Brian Godman1,2,3,4, Mainul Haque5, Judy McKimm6, Muhamad Abu Bakar7, Jacqueline Sneddon8, Janney Wale9, Stephen Campbell10,11, Antony P Martin3, Iris Hoxha12, Vafa Abilova13, Bene D Anand Paramadhas14, Pinkie Mpinda-Joseph15, Matshediso Matome16, Livia Lovato Pires de Lemos17,18, Israel Sefah19, Amanj Kurdi1,20, Sylvia Opanga21, Arianit Jakupi22, Zikria Saleem4,23, Mohamed Azmi Hassali4, Dan Kibuule24, Joseph Fadare25, Tomasz Bochenek26, Celia Rothe26, Jurij Furst27, Vanda Markovic-Pekovic28, Ljubica Bojanić29,30, Natalie Schellack2, Johanna C Meyer2, Zinhle Matsebula31, Thuy Nguyen Thi Phuong32, Binh Nguyen Thanh32, Saira Jan33,34, Aubrey Kalungia35, Sekesai Mtapuri-Zinyowera36, Massimo Sartelli37, Ruaraidh Hill38. 1. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom. 2. School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa. 3. Health Economics Centre, University of Liverpool, Liverpool, UK. 4. School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. 5. Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia. 6. Swansea University School of Medicine, Grove Building, Swansea University, Wales UK. 7. Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia. 8. Healthcare Improvement Scotland, Glasgow, UK. 9. Independent Consumer Advocate, Brunswick, Victoria, Australia. 10. Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK. 11. NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK. 12. Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania. 13. Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic. 14. Department of Pharmacy, Nyangabgwe Hospital, Francistown, Botswana. 15. Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana. 16. Department of Managed Care, AFA, Gaborone, Botswana. 17. 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. 18. Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil. 19. Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana. 20. Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq. 21. Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya. 22. UBT - Higher Education Institute, Prishtina, Kosovo. 23. Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan. 24. Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia. 25. Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria. 26. Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland. 27. Health Insurance Institute, Ljubljana, Slovenia. 28. Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina. 29. Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina. 30. Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina. 31. Raleigh Fitkin Memorial Hospital, Manzini, Swaziland. 32. Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam. 33. Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA. 34. Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA. 35. Department of Pharmacy, University of Zambia, Lusaka, Zambia. 36. National Microbiology Reference Laboratory, Harare, Zimbabwe. 37. Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy. 38. Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK.
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.
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.
Authors: Peter Konstantin Kurotschka; Alice Serafini; Marco Massari; Roberto Da Cas; Adolfo Figueiras; Viviana Forte; Maria Francesca Moro; Matteo Massidda; Federico Contu; Luigi Minerba; Maurizio Marcias; Marco Nardelli; Alessandra Perra; Mauro Giovanni Carta; Stefania Spila Alegiani Journal: BMJ Open Date: 2020-07-06 Impact factor: 2.692
Authors: Brian Godman; Debashis Basu; Yogan Pillay; Julius C Mwita; Godfrey Mutashambara Rwegerera; Bene D Anand Paramadhas; Celda Tiroyakgosi; Patrick Mbah Okwen; Loveline Lum Niba; Justice Nonvignon; Israel Sefah; Margaret Oluka; Anastasia N Guantai; Dan Kibuule; Francis Kalemeera; Mwangana Mubita; Joseph Fadare; Olayinka O Ogunleye; Larry A Distiller; Enos M Rampamba; Jeffrey Wing; Debjani Mueller; Abubakr Alfadl; Adefolarin A Amu; Zinhle Matsebula; Aubrey Kalungia; Trust Zaranyika; Nyasha Masuka; Janney Wale; Ruaraidh Hill; Amanj Kurdi; Angela Timoney; Stephen Campbell; Johanna C Meyer Journal: Front Pharmacol Date: 2020-03-20 Impact factor: 5.810