Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia

Abstract

Introduction: The rapid spread of drug resistance is forcing standard treatment guidelines (STGs) to become more appropriate with due consideration of the evidence on the antimicrobial resistance (AMR) situation in Ethiopia. Therefore, we aimed to assess the local AMR recommendations in the STGs for empirical antibacterial prescriptions for the five common infectious syndromes. We also determined the quality of AMR reviews conducted in the country. Methods: We conducted a review of the STGs used in the health centers, general hospitals, Digital Features To view digital features for this article go to

Antimicrobial Resistance Among Uropathogens: Surveillance Report From South India

“…In a study from the United States in 2017 across both community and hospital E. coli isolates, AMR prevalence was very low, with maximum resistance observed for cotrimoxazole (32%), while carbapenems had 100 percent sensitivity (Table 5 ) [ 25 ]. Our analysis shows that the prevalence of AMR is alarmingly high in the developing countries as compared to developed nations in concurrence with other authors [ 8 , 10 ].…”

“…This factor has not been considered in antimicrobial surveillance protocols to a large extent till now. Evidence supports that empirical treatment guidelines based on local bacterial spectrum and AMR surveillance provide the best clinical results and also prevent the emergence of resistant strains [ 8 ]. Thus, AMR surveillance forms the link between testing and treatment guidelines, which are often provided by different kinds of agencies.…”

“…World Health Organization's global plan of action on AMR has stressed AMR surveillance across nations as an important strategy for reducing AMR [ 9 ]. Also, it has been shown that the emergence of AMR is proportionately more in the low- and middle-income countries [ 8 , 10 ]. This warrants continuous reporting and surveillance of the emergence of AMR among the uropathogens across regions and nations.…”

Magnitude and antimicrobial susceptibility profiles of Gram-Negative bacterial isolates among patients suspected of urinary tract infections in Arba Minch General Hospital, southern Ethiopia

“…Of the 131 Gram-negative uropathogenic isolates, 14% (17) were resistant to either imipenem or meropenem. Of them, 29.4% (5/17) were imipenem resistant, whereas the remaining 70.6% (12/17) were meropenem resistant.…”

“…Apart from the empirical use of antimicrobials in clinical settings in Ethiopia, the absence of strict regulations in sales is also a driving factor related to the access and misuse of antimicrobials in both urban and rural parts of the country [16]. Another vexing problem is that local antimicrobial resistance recommendations for the empirical prescription of antibacterial for UTIs were not considered at all in formulating the standard treatment guidelines [17]. This leads to poor diagnosis and irrational usage of antibiotics causing the emergence and worsening the spread of multidrug-resistant bacteria.…”