High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries

Bortone, Barbara; Jackson, Charlotte; Hsia, Yingfen; Bielicki, Julia; Magrini, Nicola; Sharland, Mike

doi:10.1371/journal.pone.0241899

Cited by 32 publications

(36 citation statements)

References 22 publications

(37 reference statements)

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“…Ampicillin-cloxacillin is listed as “not recommended” in the WHO AWaRe antibiotic classification database. It is considered as an inappropriate fixed-dose combination and is a problem not only in Uganda but in many low- and middle-income countries [ 64 , 65 ]. Ampicillin-cloxacillin was removed from the 2016 Uganda Clinical Guidelines.…”

Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

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Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

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Section: Discussionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

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“…These disparities are partly due to existing healthcare and diagnostic facilities, affordability, and antibiotic availability in those countries. 40,41]. Importantly, antibiotic FDCs has been reported about the lack of proven efficacy, increasing toxicity, potential for developing AMR.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known fact that India is a global paradise of pharmaceuticals and has the highest numbers of FDC antibiotics[40,41]. Conversely, FDC use is potentially inappropriate and majority of the FDC antibiotics were not approved by either US FDA or WHO EML[18,…”

mentioning

confidence: 99%

Antibiotic Prescribing Practices in Primary Care Settings Using 2019 WHO AWaRe Framework

Pasupulati

Avadhanula

Mamilla

et al. 2021

JPRI

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Background: Bacteria have ability to rapidly evolve, develop strategies to resist antibiotics, and reduce the effectiveness of antibiotics. The emergence and spread of antimicrobial resistance is an important global public health challenge to tackle. Studying antibiotic prescribing practices would allow rational use and preserve effectiveness of antibiotics. Objective: To study prescribing practices of antibiotics in out-patients in primary care settings using the WHO AWaRe framework. Methodology: A prospective cross-sectional study was conducted to evaluate prescribing practices of antibiotics in the primary care facility of three private hospitals using the WHO ‘core prescribing indicators’ and Access, Watch, and Reserve (AWaRe) classification. A systematic sampling technique was employed to collect the prescriptions at each hospital for three months. Descriptive statistics were applied to the collected data. Results: A total of 2685 prescriptions were systematically evaluated. 1280 encounters had at least one antibiotic (47.7%), of which 1041 consist of only one antibiotic (81.5%). Among 1280 antibiotic encounters, the average number of antibiotics per encounter was 1.2 and 14.6% were prescribed with a parenteral antibiotic. 26.6% and 78.6% antibiotics were prescribed using generic names and from the WHO Essential Medicines List, respectively. Amoxicillin/clavulanic acid, ceftriaxone, azithromycin, cefoperazone, and amoxicillin were the five most commonly prescribed antibiotics. According to the WHO AWaRe classification, a total of 27 specific antibiotics (Access 11, Watch 14, and Reserve 2) were prescribed. 38.4%, 53.7%, 0.3%, and 10.5% of antibiotics prescribed were from the ‘Access’, ‘Watch’, ‘Reserve’, and ‘Not Recommended’ categories, respectively. Third generation cephalosporins (24.0%) were prescribed in high rate among ‘Watch’ category. The most commonly prescribed ‘Access’ and ‘Watch’ antibiotics were amoxicillin/clavulanic acid (12.5%) and ceftriaxone (10.6%), respectively. Amoxicillin index was 19.5% and ‘Access-to-Watch’ index was 0.76, which were below the priority values. Conclusion: Except few indicators, still better prescribing practices of antibiotics are needed to fully meet the WHO recommendations. Antibiotic prescribing guidelines as per the WHO AWaRe framework, changes in prescription patterns and preference of “Access” over ‘Watch’ antibiotics are crucial to preserve effectiveness and promote rational use of antibiotics.

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“…In this context, Bortone et al [11] reported an increase in antimicrobial consumption of 65% between 2000 and 2015. Recently, the pandemic due to COVID-19 has dramatically favored the large-scale use of a group of antimicrobials for therapeutic purposes (azithromycin, ivermectin, remdesivir, favipiravir, among others) [12].…”

Section: Introductionmentioning

confidence: 99%

Occurrence and Effects of Antimicrobials Drugs in Aquatic Ecosystems

et al. 2021

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Currently, thanks to the development of sensitive analytical techniques, the presence of different emerging pollutants in aquatic ecosystems has been evidenced; however, most of them have not been submitted to any regulation so far. Among emerging contaminants, antimicrobials have received particular attention in recent decades, mainly due to the concerning development of antibiotic resistance observed in bacteria, but little is known about the toxicological and ecological impact that antimicrobials can have on aquatic ecosystems. Their high consumption in human and veterinary medicine, food-producing animals and aquaculture, as well as persistence and poor absorption have caused antimicrobials to be discharged into receiving waters, with or without prior treatment, where they have been detected at ng-mg L−1 levels with the potential to cause effects on the various organisms living within aquatic systems. This review presents the current knowledge on the occurrence of antimicrobials in aquatic ecosystems, emphasizing their occurrence in different environmental matrixes and the effects on aquatic organisms (cyanobacteria, microalgae, invertebrates and vertebrates).

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High global consumption of potentially inappropriate fixed dose combination antibiotics: Analysis of data from 75 countries

Cited by 32 publications

References 22 publications

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Antibiotic Prescribing Practices in Primary Care Settings Using 2019 WHO AWaRe Framework

Occurrence and Effects of Antimicrobials Drugs in Aquatic Ecosystems

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