Abstract
BackgroundInappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries.AimsTo determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies.Materials and MethodsResults from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing.ResultsData were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of ≥20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiotic use data from linited surveys.ConclusionsSelected essential medicines policies were associated with lower antibiotic use in low and middle income countries.
Highlights
Antibiotic drug resistance is a serious global public health problem with high human and financial costs.[1,2,3,4,5,6] Inappropriate and over use of antibiotic drugs is widespread and contributes to rapidly increasing bacterial resistance.[7,8]Policy-relevant interventions to combat inappropriate medicines use have generally had small effects.[9]
A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness
Policies seemed to be associated with greater effects in antibiotic use for upper respiratory infection (URTI) and diarrhea compared with antibiotic use in all patients
Summary
Policy-relevant interventions to combat inappropriate medicines use have generally had small effects.[9] In the case of antibiotic drugs this may be because the determinants of use, in developing countries, have not been sufficiently understood or addressed.[10] The World Health Organisation (WHO) has long advocated for introduction of essential medicines policies to encourage rational use of medicines.[11, 12] These include specific measures to promote prudent use of antibiotic drugs to minimize the development of resistance.[13,14,15] implementation of policies in many low and middle-income countries is suboptimal with less than half of countries implementing many recommended policies.[16, 17]. Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries
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