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Mori V, Grant G, Hattingh L. Evaluation of antimicrobial resistance surveillance data sources in primary care setting: a scoping review. Fam Pract 2025; 42:cmaf013. [PMID: 40156114 PMCID: PMC11953028 DOI: 10.1093/fampra/cmaf013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health warning that increases mortality, morbidity, and medical expenses. Effective AMR surveillance is essential to guide interventions and maintain treatment efficacy. While AMR surveillance is studied in various healthcare settings, data sources in primary care settings need to be evaluated. AIM To identify the value of utilizing AMR surveillance data in primary care settings to inform community antimicrobial stewardship (AMS) practices. METHODS Eligibility criteria included primary studies, randomized and nonrandomised controlled trials, observational studies, surveys, qualitative studies, mixed-method studies, and grey literature in primary care published worldwide from 2001 to 2024. RESULTS Our review of 21 included studies emphasized the significance of utilizing AMR surveillance data to enhance clinical care. Clinicians need to better understand the local AMR pattern when prescribing primary care antibiotics. Despite limitations, educational interventions can change prescribing behaviour. AMR increased because local susceptibility data frequently did not inform empirical antibiotic treatment. Digital and geospatial platforms could enhance surveillance with institutional support and standardized data integration. CONCLUSION This analysis highlights the need for user-friendly, real-time, and easily accessible data visualization platforms to improve AMR surveillance and AMS in primary care. Addressing data accessibility and providing training and education are crucial elements. Standardising data and utilizing digital technologies can improve decision-making and antibiotic prescribing. These elements must be incorporated into a consistent and adaptive plan for effective AMS interventions and public health outcomes.
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Affiliation(s)
- Vimrata Mori
- Department of School of Pharmacy and Medical Sciences, Griffith University, 1 Parklands Drive, Southport, Gold Coast, Queensland 4215, Australia
| | - Gary Grant
- Department of School of Pharmacy and Medical Sciences, Griffith University, 1 Parklands Drive, Southport, Gold Coast, Queensland 4215, Australia
| | - Laetitia Hattingh
- Department of School of Pharmacy and Medical Sciences, Griffith University, 1 Parklands Drive, Southport, Gold Coast, Queensland 4215, Australia
- Allied Health Research, Allied Health and Rehabilitation Services, Gold Coast Hospital and Health Services, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast, Queensland 4215, Australia
- Department of School of Pharmacy, University of Queensland, UQ Dutton Park, Level 4, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
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Kadirhaz M, Zhang Y, Atif N, Liu W, Ji W, Zhao N, Peng J, Xu S, Xu M, Tang C, Fang Y, Chang J. Primary Healthcare Physicians' Insufficient Knowledge Is Associated with Antibiotic Overprescribing for Acute Upper Respiratory Tract Infections in China: A Cross-Sectional Study. Antibiotics (Basel) 2024; 13:923. [PMID: 39452190 PMCID: PMC11505141 DOI: 10.3390/antibiotics13100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 10/26/2024] Open
Abstract
OBJECTIVES Overuse of antibiotics in healthcare remains prevalent and requires urgent attention in China, particularly in primary healthcare (PHC) facilities. This study aimed to describe the patterns of antibiotic prescriptions for acute upper respiratory tract infections (URTIs) in PHC facilities in China and to investigate how PHC physicians' knowledge influences their antibiotic prescribing behavior. METHODS A cross-sectional survey linking physician questionnaire responses and their prescription data was conducted in Shaanxi Province, China. The proportions of URTI visits that received at least one antibiotic, combined antibiotics, and broad-spectrum antibiotics were the main outcomes reflecting antibiotic prescribing behavior. Multivariate mixed-effects logistic regressions were applied to analyze the relationship between PHC physicians' knowledge about antibiotics and their antibiotic prescribing behavior. RESULTS A total of 108 physicians filled out the questionnaires between February 2021 and July 2021, and a sample of 11,217 URTI visits attended by these physicians from 1 January 2020 to 31 December 2020 were included in the analysis. The overall mean score of our respondents on the knowledge questions was 5.2 (total score of 10). Over sixty percent (61.2%; IQR 50.2-72.1) of the URTI visits received antibiotics. The percentages of URTI visits prescribed with combined and broad-spectrum antibiotics were 7.8% (IQR 2.3-10.2) and 48.3% (IQR 36.7-58.7), respectively. Third-generation cephalosporins were the most frequently used antibiotics. Physicians with lower antibiotic knowledge scores were more inclined to prescribe antibiotics (p < 0.001), combined antibiotics (p = 0.001), and broad-spectrum antibiotics (p < 0.001). CONCLUSIONS Physicians' insufficient knowledge was significantly associated with antibiotic overprescribing. Professional training targeting physicians' knowledge of antibiotics is urgently needed to improve the rational use of antibiotics in grassroots healthcare facilities in China.
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Affiliation(s)
- Muhtar Kadirhaz
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yushan Zhang
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Naveel Atif
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Wenchen Liu
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Wenjing Ji
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Nan Zhao
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jin Peng
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Sen Xu
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Miaomiao Xu
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Chengzhou Tang
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yu Fang
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jie Chang
- Department of Pharmacy Administration, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.K.); (Y.Z.); (N.A.); (W.L.); (W.J.); (N.Z.); (J.P.); (S.X.); (M.X.); (C.T.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
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Alnasser AHA, Al-Tawfiq JA, Ahmed HAA, Alqithami SMH, Alhaddad ZMA, Rabiah ASM, Albrahim MAA, Al Kalif MSH, Barry M, Temsah MH, Al-Kalaif ZSH, Shahadah RFB, Alharbi KKS, Alnasser AAH. Public knowledge, attitude and practice towards antibiotics use and antimicrobial resistance in Saudi Arabia: A web-based cross-sectional survey. J Public Health Res 2021; 10. [PMID: 34313091 PMCID: PMC8715265 DOI: 10.4081/jphr.2021.2276] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Antimicrobial resistance is a global issue that causes significant morbidity and mortality. Therefore, this study aims to assess knowledge, attitudes, and practices (KAP) of the general Saudi populations toward antibiotics use. Design and method: A cross-sectional, anonymous online survey was conducted from January 1 to May 11, 2020, across five major regions of Saudi Arabia. Participants (aged ≥18 years) were invited through social media to complete an online self-structured questionnaire. All data were analyzed by Statistical Package (SPSS v. 25). Descriptive statistics, Pearson’s Chi-squared, t-tests, one-way analysis of variance (ANOVA), and Pearson correlation analyses were conducted. Results: Out of 443 participants, the majority (n=309, 69.8%) were females, 294 (64.4%) were married, 176 (39.7%) were 25-34 years of age, 338 (76.3%) were living in the Eastern Province, 313 (70.7%) had college or higher education, 139 (31.4%) were not working, and 163 (36.8%) had a monthly income of USD 800-1330. Overall, most participants demonstrated good knowledge and practice (88% and 85.6%, respectively). However, 76.8%had inadequate attitude score levels towards antibiotics use. Of all the respondents, 74.9% knew that not completing a full course of antibiotics may cause antibiotics resistance, 91.33% did not agree that antibiotics should be accessed without a prescription, and 94.04% will not hand over leftover antibiotics to family members. Factors associated with adequate knowledge were female, medical jobs, and higher income (p<0.05). Conclusions: Our findings revealed that while most participants were aware of antibiotics use and demonstrated good knowledge, good practices, they had negative attitudes towards antibiotics use. Significance for public health Antibiotics are considered the miracle of medicine that can cure patients with infectious diseases. In the Kingdom of Saudi Arabia, few studies described antimicrobial practices. Most of the surveys were limited to certain areas. Therefore, this study assessed general knowledge, practices, and attitudes towards antibiotics use in multiple regions of Saudi Arabia. The findings could be used to assess the level of awareness about antibiotic use and may help policymakers to develop plans, laws, and programs to limit misuse of antibiotics and to preserve the health of the general population of Saudi Arabia.
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Affiliation(s)
- Ali Hassan A Alnasser
- Department of Laboratory, Dhahran Eye Specialist Hospital, Ministry of Health, Dhahran 31942, Saudi Arabia.
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | - Maryam Ali A Albrahim
- Department of Dentistry, Dammam Medical Complex, Ministry of Health, Dammam, Saudi Arabia.
| | - Mohammed Sheker H Al Kalif
- Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Technical and Vocational Training Corporation, Riyadh, Saudi Arabia.
| | - Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | | | - Khulud Khalid S Alharbi
- College of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia, The Panuska College of Professional Studies, The University of Scranton, Scranton, PA, USA.
| | - Aqeela Ali H Alnasser
- Al-Awjam First Secondary School for Girls, Al-Qatif Girls Education Office, General Administration of Education in the Eastern Region, Ministry of Education, Qatif, Saudi Arabia.
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