Consumption of antibiotics in a small Pacific island nation: Samoa

Abstract

High levels of antibiotic use contribute to development of antibiotic resistance. There is little known about levels of antibiotic use in Samoa, although anecdotally, there are high levels of use, and a strain of methicillin-resistant Staphylococcus aureus may have developed there. The study aimed to gather basic data on levels of antibiotic use in Samoa.All those who import medicines into Samoa were interviewed; invoices, prescription records in hospitals, pharmacies and health centres were reviewed; and prospective observation was carried out in private pharmacies.Analysis of orders made in one year provided an estimate of overall antibiotic consumption of 37.3 Defined Daily Doses (DDDs) per 1000 inhabitant days. Penicillins comprised 63% of DDDs used. Antibiotics were around a third of all prescribed drugs in hospitals and pharmacies, and 44% of those dispensed in health centres. Approximately two-thirds of prescriptions dispensed included an antibiotic. A quarter of antibiotic sales in pharmacies were without a prescription.Samoa has high rates of use of antibiotics and very high reliance on penicillins, compared to other developing countries. Levels of prescribing are high compared with other developing nations. It is feasible to calculate total consumption of medicines in very small developing nations.

High prescription of antimicrobials in a rural district hospital in India

“…A comparison of our outpatient antibiotic use with western countries is difficult because other studies have utilized DDDs/1000 inhabitants daily to measure outpatient antibiotic consumption 12,13. The proportion of patients with diarrhoea or URTI who received antibiotics was higher than previously reported in other sites 14-16.…”

Understanding and use of antibiotics amongst Samoan people in New Zealand

“…Antibiotics are also available without prescription from pharmacies. 10 The belief that exposure to cold and changes in weather can cause colds may also be common in Western cultures. 16 However, to our knowledge, the belief that dust causes colds and flu has not been reported elsewhere, although it may have been part of medical orthodoxy some time ago.…”

“…9 In Samoa the use of antibiotics is high, and antibiotics are available without prescription from pharmacies. 10 This may affect Samoan people's expectations of treatment and patterns of antibiotic use in New Zealand. One clone of community-acquired methicillin-resistant Staphloccocus aureus has been labelled Western Samoan Phage Pattern (WSPP) MRSA, because its prevalence amongst Samoans and other Pacific Islanders suggests that it may have emerged in Samoa.…”

Methicillin-ResistantStaphylococcus aureus, Samoa, 2007–2008

“…As in many other developing countries ( 27 ), use of antimicrobial drugs is extremely high in Samoa. More than 60% of all prescriptions dispensed in hospitals and private pharmacies include an antimicrobial drug ( 28 ). No current data are available on the prevalence of antimicrobial drug resistance in Samoa.…”