Comparison of national antimicrobial treatment guidelines, African Union.

Jessica Craig,Isabel Frost,Geetanjali Kapoor,,Yewande Alimi,Jay Varma,Kayli Hiban

doi:10.2471/blt.21.286689

Abstract

ObjectiveTo identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.MethodsWe reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines.FindingsWe identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes.ConclusionAU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.

Highlights

Antimicrobial resistance poses significant public health challenges and threatens the ability to treat many common infectious diseases
The public health consequences of antimicrobial resistance may be higher in African countries because of failure to diagnose antimicrobial-resistant infections and the absence of expensive second-line therapies
We reviewed the websites of health ministries, national public health institutes or equivalent national government agencies of all 55 African Union (AU) Member States for relevant published standardized treatment guidelines.[8]

Summary

Introduction

Antimicrobial resistance poses significant public health challenges and threatens the ability to treat many common infectious diseases. Major drivers of antimicrobial resistance include: the misuse and overuse of antimicrobials in the human health and agricultural sectors; lack of access to clinically appropriate antimicrobials; lack of regulation and/or regulatory enforcement restricting access to antimicrobials to prescription-only use; and a higher burden of infectious diseases which is driven by low vaccination coverage and limited water, sanitation and hygiene infrastructure.[2,3,4] Given these risk factors for antimicrobial resistance, low- and middle-income countries are at a higher risk for the propagation of resistant pathogens compared to high-income countries. The public health consequences of antimicrobial resistance may be higher in African countries because of failure to diagnose antimicrobial-resistant infections and the absence of expensive second-line therapies

Methods

Results

Conclusion