1
|
Ngoma MT, Sitali D, Mudenda S, Mukuma M, Bumbangi FN, Bunuma E, Skjerve E, Muma JB. Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship. JAC Antimicrob Resist 2024; 6:dlae034. [PMID: 38449513 PMCID: PMC10914457 DOI: 10.1093/jacamr/dlae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. Methods This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Results Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. Conclusions This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.
Collapse
Affiliation(s)
- Maty Tsumbu Ngoma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Doreen Sitali
- Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science, School of Agricultural Sciences and Nutrition, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Emmanuel Bunuma
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| |
Collapse
|
2
|
Tomsone LE, Neilands R, Kokina K, Bartkevics V, Pugajeva I. Pharmaceutical and Recreational Drug Usage Patterns during and Post COVID-19 Determined by Wastewater-Based Epidemiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:206. [PMID: 38397695 PMCID: PMC10888181 DOI: 10.3390/ijerph21020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Wastewater-based epidemiology (WBE) was applied to evaluate the consumption trends of pharmaceuticals (i.e., antibiotics, non-steroidal anti-inflammatory drugs, antiepileptics, antihypertensives, and others), as well as recreational drugs (caffeine, alcohol, and nicotine), in Latvia from December 2020 to July 2023. The time period covers both the COVID-19 pandemic and the post-pandemic periods; therefore, the impact of the implemented restrictions and the consequences of the illness in terms of the usage of pharmaceuticals thereon were investigated. Additionally, the seasonality and impact of the seasonal flu and other acute upper respiratory infections were studied. The results revealed that the pandemic impacted the consumption of alcohol, nicotine, and caffeine, as well as several pharmaceuticals, such as antihypertensives, antidepressants, psychiatric drugs, and the painkiller ibuprofen. The findings suggest that the imposed restrictions during the pandemic may have had a negative effect on the population's health and mental well-being. Distinct seasonal trends were discovered in the consumption patterns of caffeine and alcohol, where lower use was observed during the summer. The seasonal consumption trends of pharmaceuticals were discovered in the case of antibiotics, the antiasthmatic drug salbutamol, and the decongestant xylometazoline, where higher consumption occurred during colder seasons.
Collapse
Affiliation(s)
- Laura Elina Tomsone
- Institute of Food Safety, Animal Health and Environment “BIOR”, Lejupes Street 3, LV-1076 Riga, Latvia; (L.E.T.)
| | - Romans Neilands
- Faculty of Natural Sciences and Technology, Riga Technical University, Kipsalas Street 6B, LV-1048 Riga, Latvia
| | - Kristina Kokina
- Faculty of Natural Sciences and Technology, Riga Technical University, Kipsalas Street 6B, LV-1048 Riga, Latvia
| | - Vadims Bartkevics
- Institute of Food Safety, Animal Health and Environment “BIOR”, Lejupes Street 3, LV-1076 Riga, Latvia; (L.E.T.)
| | - Iveta Pugajeva
- Institute of Food Safety, Animal Health and Environment “BIOR”, Lejupes Street 3, LV-1076 Riga, Latvia; (L.E.T.)
| |
Collapse
|
3
|
Khan S, Bond SE, Lee-Milner J, Conway BR, Lattyak WJ, Aldeyab MA. Antimicrobial consumption in an acute NHS Trust during the COVID-19 pandemic: intervention time series analysis. JAC Antimicrob Resist 2024; 6:dlae013. [PMID: 38328263 PMCID: PMC10848649 DOI: 10.1093/jacamr/dlae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Objective To determine the impact of the COVID-19 pandemic on antimicrobial consumption and trends of therapeutic drugs for COVID-19 treatments, including corticosteroids, remdesivir and monoclonal antibodies (tocilizumab) from April 2017 to September 2022 in a secondary care NHS Trust in England. Methods A retrospective intervention time series analysis was conducted for April 2017 to September 2022 at the Mid Yorkshire Teaching NHS Trust. Data were retrieved from the pharmacy dispensing system as defined daily doses (DDDs) monthly and reported per 1000 occupied bed days (OBDs). Antimicrobial consumption and COVID-19 treatment options were measured. DDDs were calculated according to the classification of antimicrobials for systemic use (J01) and for other drugs classification. Trends for antimicrobial consumption and other therapeutic drugs for treating COVID-19 were also determined in each wave in England. Results During the pandemic: total antibiotic consumption decreased from 826.4 to 728.2 DDDs per 1000 OBDs (P = 0.0067); piperacillin/tazobactam use increased (P < 0.0001) and ciprofloxacin use decreased (P < 0.0001); there were no changes in Access, Watch, Reserve antibiotic use, and the proportion of antifungal consumption was consistent throughout the study. The use of total antibiotics (P = 0.024), levofloxacin (P = 0.0007), piperacillin/tazobactam (P = 0.0015) and co-amoxiclav (P = 0.0198) increased during wave one. Consumption of COVID-19 treatment drugs was highest during wave two, with 624.3 DDDs per 1000 OBDs for dexamethasone (P = 0.4441), 6.8 DDDs per 1000 OBDs for remdesivir (P < 0.0001) and 35.01 DDDs per 1000 OBDs for tocilizumab (P = 0.2544). Discussion This study determined the consumption of antimicrobials trends before and during the pandemic. The individual wave antimicrobial consumption indicates maximum consumption in the first wave, advocating for antimicrobial stewardship and preparedness for future pandemics.
Collapse
Affiliation(s)
- Sidra Khan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Stuart E Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Jade Lee-Milner
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - William J Lattyak
- Statistical Consulting Department, Scientific Computing Associates Corp., River Forest, IL 60305, USA
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| |
Collapse
|
4
|
AbdEl-Aty MA, Amin MT, Ahmed SM, Elsedfy GO, El-Gazzar AF. Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study. Antimicrob Resist Infect Control 2024; 13:2. [PMID: 38185690 PMCID: PMC10773027 DOI: 10.1186/s13756-023-01357-2] [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: 06/26/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Over-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem. METHODS This qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software. RESULTS Two main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients' demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed. CONCLUSIONS The study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.
Collapse
Affiliation(s)
- Mahmoud Attia AbdEl-Aty
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mariam Taher Amin
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
| | - Sabra Mohamed Ahmed
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Ghada Omar Elsedfy
- Department of Pediatrics, Faculty of Medicine, Children's Hospital, Assiut University, Assiut, Egypt
| | - Amira Fathy El-Gazzar
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
- Department of Public Health and Community Medicine, Badr University in Cairo, Badr City, Egypt
| |
Collapse
|
5
|
Nawa AIA, Shareef J, Rao PGM, Rashid AU. Assessment of drug utilization pattern of antimicrobial agents in hospitalized patients with Infectious Diseases: A cross-sectional study in the United Arab Emirates. J Adv Pharm Technol Res 2023; 14:299-305. [PMID: 38107453 PMCID: PMC10723168 DOI: 10.4103/japtr.japtr_79_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 12/19/2023] Open
Abstract
Efficacious use of antimicrobial agents (AMAs) is paramount to combat a wide range of infections, ensure patient safety, and reduce antimicrobial resistance. To assess the drug utilization patterns of AMAs in hospitalized patients with infectious diseases in a secondary care hospital. A prospective observational study was conducted for 6 months in the internal medicine department. Data were collected, antimicrobial prescription patterns were screened, and drug utilization was assessed using the anatomical therapeutic chemical/defined daily dose methodology. Furthermore, predictors of the prescription of multiple AMAs were also analyzed. A total of 146 patient case records were reviewed and 285 AMAs were prescribed during the study period with a mean patient age of 54.2 ± 24.4 years. The average number of antimicrobials administered per patient was 1.94 ± 0.94. Respiratory tract infection and urinary tract infection were the common indications, and penicillins were the most prescribed class of AMAs. Multivariate analysis showed that the presence of comorbidities (P < 0.05) and longer hospital stays (P < 0.0001) increased the likelihood of prescribing multiple AMAs. The study provides insight into the pattern of prescribing of AMAs which help to improve the quality of care. Prescribing AMAs by generics and from the hospital formulary list according to the recommendations of the World Health Organization is a good sign of clinical practice. The study signifies the need to continuously monitor AMAs to optimize drug therapy and enhance the quality of drug use in clinical practice.
Collapse
Affiliation(s)
- Ahmad Ismail Abu Nawa
- Department of Clinical Pharmacy and Pharmacology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Javedh Shareef
- Department of Clinical Pharmacy and Pharmacology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Padma Guru Madhav Rao
- Ras Al Khaimah College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ain Ur Rashid
- Ibrahim Bin Hamad Obaidullah Hospital, Ras Al Khaimah, United Arab Emirates
| |
Collapse
|
6
|
Drakul D, Joksimović B, Milić M, Radanović M, Dukić N, Lalović N, Nischolson D, Mijović B, Sokolović D. Public Knowledge, Attitudes, and Practices towards Antibiotic Use and Antimicrobial Resistance in Eastern Region of Bosnia and Herzegovina in the COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:1274. [PMID: 37627694 PMCID: PMC10451907 DOI: 10.3390/antibiotics12081274] [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: 06/14/2023] [Revised: 07/15/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study aimed to identify knowledge, attitudes, and practices about AB use and AMR within the general population, stratified by age, gender, and urban/rural areas during the COVID-19 pandemic. This questionnaire-based cross-sectional study was conducted in April 2022 among patients who visited three health centers in the eastern region of Bosnia and Herzegovina. A high frequency of AB use was observed during the COVID-19 pandemic (64.2% of respondents were treated with AB). Age and place of residence have not been shown to be factors associated with AB use practices that pose a risk for AMR. However, female gender (β = 0.063; p = 0.041), better knowledge (β = 0.226; p < 0.001), and positive attitudes (β = 0.170; p < 0.001) about use of AB and towards to AMR proved to be factors associated with better practice by respondents. Women, younger respondents, and respondents from urban areas showed better knowledge, attitudes, and behavior about the use of AB and AMR during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Dragana Drakul
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
| | - Bojan Joksimović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
| | - Marija Milić
- Department of Epidemiology, Faculty of Medicine, University of Pristina Temporarily Seated in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia;
| | - Milica Radanović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
| | - Nikolina Dukić
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
| | - Nenad Lalović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
| | - Desmond Nischolson
- Department of Regional Health Services Region Five, Ministry of Public Health, Georgetown 101110, Guyana;
| | - Biljana Mijović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
| | - Dragana Sokolović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina; (D.D.); (B.J.); (M.R.); (N.D.); (N.L.); (B.M.)
| |
Collapse
|