Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

Related collections

Most cited references 394

Record: found
Abstract: found
Article: not found

A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

Bin Cao, Yeming Wang, Danning Wen … (2020)

Abstract Background No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. Methods We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao 2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao 2) to the fraction of inspired oxygen (Fio 2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir–ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. Results A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir–ritonavir group, and 100 to the standard-care group. Treatment with lopinavir–ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.24; 95% confidence interval [CI], 0.90 to 1.72). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir–ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir–ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. Conclusions In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308.)

0 comments Cited 2604 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Eili Klein, Thomas P Van Boeckel, Elena M Martinez … (2018)

Significance Antibiotic resistance, driven by antibiotic consumption, is a growing global health threat. Our report on antibiotic use in 76 countries over 16 years provides an up-to-date comprehensive assessment of global trends in antibiotic consumption. We find that the antibiotic consumption rate in low- and middle-income countries (LMICs) has been converging to (and in some countries surpassing) levels typically observed in high-income countries. However, inequities in drug access persist, as many LMICs continue to be burdened with high rates of infectious disease-related mortality and low rates of antibiotic consumption. Our findings emphasize the need for global surveillance of antibiotic consumption to support policies to reduce antibiotic consumption and resistance while providing access to these lifesaving drugs.

0 comments Cited 880 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Alessandro Cassini, Liselotte Diaz Högberg, Diamantis Plachouras … (2019)

Summary Background Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases. Funding European Centre for Disease Prevention and Control.

0 comments Cited 829 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Caterina Aurilio: Role: Academic Editor

Antonella Paladini: Role: Academic Editor

Pasquale Sansone: Role: Academic Editor

Vincenzo Pota: Role: Academic Editor

Journal

Journal ID (nlm-ta): Life (Basel)

Journal ID (iso-abbrev): Life (Basel)

Journal ID (publisher-id): life

Title: Life

Publisher: MDPI

ISSN (Electronic): 2075-1729

Publication date (Electronic): 07 June 2021

Publication date Collection: June 2021

Volume: 11

Issue: 6

Electronic Location Identifier: 528

Affiliations

[1 ]Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK; amanj.baker@ 123456strath.ac.uk

[2 ]Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa; hannelie.meyer@ 123456smu.com

[3 ]School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia

[4 ]AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria; abiodun.egwuenu@ 123456ncdc.gov.ng

[5 ]Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia; runurono@ 123456gmail.com

[6 ]Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya; ombevaom@ 123456gmail.com

[7 ]East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda

[8 ]Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa; natalie.schellack@ 123456up.ac.za

[9 ]Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India; drsantoshkumar2004@ 123456gmail.com

[10 ]Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; xikria@ 123456gmail.com

[11 ]Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; jacqueline.sneddon@ 123456nhs.scot (J.S.); Andrew.Seaton@ 123456ggc.scot.nhs.uk (R.A.S.)

[12 ]Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania; iris.hoxha@ 123456umed.edu.al

[13 ]Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; salequl@ 123456juniv.edu

[14 ]Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana; mwitajc@ 123456ub.ac.bw

[15 ]Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil; renata.nascimento@ 123456ufop.edu.br

[16 ]Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil; isabellapiassi@ 123456gmail.com

[17 ]Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil

[18 ]Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon; lumnyanga@ 123456gmail.com

[19 ]Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon

[20 ]Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini; folarinamu@ 123456gmail.com

[21 ]Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; joezy_35@ 123456yahoo.com (J.A.); robertincoom30@ 123456yahoo.com (R.I.)

[22 ]Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana; isefah1980@ 123456gmail.com

[23 ]Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana

[24 ]Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; sopanga@ 123456uonbi.ac.ke

[25 ]Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq

[26 ]Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; ichikowe@ 123456medcol.mw (I.C.); fkhuluza@ 123456medcol.mw (F.K.)

[27 ]Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia; dkibuule@ 123456unam.na

[28 ]Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria; yinkabode@ 123456yahoo.com

[29 ]Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria

[30 ]Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria; olayinka.ogunleye@ 123456lasucom.edu.ng

[31 ]Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria

[32 ]Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; vanda.markovic-pekovic@ 123456med.unibl.org

[33 ]National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan; abubakr13@ 123456yahoo.com

[34 ]Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia

[35 ]Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam; thuy_ntp@ 123456hup.edu.vn

[36 ]Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia; chichokalungia@ 123456gmail.com

[37 ]Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK; stephen.campbell@ 123456manchester.ac.uk

[38 ]NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK

[39 ]Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; alice.pisana@ 123456stud.ki.se

[40 ]Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia; socrates111@ 123456bigpond.com

[41 ]Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK

[42 ]Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK

Author notes

[* ]Correspondence: brian.godman@ 123456strath.ac.uk ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562

Author information

Brian Godman https://orcid.org/0000-0001-6539-6972

Abiodun Egwuenu https://orcid.org/0000-0002-9369-4771

Mainul Haque https://orcid.org/0000-0002-6124-7993

Santosh Kumar https://orcid.org/0000-0002-5117-7872

Zikria Saleem https://orcid.org/0000-0003-3202-6347

Renata Cristina Rezende Macedo do Nascimento https://orcid.org/0000-0001-7756-2157

Isabella Piassi Dias Godói https://orcid.org/0000-0002-0568-6625

Loveline Lum Niba https://orcid.org/0000-0002-5938-4913

Joseph Acolatse https://orcid.org/0000-0001-6556-3208

Israel Abebrese Sefah https://orcid.org/0000-0001-6963-0519

Amanj Kurdi https://orcid.org/0000-0001-5036-1988

Ibrahim Chikowe https://orcid.org/0000-0002-8231-9140

Dan Kibuule https://orcid.org/0000-0002-6908-2177

Adesola Olalekan https://orcid.org/0000-0002-8921-1909

Article

Publisher ID: life-11-00528

DOI: 10.3390/life11060528

PMC ID: 8229985

PubMed ID: 34200116

SO-VID: 7a1879dc-1c1b-4dde-a290-1f5f496fb944

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Read this article at

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 394

A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 33

Cited by 69

Most referenced authors 5,152