Impact of national interventions to promote responsible antibiotic use: a systematic review

Abstract

Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan

“…In this context, adequate knowledge of healthcare professionals about rational antibiotic use and antimicrobial resistance (AMR) prevention could play a significant role in limiting ABR momentum and sustaining the effectiveness of antibiotics [ 8 , 9 ]. One of the most integral elements of the World Health Organization (WHO) global action plan to manage ABR is to enhance understanding and awareness about antibiotics among healthcare professionals and the public by effective education, training, and communication [ 10 ].…”

Systematic Review on the Impact of Guidelines Adherence on Antibiotic Prescription in Respiratory Infections

“…Interestingly, a pattern was noticed when the study accessed the rates of antibiotic prescribing and its appropriateness, as both had the same significant result, suggesting that reducing inappropriate prescriptions is directly related with reduction of the antibiotic prescription rates, providing more information towards this theory discussed in previous reviews [18].…”

“…Therefore, healthcare professionals play an important role in tackling this problem. Several clinical interventions have been carried out in order to improve prescription’s quality and to reduce antibiotic misuse in general and, particularly, in RTIs [ 17 , 18 , 19 , 20 ]. Some of the interventions implemented involved the presentation or clarification of antibiotic prescription guidelines [ 17 , 18 ].…”

“…Several clinical interventions have been carried out in order to improve prescription’s quality and to reduce antibiotic misuse in general and, particularly, in RTIs [ 17 , 18 , 19 , 20 ]. Some of the interventions implemented involved the presentation or clarification of antibiotic prescription guidelines [ 17 , 18 ]. These guidelines provide support for proper decision-making based on evidence regarding management, diagnosis, and practical strategies for prescribing antibiotics, advising on whether or not a patient needs antimicrobial treatment and which antibiotic should be prescribed [ 21 , 22 ].…”

An Environmental Escherichia coli Strain Is Naturally Competent to Acquire Exogenous DNA

“…Antibiotic Resistance (AR) is a public concern for global health. About 700,000 people die every year from antibiotic resistant bacteria-infections and 10 million annual deaths caused by antibiotic resistant pathogens are estimated by 2050 (Lim et al, 2019). In the last century, antibiotics have been widely used in medicine, plant production and livestock industries, imposing a strong selective pressure on the environmental microbial communities (Van Hoek et al, 2011).…”