A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance

Abstract

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the ‘Access’ group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than ‘Watch’ antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.

A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications

“…A narrative review also gives more flexibility and greater coverage of the relevant literature to provide future direction to all key stakeholder groups, similar to our recent paper in South Africa [110]. We are aware though that there are limitations with this approach in terms of rigor.…”

Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications

“…Lastly, there is a need to routinely assess the quality of prescribing antibiotics based on the recently available AWaRe book in line with suggestions for other African countries. 32 , 33 , 142 , 143 For instance, nitrofurantoin (0.3%) was rarely prescribed for patients with UTIs, despite it being highly recommended for the treatment of UTIs in Zambia and as an alternative antibiotic in the AWaRe book. In the first instance, this can include prescribing targets for percentage adherence to current guidance, with these targets regularly monitored and discussed.…”

“…In the first instance, this can include prescribing targets for percentage adherence to current guidance, with these targets regularly monitored and discussed. 142 , 143 …”

Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship

“…The inappropriate prescription of antimicrobials is tied to the prescribers’ lack of knowledge and attitudes towards the rational use of antimicrobials, and physicians can be forced to prescribe antibiotics for conditions like upper respiratory tract infections (URTIs) due to the perceived effectiveness of these drugs, even when the evidence indicates that antibiotics may not be necessary. 56–60 This pressure is noted to be significant in the context of South Africa, among other African countries. 23 , 56 , 61 , 62 Additionally, the inappropriate use of antibiotics has been reported to be due to a lack of: diagnostic tests; poor infection, prevention and control (IPC) practices; insufficient funding; poor vaccine coverage and uptake; illegal drug stores; substandard antibiotics; irresponsible use of laboratory services by clinicians; and a lack of political will.…”

“… 56–60 This pressure is noted to be significant in the context of South Africa, among other African countries. 23 , 56 , 61 , 62 Additionally, the inappropriate use of antibiotics has been reported to be due to a lack of: diagnostic tests; poor infection, prevention and control (IPC) practices; insufficient funding; poor vaccine coverage and uptake; illegal drug stores; substandard antibiotics; irresponsible use of laboratory services by clinicians; and a lack of political will. 31 , 63–65 The most inappropriate use of antibiotics is observed in cases of: URTIs; generally self-limited viral infections; acute diarrhoea; and urinary tract infections.…”