Irrational Use Of Antimicrobials Research Articles

Knowledge, attitude and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates in a tertiary care hospital

Background: Irrational use of antimicrobials and inaccurate practicing behavior leads to the issue of antibiotic resistance. This can be tackled by spreading awareness with the assistance of future medical practitioners. Hence, the present study was taken to determine the knowledge, attitude, and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates.Methods: The study was conducted on interns and postgraduates in a tertiary care hospital. A standardized questionnaire was distributed to 120 participants and Ethical approval was taken before the study. Data was analyzed using SPSS software. For data comparisons, Chi-square tests were used, p≤0.05 is considered significant.Results: The study showed a majority in the 25 to 34 years of age group with female predominance. The subject of antibiotic resistance was moderately relevant to a majority, which highlighted a need for an increase in awareness workshops. The actual knowledge of respondents seems to be accurate in the study, a fair amount of attitude and practicing behavior was observed as well. A significant difference between the interns and postgraduates in knowledge (χ2=13.736, p=0.03), attitude (χ2=68.091, p=0.01), and practice (χ2=34.821, p=0.01) were noticed.Conclusions: Accurate knowledge and practicing behavior were observed in postgraduates and a fair attitude was observed in interns towards antimicrobial use and resistance. The awareness must be extended regarding this issue by conducting educational programs and by updating guidelines. Advancement in antibiotic prescribing pattern is required.

Profiling of antimicrobial dispensing practices in accredited drug dispensing outlets in Tanzania: a mixed-method cross-sectional study focusing on pediatric patients

BackgroundThe emergency of antimicrobial resistance due to irrational antimicrobial use has put public health under threat. Accredited Drug Dispensing Outlets (ADDOs) play an important role in enhancing availability and accessibility of antimicrobials, however, there is a scarcity of studies assessing antimicrobial dispensing practices in these outlets, focusing on children in Tanzania.ObjectiveThis study was conducted to assess the antimicrobial dispensing practices among ADDO dispensers and explore the factors influencing the use of antimicrobials for children in Tanzania.MethodsA community-based cross-sectional study utilizing both qualitative (interviews) and quantitative (simulated clients) methods was conducted between June and September 2020 in seven zones and 14 regions in Tanzania.ResultsThe study found inappropriate dispensing and use of antimicrobials for children, influenced by multiple factors such as patient’s and dispenser’s knowledge and attitude, financial constraints, and product-related factors. Only 8% (62/773) of dispensers asked for prescriptions, while the majority (90%) were willing to dispense without prescriptions. Most dispensers, 83% (426/513), supplied incomplete doses of antimicrobials and only 60.5% (345/570) of the dispensers gave proper instructions for antimicrobial use to clients. Over 75% of ADDO dispensers displayed poor practice in taking patient history.ConclusionADDO dispensers demonstrated poor practices in dispensing and promoting rational antimicrobial use for children. Training, support, and regulatory interventions are required to improve antimicrobial dispensing practices in community drug outlets.

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos en pediatría hospitalaria

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately.The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential.The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.

A cross-sectional study of antimicrobial use among self-medicating COVID-19 cases in Nyeri County, Kenya

BackgroundDuring the COVID-19 pandemic, Nyeri County in Kenya was among the regions reporting a high number of confirmed cases. This exemplified the increased need of addressing potential antimicrobial resistance (AMR) and self-medication during disease outbreaks. This study examined the extent of self-medication with antimicrobials among COVID-19 confirmed cases in the County.MethodsA cross-sectional survey using phone-based interviews was conducted in August 2021 among a sample of 280 out of 2317 confirmed COVID-19 cases in the County using a pre-coded questionnaire. Descriptive analyses of frequencies and causal logistic regression were conducted using STATA version 13.ResultsA total of 193 (68.9%) of the respondents indicated developing COVID-19 related symptoms-mainly cough (41.5%), headache (38.3%), and fatigue (34.7%). Over one-fifth (23.4%) of the respondents had self-medicated with antibiotics, 60.6% of whom did so at the onset of symptoms before the confirmatory test, and 51.5% self-medicating more than once. Common antibiotics used were Azithromycin (40.0%) and Amoxycilline (23.3%), with a considerable 21.7% having difficulty remembering the name of the drugs. Only half (50.4%) of the respondents (128/254) were aware of regulations towards self-medication with antibiotics. Age was the only socio-demographic variable significantly related to reduced self-medication, with older persons less likely to self-medicate. On the other hand, developing COVID-19 symptoms, awareness of COVID regulations, and appreciation of the need for self-medication awareness were related to increased self-medication.ConclusionBeing older, developing COVID-19 symptoms, and appreciating self-medication awareness have influential effects on the use of antimicrobials. Public health interventions should be timely during infectious disease outbreaks to prevent undesirable health-seeking behavior such as irrational antimicrobial use. AMR policies should enhance awareness of the risks of self-medication and address barriers that deter people from timely access of health services during disease outbreaks. Further research should be conducted on the self-medication and AMR nexus, especially during health emergencies.

Curbing antimicrobial resistance in post-COVID Africa: Challenges, actions and recommendations.

BackgroundAntimicrobial self‐medication and use have significantly increased in the COVID‐19 era—increasing antibiotic consumption and resulting in a high prevalence of antimicrobial resistance in Africa (AMR). We conducted a narrative review to investigate challenges associated with curbing AMR in a post‐COVID‐19 setting in Africa, suggesting practical measures applicable for policy‐informed implementation.MethodA narrative review was performed to pinpoint AMR challenges and actions on the African continent. A comprehensive search was conducted in the scientific databases that include PubMed, PubMed Central and Google Scholar using predetermined search terms.ResultsThe emergence of the COVID‐19 outbreak has added to the challenges of tackling AMR on the continent, which has jeopardized AMR interventions' hard‐won gains. Identified challenges have been Health systems disruption, Irrational Antimicrobial Use, Weak Antimicrobials Regulatory Ecosystem, Inefficient Population Infection Prevention, and Control Practices, Inadequate access to Health Services and data challenge on AMR surveillance.ConclusionThe COVID‐19 pandemic fueled AMR in Africa. There is a need for AMR control post‐COVID, such as measures for ongoing antimicrobial stewardship and good infection control practices. Further, curbing AMR requires rigorous regulatory enforcement and efficient AMR Surveillance. There should be a body to raise AMR awareness among the population. Research, Innovation and Technology could play an essential role supported by capacity building and global partnership.

Exploring Knowledge of Antibiotic Use, Resistance, and Stewardship Programs among Pharmacy Technicians Serving in Ambulatory Care Settings in Pakistan and the Implications.

Antimicrobial resistance (AMR) is a leading global health threat, increasing morbidity, mortality, and costs, with excessive and irrational use of antimicrobials contributing to the development of AMR. Consequently, the aims of this study were to evaluate the understanding of antibiotic use, AMR, and antimicrobial stewardship programs (ASPs) among pharmacy technicians serving in ambulatory healthcare settings in Pakistan. A cross-sectional survey was conducted among pharmacy technicians serving in 144 ambulatory care settings in seven districts of Punjab province using a validated questionnaire. Overall, 376 technicians completed the survey (85.8% response rate). The majority were men (89.1%), aged 25–35 years (45.1%), serving in emergency departments (43.9%) and filling 31–60 prescriptions per day (37.5%). Most (79.5%) knew that antibiotics were one of the most frequently prescribed drug classes, while 59.8% believed antibiotics for common colds did not speed up recovery. Inadequate duration (59.6%) and inadequate dosages (57.7%) of antibiotic therapy were reported as the leading causes of AMR. Terms including ‘superbugs’, ‘multidrug resistance’, and ‘extensively drug resistance’ were known to 42.0%, 25.3%, and 20.7% of participants, respectively; however, <10% knew about ASPs, including their core elements and purpose. Our study revealed that pharmacy technicians have adequate awareness of antibiotic use but are currently unaware of AMR and ASPs, which is a concern.

A Survey on Knowledge, Attitude, and Practices of Large-Animal Farmers towards Antimicrobial Use, Resistance, and Residues in Mymensingh Division of Bangladesh.

The widespread and indiscriminate use of antimicrobials in food animals is a key contributor to antimicrobial resistance and antimicrobial residue, which have become a growing public and animal health concern in developing countries such as Bangladesh. This study was aimed to assess the knowledge, attitude, and practices (KAP) of large-animal farmers towards antimicrobial use (AMU), antimicrobial resistance (AMR), and antimicrobial residue (AR) with their correlation. A cross-sectional survey was conducted with a structured and pretested questionnaire in the Mymensingh division of Bangladesh. A total of 212 large-animal farmers (dairy, beef fattening, buffalo, sheep, and goat farmers) were surveyed. Results showed that most of the farmers are male (85.8%) and belong to the 18–30 age group (37.3%). About 20.3% had no formal education, and nearly half of the participants (48.1%) received training regarding antibiotic use and resistance. Penicillin is the most common class of antibiotic used (61.8%) in the study area, followed by other antimicrobials. Only 37.7% of the farmers used antimicrobials on the recommendation of their veterinarian. Overall, 41.5%, 42.5%, and 21.7% of farmers possess adequate knowledge and a satisfactory attitude and perform desirable practices, respectively. Farmers in the 31–40 age group have adequate knowledge, attitude, and ability to implement desired practices compared to farmers in the 18–30 age group. Farmers having a graduate or post-graduate degree scored better in relation to knowledge, attitude, and practice than other farmers. Analysis revealed that farmers who received training on AMU and AMR had 10.014 times (OR = 10.014, 95% CIs: 5.252–19.094), 9.409 times (OR = 9.409, 95% CIs: 4.972–17.806), and 25.994 times (OR = 25.994, 95% CIs: 7.73–87.414) better knowledge, attitude, and performance, respectively, compared to their counterparts. A significant proportion of farmers (97.2%) dispose of leftover antibiotics inappropriately. The findings of the present study will be used to intervene in the education and training of the farmers, which will help to limit the indiscriminate and irrational use of antimicrobials, leading to reducing the chances of developing AMR.

Association between Consumption of Fluoroquinolones and Carbapenems and Their Resistance Rates in Pseudomonas aeruginosa in Argentina.

Background Irrational use of antimicrobials (ATMs) triggers microbial resistance (AMR) which has severe consequences for human health. ATM consumption varies among countries and within each territory. These data should be known, in order to perform local policies towards AMR reduction. This work aimed to expose the association of the level of consumption of carbapenems and fluoroquinolones with their resistance rates in Pseudomonas aeruginosa in Argentina. Method Consumption of antimicrobials was expressed by defined daily dose (DDD)/1000 inhabitants for each ATM during one year period, discriminating by each country region. Resistance of P. aeruginosa to carbapenems/fluoroquinolones groups was recorded. Consumption/resistance ratio “R” was calculated for each region of the country, comparing results with other countries. Results P. aeruginosa resistance rate to fluoroquinolone (F) was 26.4% in blood samples and 29.7% in urine samples, whereas resistance rates to carbapenems (C) were 19.9 and 17.7% in blood and urine, respectively. Correlation between consumption and resistance was demonstrated for both antimicrobials (C : R = 0.58; p=0.003 and F : R = 0.77; p=0.0001). Great fluctuations of resistance levels were seen among regions within the country, always correlating resistance with areas in which a higher level of ATM consumption was detected. Conclusion P. aeruginosa resistance to fluoroquinolone/carbapenems in Argentina directly correlated with antimicrobial consumption levels. A great heterogeneity in resistance profile was observed among areas where ATMs were widely used. Global data at the national level might mask local realities that require specific health policies in order to control the irrational use of ATMs.

Knowledge, Attitude, Practice (KAP) study regarding antimicrobial use guidelines of ICMR among doctors working in primary, secondary, tertiary healthcare facilities in a tribal area of North Odisha

Background: Antimicrobial resistance occurs with irrational use of antimicrobials, self-medication, and misuse of drug. Using data from ICMR's AMR surveillance, ICMR has developed evidence-based treatment guidelines for the treatment of 10 syndrome and infection.Aims and Objective:To assess the knowledge, attitude, and practice regarding the use of antimicrobials according to ICMR guidelines among doctors working in a tribal area of North Odisha.Methods: A self-administered 18-question KAP survey tool was provided to total 53 doctors working in primary, secondary, tertiary healthcare facilities.The study systematically was done at the primary health center (in Rangamatia) and then upgraded primary health center (in Kisantandi), then community health center (in Bangiriposi) and finally medical college (PRM Medical College, Baripada) from June to August.Data were collected regarding how they are practicing use of antimicrobials inProphylaxis and treatment of surgical site infections.Use of antimicrobials for upper respiratory tract infectionFor management of antibiotic-associated diarrhea.Results: We discovered that most of the doctor's, i.e., 77% are unaware about the ICMR guideline while 13% know very well. In case of attitude of doctors toward ICMR guideline of antimicrobial use, it is found that majority of them, i.e., 90%, have very good attitude. So while 5% of doctors have no attitude toward the guideline. But when it comes to practice according to ICMR guidelines, a majority of doctors i.e., 58% fared well.Conclusions: Our findings indicate dissonance between knowledge and practices among doctors. So there needs to be much more widened awareness program so that the treatment guideline can be reached near the doctors working in tribal areas.

Study of prescribing pattern of antimicrobials in a tertiary care hospital

Background: Antimicrobials are routinely prescribed in several disease conditions in which infections are established or suspected to be the reason for the illness. Excessive and irrational use of antimicrobials leads to development of drug resistance in microorganisms, besides increasing health-care expenditure. Antimicrobial resistance (AMR) leads to increase in morbidity and mortality. The rational use of antimicrobials is a major health need in all countries. Hence, assessment of prescribing pattern of antimicrobials is essential for clinical, educational, and economic purposes. Aims and Objectives: The objectives of the study were to evaluate and compare the prescribing pattern of antimicrobials by assessing – (i) commonly used antimicrobials; and (ii) disease conditions for which they were prescribed. Materials and Methods: It was a prospective observational study done for a period of 1 month. All the prescriptions in which antimicrobials were prescribed in the outpatient departments (OPD) and in-patient wards (IP) were included in the study. Prescriptions were analyzed for demographic and antibiotic data. Results: 1092 prescriptions were collected and analyzed. Among them, 690 prescriptions were from OPD and 382 prescriptions from in patient wards. Out patient data: Cefixime (21.30%) was commonly prescribed followed by fixed dose combination of Amoxicillin + Clavulanic acid (14.64%) and Ciprofloxacin (8.84%). Cefixime was commonly prescribed for URTI (13.43%). Oral route (82.17%) was the preferred route of administration. IP data: Cefotaxime (26.45%) was commonly prescribed followed by fixed dose combination of Piperacillin + Tazobactum (15.29%) and Ceftriaxone (14.46%). Cefotaxime was commonly prescribed preoperatively for most of the surgeries (76.56%). Intravenous route (46.86%) was the preferred route of administration. Single antimicrobial therapy (81.41%) was preferred followed by double (17.80%) and triple (0.79%) antimicrobial therapy. Conclusion: Cefixime and cefotaxime were commonly used in OPD and in patient wards, respectively. Oral route and intravenous route were the preferred route in OPD and IP wards, respectively. Single antimicrobial therapy was commonly preferred in both IP and out-patient wards. Although double and triple antimicrobial therapy was prescribed in small number of patients, it should be cautiously used to prevent AMR.

The implementation of antimicrobial stewardship in Indonesia: a regional survey in hospitals

Antibiotic resistance is becoming more common worldwide because of irrational antimicrobial use. Antimicrobial resistance occurs practically all over the world, leading the World Health Organization (WHO) to create a &ldquo;Global Action Plan on Antimicrobial Resistance&rdquo; in 2015. This study investigates the implementation of the antimicrobial stewardship program&rsquo;s actions in Indonesia&rsquo;s hospitals from the perspective of health professionals. This survey describes activities, th

Assessing Antimicrobial Resistance, Utilization, and Stewardship in Yemen: An Exploratory Mixed-Methods Study.

Antimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multifaceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last 5 years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices, and stewardship in Yemen, supported by a nonsystematic scoping literature review and a key informant interview. Participants (96%, N = 54) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), antimicrobial sensitivity tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (81%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of reliable, affordable, quality rapid diagnostics, and AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients' awareness programs could help avoid irrational use.

Global research publications on irrational use of antimicrobials: call for more research to contain antimicrobial resistance

BackgroundIrrational use of antimicrobials is highly prevalent. It is a major driving factor for antimicrobial resistance (AMR). Research on irrational antimicrobial use is important for developing policies and regulations to combat and contain AMR. The present study aims to provide an overview of research publications on the irrational use of antimicrobials at the national and global levels.MethodsPublications on irrational use of antimicrobials were extracted from Scopus using a wide range of relevant keywords for the study period from 1980 to 2020.ResultsIn total, 656 publications on irrational use of antimicrobials were found. The bulk of publications in this field were about irrational use in humans. A limited number of publications were found on the irrational use of antimicrobials in the context of veterinary and environment. The number of publications, contributing countries, and the mean number of authors per article increased with time, most notably in the last decade. Authors from 105 different countries participated in publishing the retrieved articles with 22 (21.0%) participated in 10 or more publications. The United States led with 140 (21.6%) articles followed distantly by China (n = 49, 7.5%), India (n = 45, 6.9%), and the United Kingdom (n = 45, 6.9%). Countries in the South-East Asian region (n = 69, 10.5%) and the African region (n = 42, 6.4%) made the least contribution. The list of most frequent author keywords included “antimicrobial stewardship” and “community pharmacies”. The research themes focused on the hospital-based rational use of antimicrobials and the self-medication practices with antimicrobials in the community. In total, 420 different journals participated in publishing the retrieved documents. The Plos One journal (17, 2.6%) ranked first. The retrieved articles received an average of 15.6 citations per article and an h-index of 52. The most frequent antimicrobials encountered in the retrieved literature were penicillin, cephalosporin, and fluoroquinolones while the most frequently encountered pathogens were S. aureus and P. aeruginosa.ConclusionResearch on the irrational use of antimicrobials is needed from all countries and regions to implement appropriate policies to contain the AMR. Research on irrational use of antimicrobials in the context of veterinary is needed.

Irrational Use of Antimicrobials in Poultry Farms and Antimicrobial Resistance: A Cross-Sectional Study

Background: The rampant use of antimicrobials in poultry farms is creating a global public health threat as antimicrobial resistance (AMR) in humans may arise from such practice. This study was conducted with the objective of quantification and hence assessment of the level of antimicrobial use in Pakistani poultry farms so that appropriate utilization of such agents can be assured.&#x0D; Methods: Six randomly selected poultry farms of Pakistan with ten production cycles with 20,000- 30,000 birds in every production cycle were selected for the study from 2018 to 2019. The average dosage utilized on-farm was described by the defined daily dose (DDD) and used daily dose (UDD).&#x0D; Results: It was found that enrofloxacin, amoxicillin, doxycycline, tylocin, and lincomycin were the antimicrobials commonly used by all poultry farms. However, only Enrofloxacin (UDD/DDD = 0.95) was being used within the rational therapeutic range. All the antimicrobials were used irrationally without proper indication and suggestion by the veterinarian. No records on antimicrobials use were found on any farm. &#x0D; Conclusion: The irrational use of antimicrobials in poultry farms may lead to antimicrobial resistance which has been a global public health threat. The speedy action should be implemented to discourage such rampant use of drugs in poultry farms in Pakistan and countries with similar farming practices for the effective use of antimicrobials in the proper indication.

Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications.

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

Perspectives on antimicrobial use in pig and layer farms in thailand: legislation, policy, regulations and potential

Irrational use of antimicrobials is a major problem worldwide. The comprehensiveness of the existing legislation and veterinary pharmaceutical regulatory system has been critically evaluated and its practical implementation was assessed in this study. A cross-sectional survey study, and an in-depth interview of key informants involving the layer and pig farm owners/managers of farms located in Chiang Mai, Lamphun and Chonburi Provinces were conducted. The Thai FDA is responsible for pre-marketing and authorizes relevant officials of DLD to enforce drug acts related to the post-marketing of veterinary drugs/biologics. These existing legislations and regulations were comprehensive enough to cover all areas of pharmaceutical activities developed to protect the health of the public and animals in the country; however, the enforcement of these rules may not be properly enforced or may be ineffectively executed. Rules regarding veterinary pharmaceuticals being distributed throughout the country have not been clearly stated. Farmers can easily access veterinary pharmaceuticals, and veterinarian prescriptions were not needed. Additionally, the relevant benefits were among the most important reasons for choosing to use antimicrobials on farms, along with a lack of availability of better alternative products for the treatment of infections. Intensive legislation and regulation enforcement were considered to be the most effective means of reducing antimicrobial usage and abuse in Thailand.

Guidance for the management of adult patients with coronavirus disease 2019.

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Utilization of clinical practice guideline on antimicrobial in China: an exploratory survey on multilevel determinants

BackgroundNowadays, irrational use of antimicrobials has threatened public health. It’s necessary to expand the use of clinical practice guideline (CPG) on antimicrobial for facilitating the proper use of antimicrobial. However, the utilization status of CPG on antimicrobial and the influencing factors, especially the ones at the organizational level, remain largely unknown.MethodsA cross-sectional questionnaire survey was conducted on a sample among physicians from 16 public hospitals in the eastern, central and western parts of China. A multilevel regression model was employed to examine factors associated with physicians’ utilization of CPG on antimicrobial.ResultsA total of 815 physicians were included in this study. About 80% of the surveyed physicians reported their adherence to the CPG on antimicrobial. Dimensions of “subjective norm”, “perceived risk” and “behavioral intention” from the domain of physician belief, a dimension of “ease of use” from the domain of CPG traits, and dimensions of “top management support” and “organization & implementation” from the domain of hospital practice were significantly associated with physicians’ utilization of CPG on antimicrobial. And except for working department, most demographics characteristics of the physician were not found to be significantly related to the CPG use. In addition, it also showed that region is a significant factor affecting physicians’ CPG use.ConclusionsThis study depicted the current status of CPG on antimicrobial and comprehensively identified its potential determinants not only from the three domains at the individual level, such as physician belief, but also from the location region at the organizational level. The results will provide a direct reference for the implementation of CPG on antimicrobial.

Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors.

BackgroundAntimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a ‘snap shot’ of the current situation including existing policies and practices to address AMR, and the challenges and barriers associated with their implementation.MethodsA systematic approach was adopted for identifying, screening, and selecting relevant literature on AMR situation in Bangladesh. We used Google Scholar, Pubmed, and Biomed Central databases for searching peer-reviewed literature in human, animal and environment sectors during January 2010-August 2019, and Google for grey materials from the institutional and journal websites. Two members of the study team independently reviewed these documents for inclusion in the analysis. We used a ‘mixed studies review’ method for synthesizing evidences from different studies.ResultOf the final 47 articles, 35 were primary research, nine laboratory-based research, two review papers and one situation analysis report. Nineteen articles on human health dealt with prescribing and/or use of antimicrobials, five on self-medication, two on non-compliance of dosage, and 10 on the sensitivity and resistance patterns of antibiotics. Four papers focused on the use of antimicrobials in food animals and seven on environmental contamination. Findings reveal widespread availability of antimicrobials without prescription in the country including rise in its irrational use across sectors and consequent contamination of environment and spread of resistance. The development and transmission of AMR is deep-rooted in various supply and demand side factors. Implementation of existing policies and strategies remains a challenge due to poor awareness, inadequate resources and absence of national surveillance.ConclusionAMR is a multi-dimensional problem involving different sectors, disciplines and stakeholders requiring a One Health comprehensive approach for containment.