Overuse of antibiotics in maternity and neonatal wards, a descriptive report from public hospitals in Dar es Salaam, Tanzania

Abstract Background Overuse of antibiotics is a major challenge and undermines measures to control drug resistance worldwide. Postnatal women and newborns are at risk of infections and are often prescribed prophylactic antibiotics although there is no evidence to support their universal use in either group. Methods We performed point prevalence surveys in three hospitals in Dar es Salaam, Tanzania, in 2018 to collect descriptive data on antibiotic use and infections, in maternity and neonatal wards. Results Prescribing of antibiotics was high in all three hospitals ranging from 90% (43/48) to 100% (34/34) in women after cesarean section, from 1.4% (1/73) to 63% (30/48) in women after vaginal delivery, and from 89% (76/85) to 100% (77/77) in neonates. The most common reason for prescribing antibiotics was medical prophylaxis in both maternity and neonatal wards. Conclusions We observed substantial overuse of antibiotics in postnatal women and newborns. This calls for urgent antibiotic stewardship programs in Tanzanian hospitals to curb this inappropriate use and limit the spread of antimicrobial resistance.

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Overuse of antibiotics in maternity and neonatal wards, a descriptive report from public hospitals in Dar es Salaam, Tanzania

10.21203/rs.3.rs-200744/v1 ◽

2021 ◽

Author(s):

Mwaka Athuman Kakolwa ◽

Susannah L. Woodd ◽

Alexander M. Aiken ◽

Fatuma Manzi ◽

Giorgia Gon ◽

...

Keyword(s):

Drug Resistance ◽

Antimicrobial Resistance ◽

Antibiotic Use ◽

Dar Es Salaam ◽

Prophylactic Antibiotics ◽

Public Hospitals ◽

Descriptive Data ◽

Inappropriate Use ◽

Control Drug ◽

Postnatal Women

Abstract Background: Overuse of antibiotics is a major challenge and undermines measures to control drug resistance worldwide. Postnatal women and newborns are at risk of infections and are often prescribed prophylactic antibiotics, although there is no evidence to support their universal use in either group. Methods: We performed point prevalence surveys in three hospitals in Dar es Salaam, Tanzania, in 2018 to collect descriptive data on antibiotic use and infections in maternity and neonatal wards. Results: Prescribing of antibiotics was high in all three hospitals ranging from 90% (43/48) to 100% (34/34) in women after cesarean section, from 1.4% (1/73) to 63%(30/48) in women after vaginal delivery, and from 89%(76/85) to 100%(77/77) in neonates. The most common reason for prescribing antibiotics was medical prophylaxis in both maternity and neonatal wards.Conclusion: We observed substantial overuse of antibiotics in postnatal women and newborns.This calls for urgent antibiotic stewardship programs in Tanzanian hospitals to curb the inappropriate use and limit the spread of antimicrobial resistance.

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Educational Video Improves Knowledge about Outpatients’ Usage of Antibiotics in Two Public Hospitals in Indonesia

Antibiotics ◽

10.3390/antibiotics10050606 ◽

2021 ◽

Vol 10 (5) ◽

pp. 606

Author(s):

Fauna Herawati ◽

Rika Yulia ◽

Bustanul Arifin ◽

Ikhwan Frasetyo ◽

Setiasih ◽

...

Keyword(s):

Antibiotic Resistance ◽

General Hospital ◽

Sampling Technique ◽

Knowledge Score ◽

Antibiotic Use ◽

Public Hospitals ◽

Educational Video ◽

Inappropriate Use ◽

Quasi Experimental ◽

The Difference

The inappropriate use or misuse of antibiotics, particularly by outpatients, increases antibiotic resistance. A lack of public knowledge about “Responsible use of antibiotics” and “How to obtain antibiotics” is a major cause of this. This study aimed to assess the effectiveness of an educational video about antibiotics and antibiotic use to increase outpatients’ knowledge shown in two public hospitals in East Java, Indonesia. A quasi-experimental research setting was used with a one-group pre-test—post-test design, carried out from November 2018 to January 2019. The study population consisted of outpatients to whom antibiotics were prescribed. Participants were selected using a purposive sampling technique; 98 outpatients at MZ General Hospital in the S regency and 96 at SG General Hospital in the L regency were included. A questionnaire was used to measure the respondents’ knowledge, and consisted of five domains, i.e., the definition of infections and antibiotics, obtaining the antibiotics, directions for use, storage instructions, and antibiotic resistance. The knowledge test score was the total score of the Guttman scale (a dichotomous “yes” or “no” answer). To determine the significance of the difference in knowledge before and after providing the educational video and in the knowledge score between hospitals, the (paired) Student’s t-test was applied. The educational videos significantly improved outpatients’ knowledge, which increased by 41% in MZ General Hospital, and by 42% in SG General Hospital. It was concluded that an educational video provides a useful method to improve the knowledge of the outpatients regarding antibiotics.

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PROBLEM OF ANTIBIOTIC USE AND ANTIMICROBIAL RESISTANCE IN INDONESIA: ARE WE REALLY MAKING PROGRESS?

Indonesian Journal of Tropical and Infectious Disease ◽

10.20473/ijtid.v4i4.222 ◽

2013 ◽

Vol 4 (4) ◽

pp. 5 ◽

Cited By ~ 7

Author(s):

Usman Hadi ◽

Kuntaman Kuntaman ◽

Mariyatul Qiptiyah ◽

Hari Paraton

Keyword(s):

Antimicrobial Resistance ◽

Antibiotic Use ◽

Teaching Hospitals ◽

Resistant Bacteria ◽

Prevention Study ◽

Antibiotic Resistant ◽

Inappropriate Use ◽

Government Hospitals ◽

Inappropriate Antibiotics ◽

Very High

Background: Based on the results Antimicrobial Resistance in Indonesia: prevalence and prevention-study (AMRIN-study), the Ministry of Health of Indonesia in 2005 began a program antibiotic resistance control (PPRA) in some government hospitals, and is currently developing to all government teaching hospitals in Indonesia. Aim: The core activities of the PPRA are to implement standardized surveillance emergence of antibiotic resistant bacteria, and the surveillance of antibiotic use in terms of quantity and quality. Method: Our research in the years 2003 showed the proportion of antibiotic use 84% of patients in a hospital. The use of inappropriate antibiotics was very high, 42% no indication. Result: In 2012 the results of surveillance showed decline of inappropriate use of antibiotic, but prevalence extended-spectrum b-lactamase (ESBL)-producing K.pneumoniae (58%), and E.coli (52%) andmethicillin-resistant S.aures (MRSA) (24%) were increasing. Conclusion: It was needed to implement the most appropriate programs to prevent the growth and development of bacteria resistant to antibiotics.

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Exploring gender differences in knowledge and practices related to antibiotic use in Southeast Asia: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0259069 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0259069

Author(s):

Phuc Pham-Duc ◽

Kavitha Sriparamananthan

Keyword(s):

Gender Differences ◽

Antimicrobial Resistance ◽

Southeast Asia ◽

Scoping Review ◽

Antibiotic Use ◽

Educational Interventions ◽

Sociodemographic Factors ◽

Targeted Interventions ◽

Inappropriate Use ◽

Males And Females

Inappropriate use of antibiotics has been one of the main contributors to antimicrobial resistance, particularly in Southeast Asia. Different genders are prone to different antibiotic use practices. The objective of this scoping review is to understand the extent and type of evidence available on gender differences in antibiotic use across Southeast Asia. The search strategy for this scoping review involved PubMed, Semantic Scholar, BioMed Central and ProQuest. Two-level screening was applied to identify the final sample of relevant sources. Thematic content analysis was then conducted on the selected final sources to identify recurring themes related to gender differences in antibiotic use and a narrative account was developed based on the themes. Recommendations for next steps regarding reducing inappropriate antibiotic use and gender considerations that need to be made when developing future interventions were also identified. Research on gender and antibiotic use remains scarce. Studies that discuss gender within the context of antibiotic use often mention differences between males and females in knowledge, attitudes and/or behaviour, however, do not explore reasons for these differences. Gender differences in antibiotic use were generally examined in terms of: (i) knowledge of antibiotic use and antimicrobial resistance and (ii) practices related to antibiotic use. Evidence indicated that differences between males and females in knowledge and practices of antibiotic use varied greatly based on setting. This indicates that gender differences in antibiotic use are greatly contextual and intersect with other sociodemographic factors, particularly education and socioeconomic status. Educational interventions that are targeted to meet the specific needs of males and females and delivered through pharmacists and healthcare professionals were the most common recommendations for reducing inappropriate use of antibiotics in the community. Such targeted interventions require further qualitative research on factors influencing differences in knowledge and practices related to antibiotic use among males and females. In addition, there is also a need to strengthen monitoring and regulation practices to ensure accessibility to affordable, quality antibiotics through trusted sources.

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Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University

BMC Medical Education ◽

10.1186/s12909-021-02912-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wuraola Akande-Sholabi ◽

Amen T. Ajamu

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Healthcare Professionals ◽

Antibiotic Use ◽

The Body ◽

Healthcare Students ◽

Inappropriate Use ◽

The Past ◽

Inadequate Knowledge ◽

Nigerian University

Abstract Background Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. Methods Respondents’ knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents’ knowledge. Results Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7–22.96)], had greater knowledge of antimicrobial resistance. Conclusions The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.

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Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.28.1800339 ◽

2019 ◽

Vol 24 (28) ◽

Cited By ~ 3

Author(s):

Fabio D’Atri ◽

Jacqueline Arthur ◽

Hege Salvesen Blix ◽

Lauri A Hicks ◽

Diamantis Plachouras ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Action Plan ◽

Antibiotic Use ◽

The United States ◽

Human Medicine ◽

Antimicrobial Use ◽

Focal Points ◽

Antimicrobial Consumption ◽

Inappropriate Use ◽

And Control

Unnecessary and inappropriate use of antibiotics in human healthcare is a major driver for the development and spread of antimicrobial resistance; many countries are implementing measures to limit the overuse and misuse of antibiotics e.g. through the establishment of antimicrobial use reduction targets. We performed a review of antimicrobial use reduction goals in human medicine in Transatlantic Taskforce on Antimicrobial Resistance partner countries. On 31 March 2017, the European Centre for Disease Prevention and Control sent a questionnaire to National Focal Points for Antimicrobial Consumption and the National Focal Points for Antimicrobial Resistance in 28 European Union countries, Iceland and Norway. The same questionnaire was sent to the TATFAR implementers in Canada and the United States. Thirty of 32 countries replied. Only nine countries indicated that they have established targets to reduce antimicrobial use in humans. Twenty-one countries replied that no target had been established. However, 17 of these 21 countries indicated that work to establish such targets is currently underway, often in the context of developing a national action plan against antimicrobial resistance. The reported targets varied greatly between countries and can be a useful resource for countries willing to engage in the reduction of antibiotic use in humans.

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Impact of European pet antibiotic use on enterococci and staphylococci antimicrobial resistance and human health

Future Microbiology ◽

10.2217/fmb-2020-0119 ◽

2021 ◽

Vol 16 (3) ◽

pp. 185-201

Author(s):

Carla Miranda ◽

Vanessa Silva ◽

Gilberto Igrejas ◽

Patrícia Poeta

Keyword(s):

Public Health ◽

Veterinary Medicine ◽

Antimicrobial Resistance ◽

Family Member ◽

Close Contact ◽

Antibiotic Use ◽

Current Data ◽

Urban Households ◽

Inappropriate Use ◽

European Distribution

Due to the inappropriate use of antibiotics described in both human and veterinary medicine, there is emerging evidence of antimicrobial-resistant organisms isolated from humans and pets, forming a multifaceted problem. Although the true magnitude of antimicrobial resistance in pets and other animals, as well as humans, are not fully known; pets, in particular dogs and cats, can contribute to the spread of antimicrobial resistance due to close contact with humans and their status as a family member in urban households. This review summarizes and highlights the current data concerning the antibiotic use on pets, and the European distribution of the increasing prevalence of multiresistant bacterial pathogens, such as enterococci and methicillin-resistant staphylococci on pets, as well as its implications for public health.

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EVALUASI KUALITATIF PENGGUNAAN ANTIBIOTIK PADA PASIEN ANAK DENGAN METODE GYSSENS DI RSUD KARAWANG

Pharma Xplore : Jurnal Ilmiah Farmasi ◽

10.36805/farmasi.v4i1.620 ◽

2019 ◽

Vol 4 (1) ◽

pp. 297-302

Author(s):

Diany Astuti ◽

Yuli Nurhayati

Keyword(s):

Antimicrobial Resistance ◽

Antibiotic Therapy ◽

Typhoid Fever ◽

Pediatric Patients ◽

Descriptive Analysis ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotics Resistance ◽

Data Sampling ◽

Inappropriate Use

ABSTRAK Peresepan antibiotik untuk pasien anak-anak paling banyak digunakan dalam terapi. Penggunaan Antibiotik untuk anak-anak harus diawasi dan dikendalikan karena penggunaan antibiotik yang tidak terkontrol dan tidak tepat dapat berdampak pada kegagalan efek terapi yang diharapkan dan kemungkinan dapat meyebabkan resistensi antimikroba. Pemakaian antibiotik harus dianalisis untuk mengendalikan resistensi antibiotik. Tujuan penelitian ini untuk menilai rasionalitas terapi antibiotik pada pasien anak. Penelitian ini merupakan analisis deskriptif retrospektif dengan pengambilan data purposive sampling. Subjek dari penelitian adalah rekam medis dari bangsal anak RSUD Karawang. Rasionalitas penggunaan antibiotik adalah penilaian melalui metode gyssens. 147 data dianalisis untuk penelitian ini terdiri dari anak laki-laki (54,40%) dan perempuan (45,60%) dengan kasus demam tifoid (53,10), diare (24,5%) dan bronkopneumonia (22,4%). Antibiotik yang digunakan sefotaksim (71,43%), amoksisilin (5,44%) dan kloramfenikol (4,76%). Penilaian antibiotik melalui metode Gyssens adalah skala IVA (93,20%), skala IIB (6,12%) dan skala IIIA (0,68%). Kata Kunci: Antibiotik, Rasionalitas, Metode Gyssens. ABSTRACT Antibiotics prescription for pediatric patients is most widely used in therapy. Antibiotic use for pediatric must be watched and controlled because uncontrolled and inappropriate use of antibiotic can impact on failure of expected therapeutic effect and can also cause the possibility of antimicrobial resistance. Antibiotic consumption is must analyzed for controlling the antibiotics resistance. The aim of study The aim of this study was to assess the rationality of antibiotic therapy in pediatric patients. This research is a retrospective descriptive analysis with purposive data sampling. Subject of study are medical record from pediatric ward in RSUD Karawang. Rationality used of antibiotic is asses through Gyssens method. 147 data was analyzed for this study consist of boys (54,40%) and girls (45,60%) with case of typhoid fever (53,10), diarrhea (24,5%) and bronchopneumonia (22,4%). Antibiotic was use Cefotaxime (71,43%), Amoxicillin (5,44%), Chloramphenicol (4,76%)etc. Assessment antibiotic through Gyssens method are IVA scale (93,20%), IIB scale ( 6,12%) and IIIA scale (0,68%). Keyword : Antibiotic, Rationality, Gyssens Method.

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Inappropriate use of antibiotics in hospitals: The complex relationship between antibiotic use and antimicrobial resistance

Enfermedades Infecciosas y Microbiología Clínica ◽

10.1016/s0213-005x(13)70126-5 ◽

2013 ◽

Vol 31 ◽

pp. 3-11 ◽

Cited By ~ 31

Author(s):

Rafael Cantón ◽

Juan Pablo Horcajada ◽

Antonio Oliver ◽

Patricia Ruiz Garbajosa ◽

Jordi Vila

Keyword(s):

Antimicrobial Resistance ◽

Antibiotic Use ◽

Complex Relationship ◽

Inappropriate Use

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What are the barriers to implementing national antimicrobial resistance action plans? A novel mixed-methods policy analysis in Pakistan

Health Policy and Planning ◽

10.1093/heapol/czaa065 ◽

2020 ◽

Vol 35 (8) ◽

pp. 973-982

Author(s):

Mishal S Khan ◽

Anna Durrance-Bagale ◽

Ana Mateus ◽

Zia Sultana ◽

Rumina Hasan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Animal Feed ◽

Healthcare Providers ◽

Antibiotic Use ◽

Action Plans ◽

Political Commitment ◽

Middle Income ◽

Policy Actors ◽

Inappropriate Use ◽

Financial Interests

Abstract Despite political commitment to address antimicrobial resistance (AMR), countries are facing challenges to implementing policies to reduce inappropriate use of antibiotics. Critical factors to the success of policy implementation in low- and middle-income countries (LMIC), such as capacity for enforcement, contestation by influential stakeholders and financial interests, have been insufficiently considered. Using Pakistan as a case study representing a populous country with extremely high antibiotic usage, we identified 195 actors who affect policies on antibiotic use in humans and animals through a snowballing process and interviewed 48 of these who were nominated as most influential. We used a novel card game-based methodology to investigate policy actors’ support for implementation of different regulatory approaches addressing actions of frontline healthcare providers and antibiotic producers across the One Health spectrum. We found that there was only widespread support for implementing hard regulations (prohibiting certain actions) against antibiotic suppliers with little power—such as unqualified/informal healthcare providers and animal feed producers—but not to target more powerful groups such as doctors, farmers and pharmaceutical companies. Policy actors had limited knowledge to develop implementation plans to address inappropriate use of antibiotics in animals, even though this was recognized as a critical driver of AMR. Our results indicate that local political and economic dynamics may be more salient to policy actors influencing implementation of AMR national action plans than solutions presented in global guidelines that rely on implementation of hard regulations. This highlights a disconnect between AMR action plans and the local contexts where implementation takes place. Thus if the global strategies to tackle AMR are to become implementable policies in LMIC, they will need greater appreciation of the power dynamics and systemic constraints that relate to many of the strategies proposed.

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