Surveillance of antibiotic use in the private sector in Namibia using sales and claims data

Introduction: Antibiotics are among the most commonly used therapeutic agents for humans globally, and their use has been associated with the development of resistance. The objective of this study was to identify sources for quantifying antibiotic usage patterns and to assess such use in ambulatory patients in the private health sector of Namibia. Methodology: A retrospective analysis of prescription claims data and sales data for the period 2008 to 2011 was conducted. Antibiotic use was expressed in the number of antibiotic-containing prescriptions and volume of units sold and then standardized using defined daily dose per 1,000 inhabitants per day. Results: Antibiotic usage was highest in females (53%), in people 18–45 years of age (41%), and in Windhoek (34%). Overall, wholesale data showed higher antibiotic use than prescription claims data. However, both sources showed similar patterns of antibiotic use. Penicillins were the most used pharmacological group, with amoxicillin/clavulanic acid combination being the most used of the agents. Conclusion: Antibiotic use in the private sector of Namibia is comparable to that of high-consuming European countries such as Italy. A trend observed in this study was the decrease in the use of narrow-spectrum antibiotics in favour of broad-spectrum and newer antibiotics. Since this was the first study to assess antibiotic use in the private sector of Namibia, it could serve as a starting point for continued monitoring of antibiotic use in the whole of Namibia in the context of the World Health Organization’s Global Action Plan to contain antibiotic resistance.

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Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

BMJ Open ◽

10.1136/bmjopen-2019-030823 ◽

2020 ◽

Vol 10 (3) ◽

pp. e030823 ◽

Cited By ~ 1

Author(s):

Jesse Gitaka ◽

Moses Kamita ◽

Dominic Mureithi ◽

Davies Ndegwa ◽

Moses Masika ◽

...

Keyword(s):

Implementation Science ◽

Health Sector ◽

Antibiotic Use ◽

Economic Benefits ◽

Antibiotic Usage ◽

Sub Saharan Africa ◽

Local Context ◽

National Commission ◽

Middle Income ◽

Science Approach

IntroductionAntimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.Methods and analysisThe study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.Ethics and disseminationApprovals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.

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Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Science Advances ◽

10.1126/sciadv.aau9124 ◽

2019 ◽

Vol 5 (3) ◽

pp. eaau9124 ◽

Cited By ~ 83

Author(s):

Katariina M. M. Pärnänen ◽

Carlos Narciso-da-Rocha ◽

David Kneis ◽

Thomas U. Berendonk ◽

Damiano Cacace ◽

...

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plants ◽

Action Plan ◽

Quantitative Polymerase Chain Reaction ◽

Antibiotic Use ◽

Control Measures ◽

World Health ◽

Global Action ◽

Health Organization

Integrated antibiotic resistance (AR) surveillance is one of the objectives of the World Health Organization global action plan on antimicrobial resistance. Urban wastewater treatment plants (UWTPs) are among the most important receptors and sources of environmental AR. On the basis of the consistent observation of an increasing north-to-south clinical AR prevalence in Europe, this study compared the influent and final effluent of 12 UWTPs located in seven countries (Portugal, Spain, Ireland, Cyprus, Germany, Finland, and Norway). Using highly parallel quantitative polymerase chain reaction, we analyzed 229 resistance genes and 25 mobile genetic elements. This first trans-Europe surveillance showed that UWTP AR profiles mirror the AR gradient observed in clinics. Antibiotic use, environmental temperature, and UWTP size were important factors related with resistance persistence and spread in the environment. These results highlight the need to implement regular surveillance and control measures, which may need to be appropriate for the geographic regions.

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Antimicrobial resistance surveillance in the South African private sector report for 2016

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v33i4.160 ◽

2018 ◽

Vol 33 (4) ◽

pp. 114-117

Author(s):

Olga Perovic ◽

Husna Ismail ◽

Erika Van Schalkwyk ◽

Warren Lowman ◽

Elizabeth Prentice ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Private Sector ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Action Plan ◽

Treatment Resistance ◽

Antimicrobial Susceptibility Testing ◽

World Health ◽

Global Action ◽

High Level

Aim: The relevance of surveillance for antimicrobial resistance is increasingly recognised in the light of a global action plan to combat resistance. This report presents antimicrobial susceptibility testing on ESKAPE pathogens from private sector laboratories in South Africa for 2016.Methods: Antimicrobial susceptibility testing (AST) performed on ESKAPE organisms (Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae and Escherichia coli) isolated from blood cultures at four private pathology laboratories in 2016 were analysed. Analysis and reporting of data were done via a uniform platform created by the NICD for national AST data.Results: AST were reported on 9 029 ESKAPE organisms including 58% Enterobacteriaceae, 28% Gram-positive bacteria and 14% Gram-negative bacteria and drug-bug combination was performed following the Global Antimicrobial Surveillance System (GLASS) guidelines by the World Health Organization.Conclusions: The most important resistance to address is a high level of ESBL in Enterobacteriaceae, which necessitates the use of carbapenems for treatment. Resistance to carbapenems is recorded in this report but not confirmation of genes by genotypic methods. During this period, no increase in vancomycin-resistant Enterococci was observed.

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Antibiotic use on paediatric inpatients in a public hospital in Bangil, Indonesia

Pharmacy Education ◽

10.46542/pe/2021.212.163167 ◽

2021 ◽

pp. 163-167

Author(s):

Ika Norcahyanti ◽

Malikatur Rosyidah ◽

Abdul Kadir Jaelani ◽

Antonius N.W. Pratama

Keyword(s):

Public Hospital ◽

Anatomical Therapeutic Chemical ◽

Action Plan ◽

Antibiotic Use ◽

Defined Daily Dose ◽

Cross Sectional ◽

Pediatric Ward ◽

Global Action ◽

Bed Days ◽

Cross Sectional Design

Introduction: The importance of antibiotic use in a clinical setting was evaluated in order to support the global action plan to decelerate the spreading speed of antimicrobial resistance. Objective: This study aimed to evaluate antibiotic use among pediatric inpatients in Bangil public hospital, East Java, Indonesia. Methods: This study used a cross-sectional design. The data were obtained from medical records of pediatric patients admitted to a pediatric ward in 2017. Data were analysed using the anatomical therapeutic chemical classification system (ATC)/defined daily dose (DDD) method in conjunction with data sources from a locally developed bacterial map. Results: The results showed the paediatric patients were dominantly male (n=218; 54.2%) and mostly diagnosed with diarrhoea (n=87; 15.3%). Ampicillin-sulbactam was the most commonly used antibiotic (16.3%). The total DDD value was 66.1 DDD/100 bed-days, and ceftriaxone demonstrated the highest DDD value (10.3 DDD/100 bed-days). Conclusion: In conclusion, the use of antibiotics in the pediatric ward in Bangil public hospital was comparable to other studies conducted in Indonesia.

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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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Antibiotic Consumption and Knowledge of Antimicrobial Resistance: Online Survey

10.20944/preprints202005.0362.v1 ◽

2020 ◽

Author(s):

Nurul Shaheera Shahpawee ◽

Li Ling Chaw ◽

Siti Hanna Muharram ◽

Poh Hui Goh ◽

Zahid Hussain ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Internal Consistency ◽

Online Survey ◽

Public Awareness ◽

Antibiotic Use ◽

Antibiotic Usage ◽

The Body ◽

World Health ◽

Brunei Darussalam

Background: Public misconception and demand for the indication of antibiotics could lead to inappropriate prescribing and consumption. Successful treatment can only be achieved when the public and industrial users have knowledge on antibiotic use and resistance. This survey is aimed to assess antibiotic usage and knowledge regarding antibiotics and antimicrobial resistance (AMR) among undergraduate students of Universiti Brunei Darussalam (UBD), public university located in Brunei Darussalam. Methods: A cross-sectional study was performed using a self-administered questionnaire. The questionnaire was adapted from the World Health Organization (WHO) Antibiotic Resistance, Multi-country public awareness survey distributed online. Students at UBD were invited to participate in the online survey through internal email. The questionnaire consisted of 5 sections: demographic information, antibiotic usage, knowledge on antibiotics, antibiotic resistance (AMR) and use of antibiotics in agriculture. Data were analyzed descriptively and appropriate inferential statistics was used accordingly. Cronbach’s alpha was also done to determine the internal consistency. The section on antibiotic use and knowledge showed good internal consistency of Cronbach’s alpha 0.66 and 0.86 respectively. Research ethics approval was obtained from the PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam (UBD). Results: A total of 145 students returned the complete questionnaire. The result of the study found that 50% of the students had good level of knowledge of antibiotic and antimicrobial resistance with a mean total knowledge score of 11.4 out of 14. Respondents reported the use of antibiotic in the past (69%). Many of the students could identify the use of antibiotics for the treatment of bacterial infection. However, there were also students who incorrectly thought that antibiotics can be used for cold and flu (43%) and fever (41%). Moreover, 76% of the respondents mistakenly believed that antibiotic resistance is the result of the body becoming resistant to antibiotics. Only 12% of the respondents were found to have poor knowledge in the study. Conclusions: Misconceptions in regards to the use of antibiotics for conditions related to viral illnesses was noticed among the respondents in our study. Thus, improving knowledge on antibiotics is crucial to address those beliefs.

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Study on antibiotic use among geriatric patients based on anatomical therapeutic classification or defined daily dose methodology and world health organization-essential medicine list access, watch and reserve concept in tertiary care hospital of South India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202950 ◽

2020 ◽

Vol 9 (7) ◽

pp. 1106

Author(s):

Subash Senthilkumar ◽

Arun Raaj S. A. ◽

Padmavathi K. ◽

Dhanapal C. K. ◽

Periasamy K.

Keyword(s):

Geriatric Patients ◽

Tertiary Care ◽

Essential Medicine ◽

Antibiotic Use ◽

Essential Medicines ◽

World Health ◽

Defined Daily Dose ◽

Care Hospital ◽

Daily Dose ◽

Tract Infections

Background: Geriatric patients are more vulnerable to infections and need special consideration on antibiotic use. Resistance to antibiotics among infectious bacteria has developed within a short span. There is a direct correlation between the consumption of antibiotics and the development of resistance. And surprisingly very few literatures were available on antibiotic consumption in geriatric population using defined daily dose (DDD) concept which paved the idea to conduct this study.Methods: A prospective observational study was carried out from November 2018 to April 2019. A total of 206 prescriptions of elderly patients were included in the study. The antibiotics were categorized by anatomical therapeutic classification (ATC) and DDD indicator/1000 inhabitants/day (DID) was used to figure out antibiotic consumption.Results: About 25.2% of patients were treated with antibiotics for respiratory tract infections. The patients received antibiotics empirically (53.8%) and without bacteriological investigation (58.73%). The overall consumption of antibiotics was 20.47 DID in which oral antibiotics was (8.5 DID) 42% and parenteral antibiotics (11.8 DID) 58%. Cephalosporins was observed to be the most consumed antibiotics (33.2%), specifically cefotaxime (14.6%) and ceftriaxone (12.6%). Moreover, 54.4% of antibiotics consumed from watch category of World Health Organisation (WHO) essential medicines list (EML) which was completely against WHO standard proportion.Conclusions: Higher consumption of cephalosporins, which falls into watch category was analysed in geriatric patients. These broad-spectrum antibiotics have high potential to develop antimicrobial resistance. A strict antibiotic policy is needed to be framed that enhance rational prescribing practices in geriatrics.

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Analysis of Antibiotics on Patients Surgery, before and after Used Guidelines for Antibiotics (PPAB)

Jurnal Pharmascience ◽

10.20527/jps.v7i1.8074 ◽

2020 ◽

Vol 7 (1) ◽

pp. 51

Author(s):

Lisa Narulita ◽

Riefkah Bilal ◽

Mohammad Akram ◽

Suharjono Suharjono

Keyword(s):

Antibiotic Use ◽

Wilcoxon Test ◽

World Health ◽

Positive Sign ◽

Sign Test ◽

Defined Daily Dose ◽

Drug Resistant ◽

Cross Sectional ◽

Daily Dose ◽

Before And After

ABSTRAK Sejak tahun 2011 World Health Organisasi (WHO) dan Komite Pengedalian Resisten Antimikroba (KPRA) sejak 2015, untuk menetapkan kebijakan penggunaan antibiotik dengan menyusun formularium dan Pedoman Penggunaan Antibiotik (PPAB). Penggunaan antibiotik berlebihan berkontribusi pada resistensi maka penelitian ini bertujuan, menganalisis besarnya perbedaan penggunaan antibiotik pada pasien rawat inap bedah sebelum digunakan PPAB (Periode Mei 2018) dan setelah digunakan PPAB (Periode Mei 2019) dengan ATC / DDD (Defined Daily Dose). Jenis dan rancangan penelitian adalah deskriptif cross-sectional dengan data retrospektif. Data yang diambil meliputi peresepan antibiotik di ruang bedah. Data dianalisis dengan uji tanda (sign test) dan uji wilcoxon dengan hasil sign test yang bertanda negatif sebanyak 9 dan bertanda positif sebanyak 2 dan uji wilcoxon menyatakan Sig.(2-tailed 0,062) (α=0,05) artinya penggunaan antibiotik sebelum dan setelah digunakan PPAB tidak berbeda atau sama berdasarkan statistik. Tetapi dari persentasi penggunaan antibiotik terdapat 9 antibiotik yang penggunaannya menurun setelah digunakan PPAB seperti sefoperason 50%, seftriaxon 52%, sefuroxime 87%, sepirom 90%, siproflosasin 17%, gentamisin 99%, levofloxasin 60%, metronidazol 79% dan moxifloksasin 86%. Disimpulkan PPAB perlu ditingkatkan dalam penggunaan antibiotik di RSUD dr.H.Slamet Martodirdjo dan penggunaa seftriakson dapat meningkatkan multi drug resistant. Dengan demikian perlu adanya evaluasi dan monitoring dalam menerapkan PPAB. Kata kunci: ATC/DDD; Pasien Bedah; PPAB ABSTRACT Since 2011 the World Health Organization (WHO) and the National Antimicrobial Resistant Control Committee (KPRA) in indonesia since 2015, to establish antibiotic use policies by developing formularies and Antibiotic Use Guidelines (PPAB). Excessive use of antibiotics contributing to resistance, this study aims, analyzing the magnitude of differences in antibiotic use patients surgery before PPAB (May 2018 period) and after PPAB (May 2019 period) with ATC / DDD (Defined Daily Dose). Type and design of the study is descriptive cross-sectional with retrospective. Data taken included prescribing antibiotics. Data were analyzed by sign test and Wilcoxon test with 9 negative sign and 2 positive sign results and Wilcoxon test stated Sig. (2-tailed 0.062)> (α = 0.05), meaning that use of antibiotics before and after PPAB is not different or the same based on statistics. But from the percentage of antibiotic 9 decreased after PPAB, such as cefoperazone 50%, cefriaxone 52%, cefuroxime 87%, cefpirome 90%, ciprofloxacin 17%, gentamicin 99%, levofloxacin 60%, metronidazole 79% and moxifloxacin 86%. Concluded that PPAB needs to be improved in the use of antibiotics in RSUD dr.H. Islamet Martodirdjo and the use of ceftriaxone can increase multi drug resistant. Thus the need for evaluation and monitoring in implementing PPAB. Keywords: ATC/DDD; Surgical Patients; PPAB

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Optimising the use of antimicrobial medicines in Sudan

Journal of Pharmaceutical Research ◽

10.33140/jpr.06.01.01 ◽

2021 ◽

Vol 6 (1) ◽

Keyword(s):

Antimicrobial Resistance ◽

Quality Management System ◽

Action Plan ◽

Animal Health ◽

Antibiotic Use ◽

World Health ◽

Monitoring And Control ◽

Public And Private ◽

Existing Structures ◽

The Government

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

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Analysis of Antibiotic Use Patterns and Trends Based on Procurement Data of Healthcare Institutions in Shaanxi Province, Western China, 2015–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207536 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7536

Author(s):

Sen Xu ◽

Shengfang Yuan ◽

John Alimamy Kabba ◽

Chen Chen ◽

Wenchen Liu ◽

...

Keyword(s):

Quality Indicators ◽

Anatomical Therapeutic Chemical ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Shaanxi Province ◽

Western China ◽

World Health ◽

Fourth Generation ◽

Defined Daily Dose ◽

Antibiotic Utilization

Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization’s “Access, Watch and Reserve” (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.

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