Antibiotic use in Brazilian hospitals in the 21st century: a systematic review.

Lucas Borges Pereira,Leonardo Régis Leira Pereira,Larissa Pombeiro Sponchiado,Marília Silveira De Almeida Campos,Fabiana Rossi Varallo,João Paulo Vilela Rodrigues,Maria Olívia Barboza Zanetti

doi:10.1590/0037-8682-0861-2020

Lucas Borges Pereira, Leonardo Régis Leira Pereira + Show 5 more

Open Access

https://doi.org/10.1590/0037-8682-0861-2020

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Abstract

INTRODUCTION This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier’s abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.

Highlights

This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs
To avoid possible harmful consequences arising from inappropriate antibiotic use, developed countries and health organizations have developed recommendations and surveillance policies to promote the rational use of antibiotics, including the Strategies to Address Antimicrobial Resistance Act[7], European Surveillance of Antimicrobial Consumption Network[8], and Global Antimicrobial Resistance Surveillance System linked to the World Health Organization (WHO)[9]
Regarding the data collection sites, 43.5% of studies were carried out in adult and pediatric care units, 39.1% in units that care for only adults, and 17.4% that only care for pediatrics

Summary

Introduction

This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. To avoid possible harmful consequences arising from inappropriate antibiotic use, developed countries and health organizations have developed recommendations and surveillance policies to promote the rational use of antibiotics, including the Strategies to Address Antimicrobial Resistance Act[7], European Surveillance of Antimicrobial Consumption Network[8], and Global Antimicrobial Resistance Surveillance System linked to the World Health Organization (WHO)[9]. These initiatives aim to monitor antibiotic use, identify drug-related problems, and propose strategies to promote rational drug use. Most of these studies focused on the use of only some antibiotics[11] or a specific hospital unit[12]

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