National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda

Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.

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Evaluation of Antibiotic Use in Kazakhstan for the Period 2017–2019 Based on WHO Access, Watch and Reserve Classification (AWaRe 2019)

Antibiotics ◽

10.3390/antibiotics10010058 ◽

2021 ◽

Vol 10 (1) ◽

pp. 58

Author(s):

Gulzira Zhussupova ◽

Dinara Utepova ◽

Galiya Orazova ◽

Saule Zhaldybayeva ◽

Galina Skvirskaya ◽

...

Keyword(s):

Comparative Analysis ◽

World Health Organization ◽

Antibiotic Use ◽

The State ◽

World Health ◽

Defined Daily Dose ◽

Upward Trend ◽

The World ◽

Daily Dose ◽

Health Organization

The purpose of this study is to conduct a comparative analysis of the consumption of antibiotics for systemic use reimbursed by the state in Kazakhstan for 2017–2019 with the Access, Watch, and Reserve classification (AWaRe 2019) of the World Health Organization (WHO). The evaluation of the consumption of antibiotics for systemic use in Kazakhstan for 2017–2019 was carried out using the ATC/DDD methodology in accordance with the WHO AWaRe classification. The study used data on all antibiotics that were centrally purchased by a single purchaser during the study period. To understand how often Access group antibiotics are taken in Kazakhstan, the top-10 most consumed antibiotics were additionally studied. The results of a comparative analysis of the antibiotics for systemic use consumption for 2017–2019 by the Access, Watch, and Reserve groups showed a negative trend of a decrease in the consumption of Access group drugs from 1.17 defined daily dose (DDDs) per 1000 inhabitants per day (DID) (39%) in 2017 to 0.59 DID (30%) in 2019. There is an increase in consumption of Watch group antibiotics from 1.84 DID (61%) in 2017 to 1.37 DID (68%) in 2019, as well as an increase in consumption of Reserve antibiotics from 0.001 DID (0.03%) to 0.4 DID (2.11%). In recent years in Kazakhstan, there has been a decrease in the consumption of Access group antibiotics. In addition, the Watch group antibiotics are widely consumed with a certain upward trend. In 2019, one Reserve antibiotic was included in the top-10 most commonly consumed antibiotics. There is a predominant consumption of parenteral forms of antibiotics for systemic use in the country.

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Quality Evaluation of Ethambutol Hydrochloride Tablet Batches Available in Governmental Health Facilities of Jimma Town, Southwest Ethiopia

Advances in Pharmacological and Pharmaceutical Sciences ◽

10.1155/2021/9969157 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Meseret Yirdaw ◽

Belachew Umeta ◽

Yimer Mokennen

Keyword(s):

World Health Organization ◽

The United States ◽

Health Facilities ◽

World Health ◽

Southwest Ethiopia ◽

Weight Variation ◽

The World ◽

Storage Area ◽

Health Organization ◽

Jimma Town

Background. The availability of poor-quality drugs on the drug market might favor the ineffectiveness of the drug and/antimicrobial resistance. Aim. To evaluate the quality of similar batches of ethambutol hydrochloride tablets available in different governmental health facilities of Jimma town, southwest Ethiopia. Methods. The World Health Organization checklist was used to inspect the storage area of health facilities and check medicines for the sign of counterfeit. The test was conducted as per the United States Pharmacopeia on six similar batches of ethambutol hydrochloride sampled from different governmental health facilities. Data were analyzed using SPSS version 20, and one-way ANOVA was used for comparing the dissolution profile and weight variation of batches. Results. Three health facilities did not comply with the storage area specifications for pharmaceuticals. No batches have shown any sign of counterfeit. All of the tablet batches tested complied with USP specifications for weight variation, percentage purity, and dissolution test. Conclusions and Recommendation. The entire tablet batches complied with the World Health Organization specification for packaging and labelling of pharmaceuticals. All tablet batches complied with the test for weight variation, purity of drug substance, and dissolution. Since some health facilities did not comply with at least one specification for storage of pharmaceuticals, regulatory agencies and stack holders are advised to inspect the health facilities to ensure appropriate storage of pharmaceuticals in health facilities.

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Prevalence of Antibiotics Prescription and Assessment of Prescribed Daily Dose in Outpatients from Mexico City

Antibiotics ◽

10.3390/antibiotics9010038 ◽

2020 ◽

Vol 9 (1) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

Ramiro Sánchez-Huesca ◽

Abel Lerma ◽

Rebeca M.E Guzmán-Saldaña ◽

Claudia Lerma

Keyword(s):

Mexico City ◽

Drug Dose ◽

High Rate ◽

World Health ◽

Defined Daily Dose ◽

Duration Of Treatment ◽

Dose Frequency ◽

Antibiotic Drug ◽

Daily Dose ◽

Health Organization

Pharmacoepidemiological research about antibiotics is supported by the World Health Organization (WHO), but data regarding antibiotic prevalence based on actual prescriptions and dosing patterns are insufficient. The aims were: (i) To estimate the prevalence and prescribed daily dose (PDD) of antibiotics in outpatients from Mexico City and (ii) to compare the PDD against the defined daily dose (DDD), as established by the WHO. The study included 685 prescriptions of antibiotics selected randomly from five geographical zones of Mexico City. Drug, dose, frequency, and duration of treatment were obtained from each prescription. PDD values of each antibiotic drug were calculated as the average of the daily doses. Sub-use and overuse were determined by the ratio PDD/DDD for each prescription. The most prescribed antibiotics to outpatients from Mexico City included six pharmacological groups: quinolones (28%), penicillins (23%), cephalosporins (17%), macrolides (10%), lincosamides (9%), and sulfonamides (4%). Both overuse and sub-use were high (55% and 63%, respectively). In conclusion, most of the antibiotics with a high prevalence of prescription also had a high rate of either sub-use or overuse, with prescribed doses that significantly differ with their corresponding DDD. The dosing variation has important clinical implications since it denotes low prescription control.

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Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India

Indian Journal of Clinical Medicine ◽

10.1177/1177393617703343 ◽

2017 ◽

Vol 8 ◽

pp. 117739361770334 ◽

Cited By ~ 1

Author(s):

Sandeep Lahiry ◽

Avijit Kundu ◽

Ayan Mukherjee ◽

Shouvik Choudhury ◽

Rajasree Sinha

Keyword(s):

World Health Organization ◽

Drug Utilization ◽

West Bengal ◽

Anatomical Therapeutic Chemical ◽

World Health ◽

Defined Daily Dose ◽

Prescription Data ◽

Daily Dose ◽

Health Organization

Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class ( P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.

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Gambaran Penggunaan Antibiotik di Bangsal Penyakit Dalam RSUD Bangil Kabupaten Pasuruan

JPSCR Journal of Pharmaceutical Science and Clinical Research ◽

10.20961/jpscr.v5i1.35254 ◽

2020 ◽

Vol 5 (1) ◽

pp. 12

Author(s):

Sinta Rachmawati ◽

Rizki Laili Fazeri ◽

Ika Norcahyanti

Keyword(s):

World Health Organization ◽

Anatomical Therapeutic Chemical ◽

World Health ◽

Defined Daily Dose ◽

Daily Dose ◽

Health Organization

Penggunaan antibiotik yang tidak tepat akan berdampak terhadap terjadinya resistansi. Oleh karena itu, studi penggunaan antibiotik perlu dilakukan di fasilitas pelayanan kesehatan, termasuk rumah sakit. Penelitian ini bertujuan untuk mengetahui gambaran penggunaan antibiotik di bangsal penyakit dalam Rumah Sakit Umum Daerah (RSUD) Bangil Kabupaten Pasuruan dengan menggunakan metode Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD). ATC/DDD adalah metode perhitungan penggunaan antibiotik secara kuantitatif yang direkomendasikan oleh World Health Organization (WHO). Pengambilan data dilakukan secara retrospektif menggunakan sumber data excel berupa rekapitulasi rekam medik. Populasi pada penelitian ini adalah seluruh pasien rawat inap dewasa di bangsal penyakit dalam sepanjang tahun 2017. Sejumlah 973 data dari keseluruhan populasi memenuhi kriteria inklusi. Analisis data dilakukan berdasarkan pada karakteristik pasien, profil antibiotik dan perhitungan kuantitatif dengan metode ATC/DDD. Hasil penelitian menunjukkan bahwa golongan antibiotik yang paling banyak digunakan adalah golongan sefalosporin sebesar 51,41%, sedangkan jenis antibiotik yang paling banyak diresepkan yaitu ceftriaxone dengan jumlah sebesar 25,86%. DDD/100 patient-days tertingi adalah ceftriaxone dengan nilai 27,79 DDD/100 patient-days. Perlu dilakukan penelitian lanjutan dengan menggunakan metode Gyssens untuk mengetahui rasionalitas penggunaan antibiotik.

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Assigning Defined Daily/Course Doses for Antimicrobials in Turkeys to Enable a Cross-Country Quantification and Comparison of Antimicrobial Use

Antibiotics ◽

10.3390/antibiotics10080971 ◽

2021 ◽

Vol 10 (8) ◽

pp. 971

Author(s):

Philip Joosten ◽

Steven Sarrazin ◽

Claire Chauvin ◽

Gabriel Moyano ◽

Katharina Wadepohl ◽

...

Keyword(s):

Standard Dose ◽

World Health ◽

Production Cycle ◽

Antimicrobial Use ◽

Defined Daily Dose ◽

Daily Dose ◽

Cross Country ◽

Health Organization ◽

Antimicrobial Treatments ◽

Huge Variation

Antimicrobial resistance (AMR) threatens our public health and is mainly driven by antimicrobial usage (AMU). For this reason the World Health Organization calls for detailed monitoring of AMU over all animal sectors involved. Therefore, we aimed to quantify AMU on turkey farms. First, turkey-specific Defined Daily Dose (DDDturkey) was determined. These were compared to the broiler alternative from the European Surveillance of Veterinary Antimicrobial Consumption (DDDvet), that mention DDDvet as a proxy for other poultry species. DDDturkey ranged from being 81.5% smaller to 48.5% larger compared to its DDDvet alternative for broilers. Second, antimicrobial treatments were registered on 60 turkey farms divided over France, Germany and Spain between 2014 and 2016 (20 flocks per country). Afterwards, AMU was quantified using treatment incidence (TI) per 100 days. TI expresses the percentage of the rearing period that the turkeys were treated with a standard dose of antimicrobials. Minimum, median and maximum TI at flock level and based on DDDturkey = 0.0, 10.0 and 65.7, respectively. Yet, a huge variation in amounts of antimicrobials used at flock level was observed, both within and between countries. Seven farms (12%) did not use any antimicrobials. Aminopenicillins, polymyxins, and fluoroquinolones were responsible for 72.2% of total AMU. The proportion of treating farms peaked on week five of the production cycle (41.7%), and 79.4% of the total AMU was administered in the first half of production. To conclude, not all DDDvet values for broilers can be applied to turkeys. Additionally, the results of AMU show potential for reducing and improving AMU on turkey farms, especially concerning the usage of critically important antimicrobials.

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The Use of the World Health Organisation Anatomical Therapeutic Chemical/Defined Daily Dose Methodology in Canada

Drug Information Journal ◽

10.1177/009286150403800104 ◽

2004 ◽

Vol 38 (1) ◽

pp. 15-27 ◽

Cited By ~ 26

Author(s):

Ingrid S. Sketris ◽

Colleen J. Metge ◽

Jennifer L. Ross ◽

Mary E. MacCara ◽

Danna G. Comeau ◽

...

Keyword(s):

Anatomical Therapeutic Chemical ◽

World Health Organisation ◽

World Health ◽

Defined Daily Dose ◽

The World ◽

Daily Dose

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Utilization Trends of Antiviral and Antifungal Agents for Human Systemic Use in Tanzania From 2010 to 2017 Using the World Health Organization Collaborating Centre for Drug Statistics Methodology

Frontiers in Tropical Diseases ◽

10.3389/fitd.2021.723991 ◽

2021 ◽

Vol 2 ◽

Author(s):

Hafidh Hamim ◽

Raphael Z. Sangeda ◽

Maganga Bundala ◽

Sonia Mkumbwa ◽

Adonis Bitegeko ◽

...

Keyword(s):

World Health Organization ◽

Antifungal Agents ◽

Hiv Infections ◽

World Health ◽

P Value ◽

National Bureau ◽

Defined Daily Dose ◽

The World ◽

Drug Statistics ◽

Health Organization

IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.

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Evaluation of drug prescription pattern using World Health Organization prescribing indicators in public health facilities found in Ethiopia: systematic reviews and meta-analysis

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-021-00313-y ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Bereket Bahiru Tefera ◽

Melese Getachew ◽

Bekalu Kebede

Keyword(s):

Public Health ◽

Drug Use ◽

World Health Organization ◽

Drug Prescription ◽

Health Facilities ◽

World Health ◽

Prescribing Indicators ◽

Public Health Facilities ◽

The World ◽

Health Organization

Abstract Background Drug use evaluation is a structured, methodological, and criteria-based drug assessment system that helps to evaluate the actual trend of drug use in a particular setting. If drug prescription practices are inappropriate, need to examine the patterns of drug use is necessary to change prescribing patterns accordingly. Therefore, this review aimed to determine the drug prescription pattern in public health facilities found in Ethiopia using prescribing indicators developed by the World Health Organization. Methods This review was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Extensive searching to identify articles was conducted in PubMed, Medline, Web of Science, Research Gate, Africa Journal of Online, and Google scholar. Finally, 10 eligible articles were selected for analysis based on inclusion and exclusion criteria. The median value, as well as the 25th and 75th percentiles for each WHO prescribing indicator, were computed. Result The pooled median value of WHO prescribing indicators was reported as follows: the average number of drugs prescribed per encounter = 2.14 (IQR 1.79–2.52), the percentage of encounters with antibiotics prescribed = 43.46% (IQR 30.01–58.67), the percentage of encounters with an injection prescribed = 13.20% (6.47–40.7), percentage of drugs prescribed by generic name = 93.49% (89.13–97.96), and the percentage of medicines prescribed from essential medicines list = 92.54% (85.10–97.7). The forest plots determined for each prescribing indicator indicated that there is a high degree of heterogeneity across articles. Conclusion All of the prescribing indicators were not consistent with the standard values recommended by the World Health Organization. Therefore, public health facilities should take appropriate measures for improving the prescription patterns as per the recommendation set by the World Health Organization.

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Antibiotic use in Albania between 2011 and 2012

The Journal of Infection in Developing Countries ◽

10.3855/jidc.5375 ◽

2015 ◽

Vol 9 (01) ◽

pp. 094-098 ◽

Cited By ~ 4

Author(s):

Iris Hoxha ◽

Admir Malaj ◽

Ledjan Malaj

Keyword(s):

Antibiotic Use ◽

World Health ◽

Measurement Unit ◽

Defined Daily Dose ◽

Anatomic Therapeutic Chemical ◽

Daily Dose ◽

Health Institutions ◽

Health Organization ◽

Official Data

Introduction: Health institutions in Albania have recently reported an increase in antibiotic misuse and microbial resistance. Until now, there have been no comprehensive studies that analyzed the overall use of antibiotics in Albania. The aim of this study was to analyze the overall antibiotic use in Albania between 2011 and 2012, using standardized methodology of measurement, based on World Health Organization guidelines. Methodology: Data from 2011 and 2012 on antibiotic use from ambulatory and hospital sector were examined. Antibiotics were divided based on anatomic therapeutic chemical classification. Defined daily dose (DDD) for each drug was assigned, and DDD per 1,000 inhabitants per day (DID) was used as a measurement unit. In cases of antibiotic combinations for which DDD were not available, unit doses were assigned. Results: In 2011–2012, total antibiotic use decreased from 24.25 to 20.66 DID. Penicillin’s were the most used antibiotic class, with 10.62 DID (2011) and 10.51 DID (2012). Tetracycline use decreased from 5.45 DID (2011) to 0.98 DID (2012). Macrolides increased from 1.36 to 1.88 DID, quinolones from 1.72 to 2.51 DID. The overall antibiotic use was significantly higher than the reimbursed antibiotic use – 3.17 DID (2011) and 2.79 DID (2012) – based on the official data for the same period. Conclusions: This study enables policymakers to further analyze the quality of antibiotic prescriptions and draw comparisons to other countries. The analyzed data suggest there are different factors influencing out-of-pocket use of antibiotics and wrongly prescribed antibiotics. Further studies are necessary to evaluate these factors.

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