Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh.

Md Ariful Islam,Sukanta Chowdhury,Shahana Parveen,Md Abdullah Al Jubayer Biswas,Nitish Debnath,Mahmudur Rahman,Khaleda Islam,Syeda Mah-E-Muneer,Fahmida Chowdhury,Md Zakiul Hassan,Md Kaousar Ahmmed,Anik Palit,Zobaid Khan,Md Mahbubur Rashid,Zubair Akhtar,Md Shakil Ahmed,Probir Kumar Ghosh,Ahamed Khairul Basher,Mohammad Abdul Aleem

doi:10.3390/antibiotics11020247

Md Ariful Islam, Sukanta Chowdhury + Show 17 more

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https://doi.org/10.3390/antibiotics11020247

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Abstract

The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate antibiotic stewardship and optimal use. In Bangladesh, data on antibiotic dispensing in pharmacies according to the AWaRe classification are scarce. We aimed to explore antibiotic dispensing pattern in pharmacies according to the WHO AWaRe classification to aid pharmacy-targeted national antibiotic stewardship program (ASP). From January to July 2021, we interviewed drug-sellers from randomly selected pharmacies and randomly selected customers attending the pharmacies. We collected data on demographics and medicines purchased. We classified the purchased antibiotics into the Access, Watch, and Reserve groups among 128 pharmacies surveyed, 98 (76.6%) were licensed; 61 (47.7%) drug-sellers had pharmacy training. Of 2686 customers interviewed; 580 (21.6%) purchased antibiotics. Among the 580 customers, 523 purchased one, 52 purchased two, and 5 purchased three courses of antibiotics (total 642 courses). Of the antibiotic courses, the Watch group accounted for the majority (344, 53.6%), followed by the Access (234, 36.4%) and Reserve (64, 10.0%) groups. Approximately half of the antibiotics (327/642, 50.9%) were purchased without a registered physician’s prescription. Dispensing of non-prescribed antibiotics was higher in the Access group (139/234, 59.4%), followed by Watch (160/344, 46.5%) and Reserve (28/64, 43.8%) groups. These findings highlight the need to implement strict policies and enforce existing laws, and pharmacy-targeted ASP focusing on proper dispensing practices to mitigate antimicrobial resistance in Bangladesh.

Highlights

In 2019, the World Health Organization (WHO) listed antimicrobial resistance (AMR)as one of the top ten threats to global health [1]
116 (90.6%) drug sellers were aware of government rules on antibiotic sale and, 97 (75.8%) were aware that antibiotics cannot be sold without a prescription of a registered physician (Table 1)
There is a scarcity of data on the pattern of antibiotic dispensing in pharmacies in Bangladesh according to the WHO AWaRe classification; a recent report showed that a high proportion (86%) of Watch group antibiotics were used for the suspected cases of COVID–19 with SARI [33]

Summary

Introduction

In 2019, the World Health Organization (WHO) listed antimicrobial resistance (AMR)as one of the top ten threats to global health [1]. AMR poses a serious threat to global public health, in low- and middle-income countries (LMICs) [1,2]. Resistance to the most commonly available antibiotics has been increasing sharply in recent years as a direct consequence of irrational use of antibiotics [4,5]. An estimated 700,000 people die of AMR each year worldwide [6] This number is predicted to increase sharply, to as many as ten million deaths annually by 2050 if urgent measures are not taken to support rational use of antibiotics [7]. Without harmonized and urgent action from countries in all income brackets, the world is headed for a post-antibiotic era in which common infections could once again kill [9]

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