , Gaborone , Botswana
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , UK.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University , Ga-Rankuwa, Pretoria , South Africa
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana , Gaborone , Botswana
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Saleem Z, Hassali MA, Hashmi FK, Godman B, Ahmed Z. Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications. Heliyon 2019; 5:e02159. [PMID: 31384689 PMCID: PMC6664037 DOI: 10.1016/j.heliyon.2019.e02159] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/18/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022] Open
Abstract
Objective We are unaware of the extent of antimicrobial stewardship programs (ASPs) among hospitals in Pakistan, which is a concern given the population size, high use of antibiotics across sectors and increasing antimicrobial resistance (AMR) rates. Consequently, we sought to address this by undertaking a comprehensive survey. Method In this cross-sectional observational study in Punjab, an instrument of the measure was developed based on health care facility characteristics and ASPs after an extensive literature review. The questionnaire was circulated by mail or through drop off surveys to medical superintendents or directors/heads of pharmacy departments of hospitals. Results Out of 254, a total of 137 hospitals fully completed the questionnaire - 11 primary, 65 secondary, 46 tertiary and 15 specialized hospitals. The use of antimicrobial prescribing guidelines (68.7%), provision of infectious diseases consultation services (66.4%), clinical pharmacy service (65.7%), use of drug and therapeutics committees to approve antimicrobial prescribing (65.5%), regular audit by doctors on antimicrobial prescribing (54.1%) and use of a restricted formulary for antimicrobial (50.4%) were the most common ASPs. However, most of these activities were only somewhat or moderately successful. Whereas, electronic antimicrobial prescribing approval systems (15.3%), using a sticker to notify prescribers regarding the need to obtain approval for the antimicrobial prescribed (16.1%) and participation in the national antimicrobial utilization surveillance program (19.7%) were only seen in a few hospitals. Conclusion Study inferred that there are inadequate ASPs in the hospitals of Pakistan. A multidisciplinary approach, clinical leadership and availability of motivated and trained individuals are essential elements for the success of future ASPs.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.,Rashid Latif College of Pharmacy, Lahore, Pakistan
| | | | | | - Brian Godman
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.,Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Zakkiudin Ahmed
- Ripha Institute of Healthcare Improvement & Safety, Ripha University, Pakistan
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34
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Saleem Z, Hassali MA, Godman B, Hashmi FK, Saleem F. Antimicrobial prescribing and determinants of antimicrobial resistance: a qualitative study among physicians in Pakistan. Int J Clin Pharm 2019; 41:1348-1358. [PMID: 31273588 DOI: 10.1007/s11096-019-00875-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/27/2019] [Indexed: 12/01/2022]
Abstract
Background Understanding physicians' perception about antimicrobial use and resistance is essential to ensure that the objectives of the Pakistan national action plan on antimicrobial resistance are met. Little is currently known about physicians' perceptions in Pakistan. Objective Assess physicians' perception surrounding antibiotic use and resistance, factors influencing antibiotic prescribing and potential interventions to improve future antibiotic prescribing. Settings The study was conducted in Lahore, the capital of the province of Punjab, which is the second largest and most populous city of Pakistan. Method Qualitative study was conducted with a semi-structured interview guide involving in-depth face-to-face interviews with purposively selected physicians. Audiorecorded interviews were transcribed verbatim and transcripts analyzed by thematic content analysis. Main outcome measures Themes surrounding the perspectives of physicians on issues of antimicrobial use and resistance. Results Five major themes emerged: (1) knowledge and perception of physicians about antimicrobials, (2) antimicrobial prescribing behaviors of physicians, (3) factors influencing prescribing, (4) determinants of antimicrobial resistance, (5) and potential interventions to reduce antimicrobial resistance. The main challenges and issues associated with antibiotic prescribing were the improvement of knowledge, implementation of hygienic measures, access to and clarity of treatment recommendations and minimizing external factors influencing prescribing including pharmaceutical company activities. Suggestions for the future included stricter regulations for prescribing, improved diagnosis, availability of local guidelines and monitoring of prescribing and resistance patterns. Conclusion Identification of concerns regarding inappropriate antimicrobial prescribing will enable specific initiatives and approaches to improve future antimicrobial use and reduce antimicrobial resistance in Pakistan.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. .,Rashid Latif College of Pharmacy, Lahore, Pakistan.
| | | | - Brian Godman
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.,Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | | | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Anand Paramadhas BD, Tiroyakgosi C, Mpinda-Joseph P, Morokotso M, Matome M, Sinkala F, Gaolebe M, Malone B, Molosiwa E, Shanmugam MG, Raseatlholo GP, Masilo J, Oyeniran Y, Marumoloa S, Maakelo OG, Katjakae I, Kgatlwane J, Godman B, Massele A. Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications. Expert Rev Anti Infect Ther 2019; 17:535-546. [PMID: 31257952 DOI: 10.1080/14787210.2019.1629288] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.
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Affiliation(s)
| | - Celda Tiroyakgosi
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | - Pinkie Mpinda-Joseph
- c Infection Prevention and Control Program , Nyangabgwe Hospital , Francistown , Botswana
| | - Mathudi Morokotso
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | | | - Fatima Sinkala
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | - Mavis Gaolebe
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | | | - Emmanuel Molosiwa
- g Department of Pharmacy , Mahalapye District Hospital , Mahalapye , Botswana
| | | | | | - Joyce Masilo
- j Department of Pharmacy , Bobonong Primary Hospital , Bobonong , Botswana
| | - Yomi Oyeniran
- k Department of Pharmacy , Goodhope Primary Hospital , Gaborone , Botswana
| | - Stella Marumoloa
- l Department of Pharmacy , Lethlakane Primary Hospital , Letlhakane , Botswana
| | | | - Ishmael Katjakae
- m Department of Pharmacy , Gweta Primary Hospital , Gweta , Botswana
| | - Joyce Kgatlwane
- n School of Pharmacy , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- o Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Huddinge , Sweden.,p Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,q Health Economics Centre , Liverpool University Management School , Liverpool , UK.,r School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Amos Massele
- s Department of Biomedical Sciences, Faculty of Medicine , University of Botswana , Gaborone , Botswana
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Rousham EK, Unicomb L, Islam MA. Human, animal and environmental contributors to antibiotic resistance in low-resource settings: integrating behavioural, epidemiological and One Health approaches. Proc Biol Sci 2019; 285:rspb.2018.0332. [PMID: 29643217 DOI: 10.1098/rspb.2018.0332] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/20/2018] [Indexed: 01/04/2023] Open
Abstract
Antibiotic resistance (ABR) is recognized as a One Health challenge because of the rapid emergence and dissemination of resistant bacteria and genes among humans, animals and the environment on a global scale. However, there is a paucity of research assessing ABR contemporaneously in humans, animals and the environment in low-resource settings. This critical review seeks to identify the extent of One Health research on ABR in low- and middle-income countries (LMICs). Existing research has highlighted hotspots for environmental contamination; food-animal production systems that are likely to harbour reservoirs or promote transmission of ABR as well as high and increasing human rates of colonization with ABR commensal bacteria such as Escherichia coli However, very few studies have integrated all three components of the One Health spectrum to understand the dynamics of transmission and the prevalence of community-acquired resistance in humans and animals. Microbiological, epidemiological and social science research is needed at community and population levels across the One Health spectrum in order to fill the large gaps in knowledge of ABR in low-resource settings.
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Affiliation(s)
- Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Kalungia AC, Mwambula H, Munkombwe D, Marshall S, Schellack N, May C, Jones ASC, Godman B. Antimicrobial stewardship knowledge and perception among physicians and pharmacists at leading tertiary teaching hospitals in Zambia: implications for future policy and practice. J Chemother 2019; 31:378-387. [DOI: 10.1080/1120009x.2019.1622293] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - Sarah Marshall
- Brighton and Sussex Medical Schools, University of Sussex, Falmer, Brighton, UK
| | - Natalie Schellack
- Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Claire May
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Falmer, Brighton, UK
| | - Anja St. Claire Jones
- Brighton and Sussex University Hospitals, National Health Service, Falmer, Brighton, UK
| | - Brian Godman
- Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Fourie T, Schellack N, Bronkhorst E, Coetzee J, Godman B. Antibiotic prescribing practices in the presence of extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – A pilot study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- T. Fourie
- Mediclinic Tzaneen, 24 Douglas Ave, Tzaneen, 0850, South Africa
| | - N. Schellack
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - E. Bronkhorst
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - J. Coetzee
- Ampath National Reference Laboratory, Pretoria, South Africa
| | - B. Godman
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom
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Dlamini NN, Meyer JC, Kruger D, Kurdi A, Godman B, Schellack N. Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications. Hosp Pract (1995) 2019; 47:88-95. [PMID: 30963821 DOI: 10.1080/21548331.2019.1592880] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa. METHODS A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward. RESULTS 39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching. CONCLUSION The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching.
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Affiliation(s)
- Nokuthula N Dlamini
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Danie Kruger
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,b Pharmacy , Private Hospital , Pretoria , South Africa
| | - Amanj Kurdi
- c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,d Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden.,e Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - Natalie Schellack
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
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Robertson J, Iwamoto K, Hoxha I, Ghazaryan L, Abilova V, Cvijanovic A, Pyshnik H, Darakhvelidze M, Makalkina L, Jakupi A, Dzhakubekova A, Carp A, Cizmovic L, Rachina S, Radonjic V, Yusufi S, Aksoy M, Ibragimova M, Godman B, Kluge H, Pedersen HB. Antimicrobial Medicines Consumption in Eastern Europeand Central Asia - An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action. Front Pharmacol 2019; 9:1156. [PMID: 30890943 PMCID: PMC6411709 DOI: 10.3389/fphar.2018.01156] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.
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Affiliation(s)
- Jane Robertson
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
- Department of Clinical Pharmacology, The University of Newcastle, Callaghan, NSW, Australia
| | - Kotoji Iwamoto
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Iris Hoxha
- Department of Pharmacy, University of Medicine, Tirana, Tirana, Albania
| | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise, Ministry of Health, Yerevan, Armenia
| | - Vafa Abilova
- Department of Import Medicines and Medical Devices, Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan
| | - Ana Cvijanovic
- Sector for Providing Information on Drugs and Medical Products, Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Halina Pyshnik
- Department of Pharmaceutical Inspection and Organization of Medicinal Supply, Ministry of Health of the Republic of Belarus, Minsk, Belarus
| | - Marina Darakhvelidze
- Health Care Department, Ministry of IDPs, Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - Larissa Makalkina
- Department of Cardiology and Internal Medicine with a Course of Clinical Pharmacology and Pharmacy Astana Medical University, Astana, Kazakhstan
| | - Arianit Jakupi
- A2 – Pharmaceutical Consulting and UBT – Higher Education Institution, Pristina, Kosovo†
| | - Aigul Dzhakubekova
- Specialized Expertise of Medicines Unit, Department of Drug Provision and Medical Devices, Ministry of Health, Bishkek, Kyrgyzstan
| | - Angela Carp
- P.I. Coordination, Implementation and Monitoring Unit of the Health System Projects, Chişinãu, Moldova
| | - Lidija Cizmovic
- Department for Establishing Maximum Prices and Monitoring Consumption of Medicines, Agency for Medicines and Medical Devices, Podgorica, Montenegro
| | - Svetlana Rachina
- Internal Medicine Department with Cardiology and Functional Diagnostics Course, Russian Friendship University, Moscow, Russia
| | - Vesela Radonjic
- National Centre for Information on Medicines and Medical Device, Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Salomudin Yusufi
- Vice-Rector for Science, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Department of Rational Use of Medicines, Ministry of Health, Ankara, Turkey
| | - Muhabbat Ibragimova
- Head of the Information and Analytical Department, The State Center for Expertise and Standardization of Medicines, Medical Devices and Medical Equipment of the Agency for the Development of the Pharmaceutical Industry under the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hans Kluge
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Hanne Bak Pedersen
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Saleem Z, Hassali MA, Versporten A, Godman B, Hashmi FK, Goossens H, Saleem F. A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications. Expert Rev Anti Infect Ther 2019; 17:285-293. [PMID: 30755077 DOI: 10.1080/14787210.2019.1581063] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In line with the recent global action plan for antimicrobial resistance, this is the first time such a comprehensive antimicrobial point prevalence survey has been undertaken in Pakistan, the sixth most populous country. METHODS This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp (www.global-pps.com). RESULTS Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. The top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%), gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). The top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of the total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of the total use for surgical prophylaxis, 97.4% of antibiotics were given for more than one day. CONCLUSIONS Unnecessary prophylactic antibiotic use is extremely high, and broad-spectrum prescribing is common among hospitals in Pakistan. There is an urgent need to work on the national action plan of Pakistan on antibiotic resistance to address this.
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Affiliation(s)
- Zikria Saleem
- a School of Pharmaceutical Sciences , Universiti Sains Malaysia , Penang , Malaysia.,b Department of Pharmacy Practice , Rashid Latif College of Pharmacy , Pakistan
| | - Mohamed Azmi Hassali
- a School of Pharmaceutical Sciences , Universiti Sains Malaysia , Penang , Malaysia
| | - Ann Versporten
- c Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences , University of Antwerp , Antwerp , Belgium
| | - Brian Godman
- d Department of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,e Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK.,f Health Economics Centre , University of Liverpool Management School , Liverpool , UK
| | - Furqan Khurshid Hashmi
- g Department of Pharmacy Practice , University College of Pharmacy, University of the Punjab , Lahore , Pakistan
| | - Herman Goossens
- c Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences , University of Antwerp , Antwerp , Belgium
| | - Fahad Saleem
- h Faculty of Pharmacy and Health sciences , University of Balochistan , Quetta , Pakistan
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Ogunleye OO, Fadare JO, Yinka-Ogunleye AF, Anand Paramadhas BD, Godman B. Determinants of antibiotic prescribing among doctors in a Nigerian urban tertiary hospital. Hosp Pract (1995) 2019; 47:53-58. [PMID: 29757036 DOI: 10.1080/21548331.2018.1475997] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The problem of antimicrobial resistance (AMR) has assumed pandemic dimensions especially among low-and middle-income countries such as Nigeria. Irrational use of currently available antimicrobial agents is a major contributory factor. There remains a paucity of documented information on the determinants of antibiotic prescribing among physicians in Nigeria to guide future strategies to reduce AMR. This study therefore aimed to investigate the patterns and determinants of antibiotic prescribing among doctors in a tertiary hospital in Nigeria as the first step to improve future antibiotic use in hospitals. METHODS A cross-sectional survey of the determinants of antibiotic prescribing among doctors in the Lagos State University Teaching Hospital, Ikeja, was performed using a structured questionnaire. Information was obtained about the doctors and the factors determining their prescription of antibiotics. The results were summarized using descriptive statistics with Statistical Package for Social Science. RESULTS Ninety-eight respondents were studied with a mean age of 36.24(9.01) years, a mean duration of practice of 10.68(9.25) years, and mainly males (64.3%). Ninety-seven percent prescribe antibiotics frequently, mostly based on clinical judgment and experience with rare laboratory supports. Factors of cost, drug availability, and information from pharmaceutical representatives influenced antibiotic prescribing. There were indications of nonexistence or nonfunctional institutional policies and guidelines regarding antimicrobial therapies. CONCLUSION There is an urgent need to institute evidence-based institutional policies and guidelines for improving antimicrobial use among hospitals in Nigeria. This is already being followed up.
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Affiliation(s)
- Olayinka O Ogunleye
- a Department of Pharmacology, Therapeutics and Toxicology , Lagos State University College of Medicine , Ikeja , Nigeria
- b Department of Medicine , Lagos State University Teaching Hospital , Ikeja , Nigeria
| | - Joseph O Fadare
- c Department of Pharmacology and Therapeutics, College of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | | | | | - Brian Godman
- f Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
- g Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
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Guan X, Tian Y, Song J, Zhu D, Shi L. Effect of physicians' knowledge on antibiotics rational use in China's county hospitals. Soc Sci Med 2019; 224:149-155. [PMID: 30784853 DOI: 10.1016/j.socscimed.2019.01.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/19/2018] [Accepted: 01/28/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Irrational prescriptions of antibiotics have received significant international attention. In China, previous studies have described the impact of physicians' knowledge on antibiotic use, however, empirical studies of the relationship between physician knowledge and antibiotic prescription behavior are limited. OBJECTIVE This study aimed to examine physicians' knowledge of antibiotic and explore the effects of physicians' knowledge on rational antibiotic use in county hospitals in China. METHOD A sample of 360 physicians from 60 county hospitals was designed. Questionnaires were used to evaluate the physicians' knowledge of antibiotic use. We assessed the rationality of antibiotic use by evaluating the physicians' prescriptions. Antibiotic prescriptions were evaluated according to percentage of encounters where an antibiotic was prescribed, percentage of encounters with combined antibiotics prescriptions and the percentage of encounters treated in accordance with a standard treatment guideline. General linear model (GLM) was performed to analyze the factors influencing rational antibiotic use. RESULT A total of 58,512 valid antibiotic prescriptions by 280 physicians were included in the analysis. The average score of 62.2 The average percentage of encounters with an antibiotic and combined antibiotics prescribed were 70.1% and 40.2%, respectively. 37.9% of antibiotic prescriptions were in accordance with standard treatment guidelines. GLM analysis showed that physicians with scores exceeding 80 used less antibiotics than those who score lower than 60 (P = 0.005). The percentage of combination antibiotic therapies of those who achieved scores above 80 or in the range from 60 to 80 were lower than that of physicians in low score groups (P = 0.002, P = 0.025), and higher compliance with the guidelines than those received a score below 60 (P = 0.001, P = 0.047). CONCLUSION Results confirmed that physicians' knowledge significantly influences rational antibiotic use. Targeted training programs to promote physicians' knowledge of antibiotic especially at county hospitals in the western regions of China are urgently needed.
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Affiliation(s)
- Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Ye Tian
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jiafang Song
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dawei Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China; International Research Center for Medicinal Administration, Peking University, Beijing, China.
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Bojanić L, Marković-Peković V, Škrbić R, Stojaković N, Ðermanović M, Bojanić J, Fürst J, Kurdi AB, Godman B. Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications. Front Pharmacol 2018; 9:442. [PMID: 29896100 PMCID: PMC5987173 DOI: 10.3389/fphar.2018.00442] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.
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Affiliation(s)
- Ljubica Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ranko Škrbić
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Stojaković
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Mirjana Ðermanović
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Janja Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Epidemiology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Jurij Fürst
- Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Amanj B. Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of pharmacology and toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics Centre, Liverpool University, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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45
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Molnar A. Children as agents of change in combatting antibiotic resistance. J Health Serv Res Policy 2017; 22:258-260. [DOI: 10.1177/1355819617701512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Antibiotic resistance is a worldwide problem and changes are needed in the way antibiotics are used. The value of engaging children as key contributors in health care campaigns to increase the appropriate use of antibiotics has not been fully recognized. Little is known about how to design educational materials for children in order to enable them to be agents of change in their communities. Science education needs to improve the way it engages children so as to give them the tools needed to make responsible decisions on antibiotic use.
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Affiliation(s)
- Andreea Molnar
- Lecturer in Web and Mobile Development, School of Creative Technologies, University of Portsmouth, UK
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