Abstract
The association between antimicrobial resistance and antimicrobial usage has become a growing global concern. Many lower-middle income countries including Timor-Leste (TL) have limited information on antimicrobial usage, although recent research suggests increasing resistance rates among human pathogens there. The aim of this study was to use distribution data to estimate antibiotic consumption at both the national and sub-national level in Timor-Leste, stratifying into resistance class and adherence to the national essential medicines list (EML) and WHO AWaRe guidelines. A retrospective review of distribution data from Timor-Leste central medical store (SAMES) was undertaken to give a defined daily dose (DDD)/1000 inhabitants/day using WHO methodology. National antibiotic distribution in the TL EML in 2019 was estimated at 11.1 DDD/1000 inhabitants/day, comparable to consumption rates observed in other lower-middle-income countries using similar methodology. Differences in distribution quantities were noted between municipalities, with 4 of the 13 municipalities notably above the national average and around 32% of listed restricted antimicrobials distributed incongruent with the EML. This study provides insights into estimated antimicrobial consumption in Timor-Leste that has previously been poorly defined. Estimates of consumption can be used to understand emerging resistance in this small island nation, add to the body of knowledge on antimicrobial use to advise policy and guideline development, and help with stewardship activities.
Highlights
Excess consumption and poor prescribing of antimicrobials is a known driver of antimicrobial resistance (AMR) [1] and is believed to be a serious threat to global public health [2,3]
While AMR affects all countries, its impact is disproportionately higher in low- and-middle-income countries (LMIC) due to resource limitations and underdeveloped health infrastructure [7]
There are around 65 community health centres and 198 health posts, including a tertiary referral hospital, Hospital Nacional Guido Valadares (HNGV) in Dili, and 5 rural referral hospitals in Baucau, Maliana, Maubisse, Oecussi, and Antimicrobials were categorised according to the World Health Organization (WHO) report on Surveillance of Antibiotic Consumption: 2016–2018 early implementation [12] and WHO Access, Watch, Reserve restriction classification system [15] and the latest edition of the Timor-Leste essential medicines list (EML)
Summary
Excess consumption and poor prescribing of antimicrobials is a known driver of antimicrobial resistance (AMR) [1] and is believed to be a serious threat to global public health [2,3]. While AMR affects all countries, its impact is disproportionately higher in low- and-middle-income countries (LMIC) due to resource limitations and underdeveloped health infrastructure [7]. Timor-Leste, a small island LMIC in South East Asia, is vulnerable to AMR due to low government spending on health care, limited or poorly implemented treatment guidelines, need for adequately trained medical staff, under resourced infrastructure, and cultural beliefs around antibiotic use [8]. These factors along with weak regulatory mechanisms promote inappropriate use of antimicrobials in
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