Antibiotic use prior to seeking medical care in patients with persistent fever: a cross-sectional study in four low- and middle-income countries

Ingelbeen, Brecht; Koirala, Kanika Deshpande; Verdonck, Kristien; Barbé, Barbara; Mukendi, Déby; Phe, Thong; Safi, Sayda El; Duffel, Lukas Van; Bottieau, Emmanuel; Sande, Marianne A B van der; Boelaert, Marleen; Chappuis, François; Jacobs, Jan

doi:10.1016/j.cmi.2020.11.003

Cited by 16 publications

(20 citation statements)

References 22 publications

(32 reference statements)

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“…Exposure to carbapenems is a necessary but not sufficient prerequisite. Carbapenems are available in Ghana, but their clinical use seems to be very limited and most likely restricted to very selected patients in private or university hospitals [ 38 ]. The increasing mobility of local people nationally and even internationally for private and/or professional reasons could lead to the acquisition of carbapenem-resistant A. baumannii isolates [ 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Carbapenemase-Producing Acinetobacter baumannii in Wound Infections, Ghana, 2017/2018

et al. 2021

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Three years after a prospective study on wound infections in a rural hospital in Ghana revealed no emergence of carbapenem-resistant bacteria we initiated a new study to assess the prevalence of multidrug-resistant pathogens. Three hundred and one samples of patients with wound infections were analysed for the presence of resistant bacteria in the period August 2017 till March 2018. Carbapenem-resistant Acinetobacter (A.) baumannii were further characterized by resistance gene sequencing, PCR-based bacterial strain typing, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST “Oxford scheme”). A. baumanni was detected in wound infections of 45 patients (15%); 22 isolates were carbapenem-resistant. Carbapenemases NDM-1 and/or OXA-23 were detected in all isolates; two isolates harboured additionally OXA-420. PFGE and MLST analyses confirmed the presence of one A. baumannii strain in 17 patients that was assigned to the worldwide spread sequence type ST231 and carried NDM-1 and OXA-23. Furthermore, two new A. baumannii STs (ST2145 and ST2146) were detected in two and three patients, respectively. Within three years the prevalence of carbapenem-resistant A. baumannii increased dramatically in the hospital. The early detection of multidrug-resistant bacteria and prevention of their further spread are only possible if continuous surveillance and molecular typing will be implemented.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Carbapenemase-Producing Acinetobacter baumannii in Wound Infections, Ghana, 2017/2018

et al. 2021

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“…High and increasing use of Watch antibiotics has been observed in other low-and middleincome settings [21][22][23]. To introduce interventions to optimize antibiotic use, it is important to understand the origin and reasons why Watch antibiotics are used, both at primary health center level and without prescription at community-level.…”

Section: Discussionmentioning

confidence: 99%

Use of WATCH antibiotics prior to presentation to the hospital in rural Burkina Faso

Valia¹,

Ingelbeen

Kaboré³

et al. 2021

Preprint

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Background: In low- and middle-income countries (LMIC), the prevalence of antimicrobial resistance (AMR) is increasing. WHO recommends monitoring antibiotic use, in particular Watch antibiotics, clinical important but at risk of becoming ineffective due to increasing AMR. We investigated antibiotic use at primary care or community-level in rural Burkina Faso. Methods: During 2016-2017, patients aged >3 months admitted with severe acute fever to the rural hospital of Nanoro Health District, Burkina Faso, reported antibiotic use in the two weeks prior to consultation or hospitalization, which we analysed using the WHO Access, Watch, Reserve (AWaRe) classification. Most Watch antibiotics, e.g. ceftriaxone, are not recommended at primary health center level, as is also the case for ciprofloxacin in children. Results: Of 920 participants (63.0% ≤14 years), pre-admission antibiotic use was reported by 363 (39.5%) of whom 58 (16.0%) reported more than one antibiotic. Use was more frequent among health center referrals (231, 54.0%) than among self-referred patients (131, 26.7%, p<0.001). Of 424 antibiotics, 261 (61.6%) were Access and 159 (37.5%) Watch antibiotics. Watch antibiotics use was more frequent among >14 year olds (72, 51.1%) than 0-14 year olds (87, 30.7%) and among referrals (41, 28.1%) compared to self-referred patients (117, 42.2%). Most frequently used Watch antibiotics were ceftriaxone (114, 26.9%) and ciprofloxacin (32, 7.5%). Among antibiotics reported by referral patients, ceftriaxone and ciprofloxacin were respectively recorded 100 (36.1%) and 12 times (4.3%). Conclusion: The frequent use of Watch group antibiotics prior to presentation to the hospital in rural Burkina Faso highlights the need to address primary care, over-the-counter and informal community-level antibiotic use as part of antibiotic stewardship in LMIC, facilitating referral, access to qualified prescribers, or improving diagnostic tools in health centers.

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“…Globally, there were variations, however, the highest prescription and consumption of injectables compared to oral formulations was reported in LMICs including China and India. 14,21,34,37 Parenteral route was most commonly used route of administration which may be because the study was conducted in the in-patient departments to achieve better bioavailability and faster onset of action and recovery, which could reduce the duration of hospital stay. Moreover, inpatient setting, prevailing disease condition, and patient compliance preclude oral antibiotic preparations in a tertiary hospital.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Practice in Chronic Kidney Disease Patients in a Tertiary Care Teaching Hospital: Analysis Based on 2019 WHO AWaRe Classification

Juveriya¹,

Mounika²,

Venkataramana³

et al. 2021

Int J Life Sci Pharm Res

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Chronic kidney disease (CKD) patients are prone to infections and inevitably require antibiotics. Antimicrobial resistance (AMR) is a global threat to humans. Indeed, the most important cause for spread of AMR is irrational use of antibiotics. Therefore, the present study evaluates prescribing practice of antibiotics in CKD patients. A cross-sectional study was carried out in 382 CKD in-patients prescribed with antibiotics. The data were analysed using the WHO prescribing indicators and the WHO Access, Watch, and Reserve (AWaRe) classification. The average number of drugs prescribed per encounter was 3.1. Antibiotics prescribed by generic name and prescribed from the Essential Medicines List were 52.9% and 47.1%, respectively. % Encounters with antibiotics and parenteral antibiotics were 59.2% and 77.4%, respectively. Third generation cephalosporins (76.9%), particularly cefoperazone (40%) and ceftriaxone (21.2%), were the most commonly prescribed antibiotics. A total of 19 specific antibiotics (Access 5, Watch 13, Reserve 1, and Not Recommended 0) were prescribed. According to WHO AWaRe classification, 10.6%, 89%, and 0.4% of antibiotics prescribed were from the ‘Access’, ‘Watch’, ‘Reserve’ categories, respectively. ‘Watch’ category antibiotics, particularly cephalosporins (98%), were prescribed in high rate. The most commonly prescribed ‘Access’ and ‘Watch’ category antibiotics were amikacin (37%) and cefoperazone (44.9%), respectively. Amoxicillin index was 1.6 and ‘Access-to-Watch’ index was 0.1, which were below the priority values. Prescription pattern of antibiotics observed in this study was not fully met the WHO recommendations. Additionally, ‘Watch’ category antibiotics, particularly cephalosporins, were prescribed frequently. Changes in prescription pattern and monitoring of antibiotic use are essential to preserve effectiveness and promote rational use of antibiotics, and to overcome AMR.

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Antibiotic use prior to seeking medical care in patients with persistent fever: a cross-sectional study in four low- and middle-income countries

Cited by 16 publications

References 22 publications

High Prevalence of Carbapenemase-Producing Acinetobacter baumannii in Wound Infections, Ghana, 2017/2018

High Prevalence of Carbapenemase-Producing Acinetobacter baumannii in Wound Infections, Ghana, 2017/2018

Use of WATCH antibiotics prior to presentation to the hospital in rural Burkina Faso

Antibiotic Prescribing Practice in Chronic Kidney Disease Patients in a Tertiary Care Teaching Hospital: Analysis Based on 2019 WHO AWaRe Classification

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