Lack of regulation over antibiotic prescription and dispensation: A prospective cohort in a community setting

2021 ◽  
pp. 175717742110333
Author(s):  
Jacques Choucair ◽  
Elie Haddad ◽  
Gebrael Saliba ◽  
Nabil Chehata ◽  
Jennifer Makhoul
Keyword(s):  
Bacterial Resistance ◽  
Antibiotic Prescription ◽  
Community Setting ◽  
Care Physician ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Authorities ◽  
Amoxicillin Clavulanate ◽  
Infectious Diseases Consultation ◽  
Antibiotic Courses

Background: The emergence of bacterial resistance caused health authorities to attempt to implement strict regulations for rational antibiotic prescription. However, supervision is often neglected in low- and middle-income countries, leading to inappropriate administration of antibiotics. The objective of our study is to highlight the lack of monitoring in the community setting of a middle-income country. Material and methods: We asked 68 patients presenting to an infectious diseases consultation office to report the antibiotic courses they had taken in the three months preceding their visit. We assessed for treatment indication, molecule choice, dosing and duration, as well as microbial cultures, demographics and specialty of the prescriber. Results: Among the 68 patients included in our study, we counted a total of 95 outpatient antibiotic courses, mostly composed of quinolones (36%), followed by amoxicillin-clavulanate (21%). The prescriber was most commonly a primary care physician, but we reported several cases of auto-medication and dispensation of antibiotics by pharmacists. Only 30% of cases had true indications for antibiotics. Conclusion: In sum, our results indicate an evident lack of regulation over the administration of antibiotics. This easy accessibility needs to be promptly addressed as we run the risk of inevitable bacterial resistance.

scholarly journals Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olawale Salami ◽  
Philip Horgan ◽  
Catrin E. Moore ◽  
Abhishek Giri ◽  
Asadu Sserwanga ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diagnostic Tests ◽  
Antibiotic Prescription ◽  
Rapid Diagnostic Tests ◽  
Intervention Package ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
And Training ◽  
Low And Middle Income

Abstract Background The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections. Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration Clinicaltrials.gov NCT04081051. Registered on 6 September 2019. Protocol version 1.4 dated 20 December 2019

scholarly journals Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (6) ◽  
pp. e1003139 ◽  
Author(s):  
Giorgia Sulis ◽  
Pierrick Adam ◽  
Vaidehi Nafade ◽  
Genevieve Gore ◽  
Benjamin Daniels ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Antibiotic Prescription ◽  
Meta Analysis ◽  
Middle Income ◽  
Prescription Practices ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Charting mandatory vaccination policies worldwide

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Vanderslott ◽  
T Marks
Keyword(s):  
International Health ◽  
Vaccination Policy ◽  
Middle Income ◽  
Vaccination Rates ◽  
Comprehensive List ◽  
Middle Income Countries ◽  
Health Authorities ◽  
Media Reports ◽  
Four Levels ◽  
Mandatory Vaccination

Abstract Background Mandatory vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. However, the evidence about which countries have mandatory vaccination policy worldwide and discussions surrounding their impact has largely been limited to high-income countries. While many recent publications discuss the issue, none provide a comprehensive list. This is an obvious gap in the discussion about the merits of introducing mandatory vaccination into countries. Methods We draw on extensive desk-based research analysing a mixture of sources, including national, regional, and international vaccination policy reports, international health institution websites, ministry of health websites, and media reports. We supplemented this material by contacting a variety of health authorities, such as PAHO and the WHO as well as country's ministries of health. Results We have compiled the first comprehensive list of vaccination policies worldwide, covering 149 countries. This list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across four levels. We provide an overview of the state of mandatory vaccination across different countries, set out the general trends and issues, and engage into a discussion about why, how, and where mandatory vaccination is put in place. We also provide several case studies, which highlight the limitations of vaccine mandates because other factors such as exemptions, penalties or enforcement play an important role in their actual effect on immunisation rates. Conclusions Our key finding is that the majority of low- and middle- income countries have mandatory vaccination policies but low vaccination rates because of problems with vaccine supply, delivery, and access.

scholarly journals Impact of a Package of Diagnostic Tools, Clinical Algorithm, and Training and Communication on Outpatient Acute Fever Case Management in Low- and Middle-Income Countries: Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Olawale Salami ◽  
Philip Horgan ◽  
Catrin E Moore ◽  
Abhishek Giri ◽  
Asadu Sserwanga ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diagnostic Tests ◽  
Antibiotic Prescription ◽  
Rapid Diagnostic Tests ◽  
Intervention Package ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Impact ◽  
And Training ◽  
Low And Middle Income

Abstract Background.The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)?Methods.We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion.DiscussionThis study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs.Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Date 20 December 2019

scholarly journals Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries:  protocol for a randomized controlled trial

2020 ◽  
Author(s):  
Olawale Salami ◽  
Philip Horgan ◽  
Catrin E Moore ◽  
Abhishek Giri ◽  
Asadu Sserwanga ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diagnostic Tests ◽  
Antibiotic Prescription ◽  
Rapid Diagnostic Tests ◽  
Intervention Package ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
And Training ◽  
Low And Middle Income

Abstract Background. The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods. We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion. This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Dated 20 December 2019

scholarly journals Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries:  protocol for a randomized controlled trial

2020 ◽  
Author(s):  
Olawale Salami ◽  
Philip Horgan ◽  
Catrin E Moore ◽  
Abhishek Giri ◽  
Asadu Sserwanga ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diagnostic Tests ◽  
Antibiotic Prescription ◽  
Rapid Diagnostic Tests ◽  
Intervention Package ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
And Training ◽  
Low And Middle Income

Abstract Background. The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections.Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods. We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion. This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration: Clinicaltrials.gov, identifier NCT04081051, registered 06 SEP 2019.Protocol version 1.4 Dated 20 December 2019

scholarly journals O25 Clavulanate stability in child-appropriate formulations is inadequate for use in treating young children in Asia

2019 ◽  
Vol 104 (6) ◽  
pp. e11.1-e11
Author(s):  
I Mack ◽  
M Sharland ◽  
S Rehm ◽  
K Rentsch ◽  
J Bielicki
Keyword(s):  
Antibiotic Consumption ◽  
Storage Conditions ◽  
Asian Countries ◽  
Middle Income ◽  
Ambient Temperatures ◽  
Middle Income Countries ◽  
Oral Amoxicillin ◽  
Amoxicillin Clavulanate ◽  
Nationally Representative ◽  
Temperature Storage

BackgroundAmoxicillin-clavulanate (AMC) is among the most frequently used antibiotic for paediatric infections globally. AMC child-appropriate formulations are largely limited to dry powder suspensions, which have to be stored refrigerated once reconstituted due to stability limitations of clavulanate.MethodsOral Amoxicillin (AMX) and AMC formulations were identified from IQVIA-MIDAS wholesale data, and 2015 antibiotic consumption in courses/1000 child-years was estimated in Bangladesh, India, Indonesia, Pakistan, Philippines and Vietnam with an assumed average treatment of 7 days. Costs per course in US-$ standardised to 2015 were estimated from the same dataset. Nationally representative data on access to a refrigerator was extracted from the Demographic & Health Surveys Program. Degradation under different temperature conditions of two different AMC suspensions commercially available in Switzerland was tested. Average degradation (three bottles of each product) was measured during 8 days with ambient temperatures of 8°C versus 28°C.ResultsIn India and Pakistan more AMC than AMX courses were sold. In all countries AMC was at least twice and up to 10 times as expensive as AMX. Access to refrigeration was below 45%, even in countries with a high number of sold AMC courses (compared with AMX). In the evaluated co-formulated products, clavulanate showed a maximum degradation of 34% at 8°C, and 73% at 28°C after 8 days. AMX was largely stable at 8°C but 13% degraded at 28°C after 8 days.ConclusionsOral amoxicillin-clavulanate suspensions are widely used in six Asian countries classified as middle-income countries by the World Bank. In reconstituted liquid AMC formulations, neither component is satisfactorily stable at room temperature. Storage conditions for stability are likely inadequate for AMC in many households in the six Asian countries of interest.Disclosure(s)Nothing to disclose

Inappropriate prescription of antibiotics in pediatric practice

2016 ◽  
Vol 20 (4) ◽  
pp. 530-536 ◽  
Author(s):  
Clémence Marc ◽  
Bénédicte Vrignaud ◽  
Karine Levieux ◽  
Antoine Robine ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Best Practice ◽  
Bacterial Resistance ◽  
Antibiotic Prescription ◽  
University Hospital ◽  
Upper Respiratory Tract ◽  
Practice Recommendations ◽  
Health Authorities ◽  
Antibiotic Drugs ◽  
Antibiotic Drug ◽  
Upper Respiratory

Misuse of antibiotics is largely responsible for the emergence of bacterial resistance. Children represent a subset of the population who frequently receive antibiotics. The objectives were to calculate the frequency of antibiotic prescriptions that do not comply with best practice recommendations in paediatrics primary care and to examine the thoughts and feelings of physicians and parents about antibiotic prescription and recommendations from the national health authorities. We included children admitted at the paediatric emergency room (PER) of the NANTES university hospital between June 2011 and October 2012 and who were under antibiotic drugs. Two independent experts evaluated the compliance with the national recommendations. Parents and general practitioner (GP) who prescribed the antibiotic before admission to PER were called to collect their thoughts and feeling about antibiotic prescription. The median age of the 88 included children was 2.8 years. The upper respiratory tract infection motivated the prescription of antibiotic in 59%. Seventy-six per cent of the prescriptions analysed were inappropriate, 72% of the antibiotics had a too broad spectrum, and one-third was not indicated. Ninety-one per cent of the interviewed parents thought that the antibiotic prescribed to their child was adequate. Among the 77 prescribing GP who were called, 33% agreed that they lacked time during consultation to explain to parents that no antibiotics were required. Antibiotic prescriptions were too often inadequate in this sample of children admitted in a French PER. Efforts have to be made with physicians and general public to optimize the antibiotic drug use.

scholarly journals Antibiotic Prescription Knowledge of Dentists in Kingdom of Saudi Arabia: An Online, Country-wide Survey

2016 ◽  
Vol 17 (3) ◽  
pp. 198-204 ◽  
Author(s):  
Esam Halboub ◽  
Abdulaziz Alzaili ◽  
Mir Faeq Ali Quadri ◽  
Mohammed Al-Haroni ◽  
Mohammad Ibrahim Al-Obaida ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Bacterial Resistance ◽  
Conflicts Of Interest ◽  
Antibiotic Prescription ◽  
Knowledge Score ◽  
Kingdom Of Saudi Arabia ◽  
Validated Questionnaire ◽  
First Choice ◽  
Surgical Extraction ◽  
Amoxicillin Clavulanate

ABSTRACT Aim Dentists are probably contributing to the development of bacterial resistance to certain antibiotics. Campaigns to promote prudent use of antibiotics in dentistry are, thus, needed but require proper identification of dentists’ knowledge gaps. The objective here was to comprehensively evaluate antibiotic prescription knowledge of dentists in Saudi Arabia. Material and methods A link to an online, previously validated questionnaire was emailed to 5199 dentists registered with the Saudi Dental Society. The questionnaire comprised 42 scorable items measuring antibiotics prescription knowledge in five different domains in addition to nonscorable questions regarding first-choice antibiotics and previous attendance of a course/workshop about antibiotic prescription. Each correct answer was given one mark. Mean scores were calculated as percentages and categorized as good (> 80%), intermediate (60–80%), or poor (< 60%). Results The response rate was 9.4%; however, only 373 (7.2%) fully completed the questionnaire. Around half of the participants (52%) reported prescribing amoxicillin/clavulanate as the firstchoice antibiotic; 62% reported attending a course/workshop in the last 5 years. The average knowledge score was 69%, being highest for nonclinical indications (79%) and lowest for prophylactic use (56%). The worst per-item scores were noted for rheumatic heart disease (19%), trismus (28%), surgical extraction (30%), apicectomy (31%), and periodontal abscess (33%). Female dentists, dentists in governmental sector, and those with higher qualifications had significantly better knowledge. Conclusion The level of knowledge was hardly intermediate and several deficits were identified, indicating an urgent need for educational campaigns and provision of guidelines promoting rational use of antibiotics by dentists. Clinical Significance Irrational use of antibiotics by dentists can contribute to the problem of antibacterial resistance. How to cite this article Halboub E, Alzaili A, Quadri MFA, Al-Haroni M, Al-Obaida MI, Al-hebshi NN. Antibiotic Prescription Knowledge of Dentists in Kingdom of Saudi Arabia: An Online, Country-wide Survey. J Contemp Dent Pract 2016;17(3): 198-204. Conflicts of interest There are no conflicts of interest to declare.

scholarly journals A Virtual Skills Centre on Behaviour Management in Chronic Disease for Lay People in Low- and Middle-Income Countries (LMICs)

2020 ◽  
Author(s):  
iliatha Papachristou Nadal ◽  
Nivethitha Ganapathiram ◽  
Thomas Harrison ◽  
Deepa R ◽  
Maithili Karthik ◽  
...  
Keyword(s):  
Diabetes Complications ◽  
Community Setting ◽  
Management Skills ◽  
Middle Income ◽  
Education Professionals ◽  
Face To Face ◽  
Psychological Techniques ◽  
Middle Income Countries ◽  
Lay People ◽  
Behavioural Management

Introduction: Diabetes complications can be reduced and/or prevented by providing skills in behavioural management to lay people e.g. volunteers, family and friends. With a critical shortage of trained staff in lower- and middle-income countries (LMICs) to deliver these, lay people are a solution to fill this gap. Current programmes in LMICs are not suitable for lay people as they are (i) too complex i.e. for high education professionals and (ii) not easily accessible. We aim to address these two barriers through both a face to face and online virtual skills centre (VSC). Objectives: This paper describes the development of an online VSC that will provide access to those caring for people with diabetes within a community setting; examined the suitability and usability of the VSC using qualitative methods. Methods Drawing on the DoTTI framework for developing an online program, the VSC was i) designed and developed using psychological techniques and ii) tested for early iteration using participatory workshops. Results: A total of 23 participants from Bengaluru, India, both lay and clinicians, tested the VSC. The main themes identified were: empowerment for lay people; suitable for locals in a community setting; local services needed; user-friendly focused. Conclusion: This study found that a theory and evidence-based approach as the basis for an online behavioural management skills programme was acceptable to users. A substantive pilot will be conducted to examine whether the VSC is effective in reducing/preventing diabetes complications and how to implement into a community setting across other LMICs and chronic diseases.

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