Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Hsia, Yingfen; Sharland, Mike; Jackson, Charlotte; Wong, Ian C. K.; Magrini, Nicola; Bielicki, Julia

doi:10.1016/s1473-3099(18)30547-4

Cited by 178 publications

(181 citation statements)

References 55 publications

(73 reference statements)

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“…Regular monitoring of prescribing activities for patients with URTIs in ambulatory care using both quantitative and qualitative research methods -helped by IT systems and mobile technologies. This can include accountability systems for prescribers where they have to justify the need for an antibiotic for patients with URTIs as well as the antibiotic selected (building on restrictions for certain antibiotics in a number of countries as well as the WHO Access, Watch, Reserve -AwaRe -antibiotic groupings 40,71,387,388 ).…”

Section: Discussionmentioning

confidence: 99%

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

124

170

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Section: Discussionmentioning

confidence: 99%

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

124

170

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“…Some studies have used pharmaceutical sales data, which reflect the antibiotic consumption of whole countries rather than individuals or communities. 5,30,31 Nevertheless, despite the different data sources used, the proportion of prescribed antibiotics that were access antibiotics was broadly similar across paediatric studies. One international study found that 76.0% of all antibiotics used were access antibiotics (compared with 72.4% in our study) and 30.7% were amoxicillin (compared with 33.9% in our study).…”

Section: Researchmentioning

confidence: 99%

Measuring antibiotic availability and use in 20 low- and middle-income countries

Knowles

Sharland

Hsia

et al. 2020

Bull. World Health Organ.

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Objective To assess antibiotic availability and use in health facilities in low-and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low-and middleincome countries. Many access antibiotics were unavailable in a majority of most health-care facilities.

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“…Like many LMIC settings, ensuring appropriate access to antibiotics, while also avoiding excess use, is a major challenge in this context [60][61][62]. Bangladesh has a high degree of antibiotic resistance, posing a global and regional threat, due to misuse of antibiotics in healthcare and agricultural sectors [63].…”

Section: Plos Onementioning

confidence: 99%

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

Applegate

Ahmed²,

Harrison

et al. 2020

PLoS ONE

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Background Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0-59 days) using simplified antibiotic regimens when compliance with hospital referral is not feasible. Bangladesh was one of the first countries to adopt WHO's guidelines for implementation. We report results of an implementation research study that assessed facility readiness and provider performance in three rural sub-districts of Bangladesh during August 2015-August 2016. Methods This study took place in 19 primary health centers. Facility readiness was assessed using checklists completed by study staff at three time points. To assess provider performance, we extracted data for all infection cases from facility registers and compared providers' diagnosis and treatment against the guidelines. We plotted classification and dosage errors across the study period and superimposed a locally weighted smoothed (LOWESS) curve to analyze changes in performance over time. Focus group discussions (N = 2) and in-depth interviews (N = 28) with providers were conducted to identify barriers and facilitators for facility readiness and provider performance. Results At baseline, none of the facilities had adequate supply of antibiotics. During the 10-month period, 606 sick infants with signs of infection presented at the study facilities. Classification

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Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries

Cited by 178 publications

References 55 publications

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Measuring antibiotic availability and use in 20 low- and middle-income countries

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

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