Use Of Antimicrobial Medicines Research Articles

National action on antimicrobial resistance and the political economy of health care

ABSTRACT Antimicrobial Resistance (AMR) is one of the biggest threats to human health in the twenty-first century. A key dimension of global governance in this domain consists of encouraging governments to create national action plans (NAPs) aimed at improving awareness of AMR, improving knowledge through surveillance and research, reducing infection, optimising the use of antimicrobial medicines, and investing in new drugs, vaccines and other interventions. The adoption and implementation of NAPs occur in the context of great political and institutional diversity across countries, and this article examines the consequences of different ways of financing health care. We expect the implementation of NAPs to be more successful in optimising antibiotics use when governments play a larger role in financing health care compared to private expenditure. An analysis of patterns of antibiotic consumption in 191 countries between 2000 and 2018 supports the hypothesis.

Antimicrobial Susceptibility Profile of Methicillin Resistant Staphylococcus Aureus (MRSA) Isolates in a Tertiary Care Hospital, Mysuru, India

Antimicrobial medications have become a significant issue in the healthcare sector as a result of the increaseddeath rate from Staphylococcus aureus infections, the appearance of methicillin-resistant and other multi-drugresistant strains. The study’s goals and objectives were determining the prevalence of MRSA and assessing theantibiotic efficacy of MRSA isolates from various clinical samples.Materials and Methods: A total of 395 MRSA were isolated from various clinical specimens and identified byusing standard microbiological techniques at tertiary care hospital of Mysore, South India. Methicillin resistancewas determined by standard Kirby-Bauer disc diffusion test using cefoxitin 30μg disk.Antimicrobial resistance patterns were determined by automated Vitek2 system.Results: A total of 246 (62.27%) isolates were identified as MRSA out of 395 S. aureus isolates collected from variousclinical samples such as pus samples (86.17%), blood (3.65%), Et swabs (3.65%), ear swabs (2.84%), sputum (1.6%),urine (0.81%), and other sterile body fluids (1.21%). All MRSA isolates were susceptible (100%) to vancomycin,linezolid and daptomycin followed by other antibiotics like rifampicin (99%), tigecycline (96.74%), tetracycline(95.93%), teicoplanin (95.5%), gentamicin (73.17%). Most of the MRSA isolates were resistant to oxacillin (97.15%),trimethoprim/sulfamethoxazole (95.12%), Levofloxacin (93.49%), ciprofloxacin (92.68%), clindamycin (87.80%),erythromycin (63.41%).Conclusion: In our study, we found MRSA isolates were susceptible to most active and reliable routinely usedantibiotics. Good infection control procedures like thorough hand washing, identifying and treating MRSAcarriers, and prudent use of antimicrobial medicines are advised to prevent the formation of drug-resistantisolates. In addition to the Vitek 2 approach, we may conclude that cefoxitin disc diffusion is an essential test todiagnose MRSA.

Characterizing the antimicrobial resistance profile of Escherichia coli found in sport animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment.

Antimicrobial resistance (AMR) is a significant threat to global health and development. Inappropriate antimicrobial drug use in animals cause AMR, and most studies focus on livestock because of the widespread use of antimicrobial medicines. There is a lack of studies on sports animals and AMR issues. This study aimed to characterize the AMR profile of E. coli found in sports animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment. Bacterial isolation and identification were conducted to identify E. coli isolates recovered from fresh feces that were obtained from fighting cocks (n = 32), fighting bulls (n = 57), sport horses (n = 33), and soils from those farms (n = 32) at Nakhon Si Thammarat. Antimicrobial resistance was determined using 15 tested antimicrobial agents - ampicillin (AM), amoxicillin-clavulanic acid, cephalexin (CN), cefalotin (CF), cefoperazone, ceftiofur, cefquinome, gentamicin, neomycin, flumequine (UB), enrofloxacin, marbofloaxacin, polymyxin B, tetracycline (TE), and sulfamethoxazole/trimethoprim (SXT). The virulence genes, AMR genes, and phylogenetic groups were also examined. Five virulence genes, iroN, ompT, hlyF, iss, and iutA, are genes determining the phylogenetic groups, chuA, cjaA, and tspE4C2, were identified. The AMR genes selected for detection were blaTEM and blaSHV for the beta-lactamase group; cml-A for phenicol; dhfrV for trimethoprim; sul1 and sul2 for sulfonamides; tetA, tetB, and tetC for TEs; and qnrA, qnrB, and qnrS for quinolones. The E. coli derived from sports animals were resistant at different levels to AM, CF, CN, UB, SXT, and TE. The AMR rate was overall higher in fighting cocks than in other animals, with significantly higher resistance to AM, CF, and TE. The highest AMR was found in fighting cocks, where 62.5% of their isolates were AM resistant. In addition, multidrug resistance was highest in fighting cocks (12.5%). One extended-spectrum beta-lactamase E. coli isolate was found in the soils, but none from animal feces. The phylogenetic analysis showed that most E. coli isolates were in Group B1. The E. coli isolates from fighting cocks had more virulence and AMR genes than other sources. The AMR genes found in 20% or more of the isolates were blaTEM (71.9%), qnrB (25%), qnrS (46.9%), and tetA (56.25%), whereas in the E. coli isolates collected from soils, the only resistance genes found in 20% or more of the isolates were blaTEM (30.8%), and tetA (23.1%). Escherichia coli from fighting cock feces had significantly higher resistance to AM, CF, and TE than isolates from other sporting animals. Hence, fighting cocks may be a reservoir of resistant E. coli that can transfer to the environment and other animals and humans in direct contact with the birds or the birds' habitat. Programs for antimicrobial monitoring should also target sports animals and their environment.

Potential of Desert Medicinal Plants for Combating Resistant Biofilms in Urinary Tract Infections.

Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, with 11% of the global population getting infected every year. These infections are largely attributed to quorum sensing (QS)-dependent ability of pathogens to form biofilms in the urinary tract. Antimicrobial resistance is increasing, and the use of antimicrobial medicines in the future is yet uncertain. The desert medicinal plants have great potential to treat several diseases as per the available ethnobotanical database. Some of these plants have been used in folklore medicines to treat urinary tract infections also. There are many bioactive compounds derived from these desert medicinal plants that have been documented to possess antimicrobial as well as antibiofilm activity against uropathogens. The minimum biofilm inhibitory concentration (MBIC) of these plant extracts have been reported in the range of 31.5-250 μg/mL. The rising prevalence of drug-resistant diseases necessitates standardised modern analytical technologies to detect and isolate novel bioactive compounds from medicinal plants. This review seeks to combine the studies of desert plants with antimicrobial and anti-quorum sensing properties, supporting their sustainable use in treatment of urinary tract infections.

Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries: Current Status and Best Practices.

Antimicrobial Stewardship and Infection Prevention and Control in Low- and Middle-income Countries: Current Status and Best Practices.

An insight into the implementation of the global action plan on antimicrobial resistance in the WHO African region: A roadmap for action

IntroductionThe Global Action Plan (GAP) on antimicrobial resistance (AMR) delivers a ‘One Health’ strategy for the development of the national action plan. It encourages the optimal use of antimicrobials and strengthens the evidence base through surveillance and research. MethodsThis study evaluated the current status of implementation of the GAP on AMR in World Health Organization (WHO) African countries via a retrospective, cross-sectional analysis of routinely collected data on AMR. A SWOT analysis was used to identify the strengths, weaknesses, opportunities and threats involved in the GAP implementation. A roadmap for action was proposed. ResultsThe overall mean GAP performance score across all the countries that were assessed was 32% ± SD12 (95% CI 27–36%). The mean thematic scores were 59% ± 12 (53–65%) for multi-sector and One Health collaboration; 50% ± 22 (42–58%) for developing national AMR action plans; 38% ± 12 (33–42%) for awareness and training; 18% ± 13 (13–23%) for surveillance; 33% ± 13 (29–38%) for infection prevention and control; and 28% ± 23 (20–37%) for optimal use of antimicrobial medicines in human, animal and plant health. The difference in GAP performance scores between African sub-regions and between income categories was not statistically significant (P > 0.05). While seven countries exhibited strengths in two themes, 25 countries exhibited weaknesses across all themes. Six threats and six opportunities were identified to inform a practical roadmap for AMR action. ConclusionThe findings from this study indicate that the overall GAP implementation on AMR in the WHO African region is inadequate. Some thematic GAP scores appeared to be relatively good, but on closer inspection, individual indicators revealed a lack of progress and implementation, requiring action.

Guidelines for the hospital role of the clinical nurse in antimicrobial stewardship: A scoping review.

Background Antimicrobial stewardship aims to optimise the use of antimicrobial medicines to preserve the efficacy of these medicines and to contain antimicrobial resistance where possible. Nurses constitute the largest group of healthcare workers; however, the role played by nurses within current antimicrobial stewardship strategies is largely unacknowledged despite nurses being at point-of-care at the hospital bedside. Objectives To identify recommendations for the antimicrobial stewardship role of the bedside nurse in key global antimicrobial stewardship guidelines. Methods Scoping review methodology was used to systematically search published and ‘grey’ literature in PubMed, EBSCOhost, Google Scholar, government websites, and websites of professional societies and organisations. Search dates were 1990 to 2020. Inclusion criteria were English language antimicrobial stewardship guidelines for hospitals. Screening was conducted in two stages for title and abstract and then full text relevancy and documented according to the PRISMA Extension for Scoping Reviews. Results Of the 1 824 articles that were retrieved, only 43 met the inclusion criteria. Inclusion of the bedside nurse on the antimicrobial stewardship team occurred in 13.9% (n=6) of the papers. A role for the bedside nurse was recommended in antibiotic stewardship (32.5%; n=14), infection prevention and control (23.2%; n=10), and administration of antimicrobial medicines (20.9%; n=9) of reviewed documents. Other recommendations included the use of evidence-based antimicrobial stewardship (20.9%; n=9), collaboration with other healthcare staff (11.6%; n=5), facilitation of transition of care (18.6%; n=8), and nurse prescription of antibiotics (4.6%; n=2). Conclusion This scoping review highlights a slow but incremental increase in recognition of the role of the bedside nurse within the operational hub of antimicrobial stewardship strategies. Contributions of the study The present study was undertaken to fill the gap in the literature on clinical nurses’ contribution in antimicrobial stewardship. The findings of the review largely demonstrate that multidisciplinary antimicrobial stewardship guidelines fail to view the bedside nurse as a contributor within antimicrobial stewardship strategies.

Use of tetracyclines and sulfonamides for the treatment of infectious diseases in animals

The use of antimicrobial medicines in human and veterinary medicine has led to the problem of the development of acquired antimicrobial resistance, which causes a global threat. Were described principles of tetracyclines and sulfonamides use, which are the most common among antimicrobial substances in veterinary medicinal products for the treatment of infectious diseases of food-producing and domestic animals.
 The aim. To substantiate the clinical relevance of antimicrobial veterinary medicinal products containing tetracyclines and sulfonamides+trimethoprim in veterinary medicine.
 Materials and methods. Research materials: sales reports of antimicrobial veterinary medicinal products in Ukraine for 2015–2019, EU countries, and the USA. Methods used: written and electronic survey; bibliosemantic, analytical and generalization.
 Results and discussion. As a result of the annual monitoring for 2015–2019 sales volumes in Ukraine, it was determined that tetracyclines (29.5–37.91 %) and sulfonamides + trimethoprim (12.1–18.7 %) were most often used in the composition of veterinary medicines. The same trend regarding the use of these classes of antimicrobials exists in many countries around the world. Factors determining the clinical relevance of these groups of substances are based on the criteria for their selection.
 The principle proposed by the EMA for the choice of antimicrobial veterinary medicinal products is based on the following criteria: categories of target animal species; treatment indications; the route of administration; the type of pharmaceutical formulation; the choice of a dosage regimen. Following this principle was substantiated the feasibility of tetracyclines and sulfonamides+trimethoprim use in veterinary medicine.
 By pharmacokinetic and pharmacodynamic parameters evaluated the rationality of the choice of antimicrobial veterinary medicines.
 Conclusions. The study revealed clinical efficacy and safety of tetracyclines and sulfonamides+trimethoprim as Veterinary Critically Important Antimicrobial Agents of Category D “Prudence”

Exploring the willingness to adopt rapid diagnostic tests to improve antimicrobial medicine use amongst Tanzanian livestock farmers

This article deals with the challenge of addressing antimicrobial resistance in resource-poor countries. It explores the possibilities of using rapid diagnostic tests to improve animal health management and treatment, particularly in situations where laboratory veterinary infrastructure is limited. Using data from a survey undertaken in 2018, three composite variables, i.e. perceived usefulness, compatibility with existing practices and ease of use, derived from the Model of Technological Acceptance and Diffusion Innovation Theory are used to analyse the perceived characteristics and values of rapid diagnostic test devices for farmers. Results suggest smallholder farmers’ willingness to adopt and use the tests provided they are affordable, easy to use and suitable to their local conditions – a common referential being mobile phones. While such tests have the potential to improve how antibiotics are used in smallholder farms, they are more likely to instigate more general improvements in how treatment decisions are made without necessarily reducing unnecessary antimicrobial use. The adoption may also imply a diminishing need for traditional veterinary services, thus making farmers more self-sufficient in animal health care. Farmers also seem to be more concerned by false negatives leading to sick animals missing vital treatment than by false positives where drugs will be administered to healthy animals. Overall promoting rapid diagnostic test technologies inevitably calls for new controls and regulations.

Optimising the use of antimicrobial medicines in Sudan

Antimicrobial resistance (AMR) has been a priority area identified by the Government of Sudan and development partners. This paper is part of a study in Sudan using the available documents covering relevant fields pertaining to AMR and interviews with key informants from World Health Organization (WHO) office Sudan, Federal Ministry of Health and other relevant entities. Documents were obtained from related websites for policies, strategies, guidelines, reports, and plans as well relevant international and government agencies in Khartoum. The study was guided by the WHO’s five strategic objectives of Global Action Plan on Antimicrobial Resistance. This paper focuses on the fourth objective on optimising the use of antimicrobial medicines in human health and animal health. The study revealed the presence of numerous policies and guidelines on antibiotic use and generic prescribing at different levels with little evidence of their implementation. There were a lack of supervisory or monitoring systems to ensure proper and rational prescribing, and appropriate dispensing of antimicrobials in both public and private sectors. The system is weakened due to low capacity for monitoring and checking as a result of limited resources both in terms of human resources, skills, tools and quality checks to ensure the quality of medicines post-marketing. There is a need to set up a quality management system within the existing structures for the distribution, prescription and dispensing of antibiotics in both public and private institutions. The system should clearly define the processes and provide adequate resources to ensure appropriate monitoring and control of antibiotic distribution, prescription and dispensing

Veterinary Diagnostic Practice and the Use of Rapid Tests in Antimicrobial Stewardship on UK Livestock Farms.

In this paper we consider the shifting role, practice and context of veterinary diagnosis in addressing concerns over what is, in the context of the growing threat of antimicrobial resistance, considered unnecessary or excessive antimicrobial medicine use in UK livestock farms. With increasing policy and regulatory interest in diagnostic practices and technologies, coupled with an expanding focus on the development and deployment of new rapid and point-of-care on-farm diagnostic testing, this paper investigates current diagnostic practices amongst veterinarians working on dairy, pig and poultry farms in Great Britain (England, Wales, and Scotland) and, more specifically, veterinarians' use and perceptions of new and emerging rapid and point-of-care diagnostic tests. Drawing on a series of 30 semi-structured interviews with farm animal veterinary professionals across the three sectors, this paper examines the manner in which such tests are both used and anticipated in clinical farm animal veterinary practice and the possible impact rapid test technologies might have on broader farm animal health management and disease control. Analysis of the transcribed interviews reveals a number of complexities around the use of rapid and point-of-care diagnostic tests. The relative rapidity and simplification of such tests, facilitating immediate treatment responses, is held in balance against both the accuracy and the more detailed and documented procedures of established laboratory testing routes. In situations of multifaceted on-farm etiologies, respondents maintained that rapid tests may offer restricted diagnostic capabilities, though in other situations they were found to offer ready confirmation of disease presence. A third complexity arising from the growth of rapid and point-of-care testing and revealed in this study relates to the shifting distribution of responsibilities in animal health care within contemporary food chains. The growing availability of rapid and point-of-care tests effectively diversifies the range of diagnostic actors with consequences for the flow of diagnostic and disease information. The veterinarians in this study identified areas where new rapid and point-of-care tests would be of particular value to them in their clinical practice particularly in addressing concerns over inappropriate antimicrobial use in animal treatment. However, despite the considerable policy advocacy on rapid and point-of-care tests as key tools in shifting diagnostic practice and reducing unnecessary antimicrobial use, veterinarians in this study, while recognizing the potential future role of such tools and technologies, nonetheless viewed diagnostic practice as a far more complex process for which rapid tests might constitute only a part.

Practice of dispensing antimicrobial medicines from community pharmacies

Abstract Background Inappropriate use of antimicrobial medicines is one of the main causes of antimicrobial resistance (AMR). The objective of this work was to study the situation on dispensing antimicrobials from pharmacy outlets in Armenia. Methods The study was implemented in 30 community pharmacies from different regions of Yerevan. Medicines dispensed to 900 patients/caregivers (30 visitors in each pharmacy outlet) were analyzed. The following indicators were calculated: the percentage of antimicrobials prescribed by physicians, the percentage of visitors, who got antimicrobials without providing a prescription and so on. Results Antimicribials (n = 171) consisted 11.3% of all the dispensed medicines (N = 1513). Only 25 (14.6%) antimicrobials were dispensed to visitors who had prescriptions. Only 19 (12.6%) of 151 medicines provided without prescription were OTC-medicines, other 132 (87.4%) were prescription only medicines. According to information received from visitors, 58.5% of all dispensed antimicrobials were selected by physicians, 10.5% of antimicrobials were advised by pharmacists and almost one third was selected by patients, family members, etc. More than 90% of the total number of visitors, whom antimicrobials were dispensed, got them without providing a prescription. 13 patients received 2 and more antimicrobials. Conclusions Many prescription only antimicrobials are dispensed from community pharmacies without prescription and some medicines are not prescribed by physicians. That means many antimicrobials are used inappropriately. There is need in strategy that could prevent dispensing antimicrobials without prescription. Key messages Dispensing prescription only antimicrobials without prescription can compromise rational use of medicines. Professional knowledge and public awareness about AMR should be improved.

Knowledge, attitude and perception on antimicrobial use and antimicrobial resistance among final year medical students in the College of Medicine, Malawi.

Medical curricula need to provide adequate knowledge on antimicrobial medicine use and antimicrobial resistance (AMR). Such knowledge is critical in shaping correct attitudes and perceptions among future prescribers. However, the extent of preparation provided by medical curricula remains unknown. The current study sought to determine knowledge, attitude and perception on antimicrobial use and AMR among final year medical students in Malawi. A descriptive cross-sectional study was undertaken among all final year medical students at the College of Medicine, University of Malawi in 2016. Total population sampling and self-administered questionnaires were used. Data were entered using Microsoft Excel and analysed with Epi info. Descriptive analysis for categorical data was done using frequencies and proportions, and for continuous data using measures of central tendency. The response rate in this study was 95%. The mean and median aggregated scores were 7.2 and 7, respectively, for the 11 knowledge questions. Over 88% of the respondents answered more than half of the knowledge questions correctly. Respondents agreed that antimicrobials are overused both at national (50; 69%) and at hospital (52; 72%) levels. This study reports high aggregated knowledge scores on antimicrobial use and resistance with wide variations on correct knowledge scores per question. The study further shows varying level in attitudes and perceptions among medical students. Overall, there were gaps on antimicrobial use and knowledge of AMR which the medical curriculum should addresses.

Self-medication with antibiotics in Maputo, Mozambique: practices, rationales and relationships

Self-medication, as a form of self-care, is a common practice worldwide, and often involves the use of both over-the-counter and prescription-only medicines, including antibiotics, anti-malarials and others. Increasing concerns over the global emergence and spread of antimicrobial resistance point to the need to reduce and optimise the use of antimicrobial medicines, both in human and animal health. Over the past few decades, numerous studies on self-medication with antibiotics have sought to determine the prevalence, risks and/or factors related to ‘inappropriate’ use in different parts of the world. Yet much of this literature tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals’ own reasoning. Based on a mixed methods social science research project in Maputo, which included a household survey, observations in pharmacies and interviews with users and healthcare providers, this paper aims to discuss self-medication in light of local users’ everyday practical reasoning. While situating self-medication within local contextual contingencies, the analysis highlights the ways in which personal and socially shared experiences, articulated with forms of knowledge and information provided by different sources, shape and inform practices of and attitudes towards self-medication with antibiotics. By looking at self-medication beyond (non-)prescription use, and by examining individuals’ decisions within their socioeconomic and therapeutic landscapes in Maputo, this study sheds light on the structural and relational factors that contribute to certain consumption practices that do not always follow biomedical recommendations of ‘rational’ or ‘appropriate’ use, helping to deconstruct and further problematise the various legitimate meanings and understandings of ‘responsible’ use.

Drug utilization, rationality, and cost analysis of antimicrobial medicines in a tertiary care teaching hospital of Northern India: A prospective, observational study.

BACKGROUND:The burden of bacterial infections is huge and grossly under-represented in the current health-care system. Inappropriate use of antimicrobial medicines (AMMs) poses a potential hazard to patients by causing antibiotic resistance. This study was conducted to assess the: (i) AMM consumption and use patterns in patients attending the outpatients and inpatients of Medicine and Surgery departments of the hospital. (ii) Appropriateness of the AMM in the treatment prescribed, and (iii) cost incurred on their use in admitted patients.MATERIALS AND METHODS:An observational, prospective study was conducted among inpatients and outpatients of the Medicine and Surgery departments of a tertiary care hospital of northern India. Analysis of 2128 prescriptions and 200 inpatient records was performed using a predesigned format. The use of AMMs was reviewed using anatomical therapeutic chemical classification and defined daily doses (DDDs). To evaluate the expenditure incurred on AMMs, ABC analysis was performed.RESULTS:AMMs were prescribed to 37.9% outpatients and 73% of admitted patients. The percentage encounters with AMMs was 40.6% (medicine) and 25.6% (surgery) outpatients. The total DDDs/100 patient days of AMMs in medicine and surgery were 3369 and 2247. Bacteriological evidence of infection and AMM sensitivity was present in only 8.5% of cases. Over 90% of AMMs were prescribed from the hospital essential medicines list. Most of the AMMs were administered parenterally (64.9%). Multiple AMMs were prescribed more to inpatients (84.2% vs. 4.2% outpatients). Overall, expenditure on AMM was 33% of the total cost of treatment on medicine. ABC analysis showed that 74% of the expenditure was due to newer, expensive AMM, which constituted only 9% of the AMM used. The AMM therapy was found to be appropriate in 88% of cases as per Kunin's criteria for rationality.CONCLUSION:AMMs are being commonly prescribed without confirmation of AMM sensitivity in the hospital. A large proportion of expenditure is being incurred on expensive AMM used in a few number of patients. There is a need for developing a policy for rational use of AMM in the health facility.

Does point-of-care testing in general practice for leucocyte and differential count change use of antimicrobial medicines? A pilot study.

Diagnostic uncertainty when considering prescription of antimicrobials ('antibiotics') in primary care contributes to the major problem of microbial resistance. We conducted a feasibility evaluation of rapid testing for leucocyte and differential count in two urban general practices, surveying the GPs online and interviewing them. GPs reported that the machines were easy to use, the test results influenced their care and they would adopt the system if costs were off-set. Feasibility, acceptability and perceived benefit justify a randomised trial to test the effect on antibiotic prescribing rates and quality of care, with an economic evaluation to inform the cost-benefit.

Pharmacists’ perception of their challenges at work, focusing on antimicrobial resistance: a qualitative study from Bangladesh

ABSTRACT Background: The indiscriminate use of antimicrobial medicines has contributed to the development of microorganisms’ resistance to antibiotics. Antimicrobial resistance (AMR) is a major global health problem and is most acute in countries that have a weak health care and regulatory system and a high burden of infectious diseases, such as Bangladesh. Due to shortages of physicians available to diagnose and prescribe appropriate antibiotics, people with ailments in Bangladesh are forced to contact various types of health care services, including retail pharmacies, that lack supervision by qualified medical personnel. It is unknown how pharmacists perceive the AMR situation and the related challenges they face. Objective: The aim of the study was to understand retail pharmacist’s perceptions regarding AMR. Method: A qualitative study design was used, and in-depth interviews were held with retail pharmacists in Dhaka. Results: The participants demonstrated a variety of concerns regarding AMR. They considered that self-medication, old prescriptions, lack of regulations and supervision, and readily available antibiotics were the main factors that contributed to the misuse of antimicrobial medicines and the development of AMR. Conclusions: To control the further spread of AMR in Bangladesh, there is a need to work at several levels of the health system simultaneously. Initiatives could include establishment of the ‘Model Pharmacy’ programme nationwide, increasing and widening the focus on AMR in pharmacists’ education, ensuring the implementation of government guidelines on AMR, increasing public awareness of the consequences of antimicrobial use, and surveillance and monitoring of regulations and progress. A multipronged strategy is necessary not only for better AMR control but also for investment in a system that is well equipped to provide equitable care in the face of both existing and new health challenges.

Pathways of antibiotic use in Bangladesh: qualitative protocol for the PAUSE study

IntroductionGlobal actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding...

PIH41 - ANTIBIOTIC PRESCRIPTION PATTERNS OF PRIMARY CARE PHYSICIANS IN TREATING CHILDREN

Inappropriate prescribing and use of antimicrobial medicines is one of the main reasons of antibiotic resistance. It can lead to treatment failure and compromise patient’s safety. This study evaluated attitudes of primary care pediatricians and family physicians concerning prescribing antibiotics in children. Survey was conducted in all 11 regions of Armenia. A questionnaire was developed and distributed to pediatricians and family physicians in primary health care settings. 80.6% of 293 responded pediatricians and family physicians “completely” and “mainly” agree that when prescribing antimicrobials for children local doctors select medicines from the Armenian List of Essential Medicines (AEML), 69.2% - from the World Health Organization Model List of Essential Medicines for children and 72.0% - from national clinical guidelines (NCGs) approved by the Ministry of Health, Armenia. 64.8% of physicians reported that they mainly prefer monotherapy. 24.0% of participants prescribe antibiotics after microbiological test. When asked about selecting the medicine for the first-line empiric treatment of pneumonia in children, 45.2% of participants pointed amoxicillin, 27.0% - amoxicillin/clavulanic acid, 19.6% - ceftriaxone. In total, 12 different medicines were pointed, although approved NCG recommends only amoxicillin. When asked about the second-line empiric treatment for pneumonia in children, 40.0% of participants pointed azithromycin, 27.0% - ceftriaxone, 11.0% - amoxicillin/clavulanic acid. In total, 20 medicines were mentioned by participants as a second-line treatment in children with pneumonia; only 8 of 20 were in line with NCG. The majority of primary care physicians believe that doctors prescribe in children antimicrobials which are selected from appropriate approved documents - AEML and NCGs. However, only less than half of pediatricians and family physicians prescribe as the first-line empiric treatment for pneumonia the medicine recommended by the approved NCG. Educational strategies could be useful for improving physicians’ knowledge and adherence to treatment guidelines.

Considerations for vaccination and immunity management

Antibiotic resistance is a global challenge and the need to optimise the use of antimicrobial medicines in animal health is recognised by all. Disease prevention through the use of vaccines that prime the pig's own immune system to cope better when exposed to pathogens later in life is the favoured approach. However the fast pace at which vaccine development has evolved and the huge number of products now available can be disconcerting when designing a vaccine schedule. Along with the clinical considerations of health status and disease dynamics, there are other more practical factors to take into account. Vaccination programmes must be designed specifically for each unit as there is no standard programme that can be followed.