Surveillance of antibiotic use in the private sector in Namibia using sales and claims data

Abstract

Introduction: Antibiotics are among the most commonly used therapeutic agents for humans globally, and their use has been associated with the development of resistance. The objective of this study was to identify sources for quantifying antibiotic usage patterns and to assess such use in ambulatory patients in the private health sector of Namibia. Methodology: A retrospective analysis of prescription claims data and sales data for the period 2008 to 2011 was conducted. Antibiotic use was expressed in the number of antibiotic-containing prescriptions and volume of units sold and then standardized using defined daily dose per 1,000 inhabitants per day. Results: Antibiotic usage was highest in females (53%), in people 18-45 years of age (41%), and in Windhoek (34%). Overall, wholesale data showed higher antibiotic use than prescription claims data. However, both sources showed similar patterns of antibiotic use. Penicillins were the most used pharmacological group, with amoxicillin/clavulanic acid combination being the most used of the agents. Conclusion: Antibiotic use in the private sector of Namibia is comparable to that of high-consuming European countries such as Italy. A trend observed in this study was the decrease in the use of narrow-spectrum antibiotics in favour of broad-spectrum and newer antibiotics. Since this was the first study to assess antibiotic use in the private sector of Namibia, it could serve as a starting point for continued monitoring of antibiotic use in the whole of Namibia in the context of the World Health Organization's Global Action Plan to contain antibiotic resistance.

Estimating global trends in total and childhood antibiotic consumption, 2011-2015

“…Our results are also consistent with broader literature showing different trends in antibiotic consumption, measured from a variety of data sources, over time in different settings. For example, electronic primary care data from five European countries showed no evidence of a trend in the prevalence of antibiotic prescribing between 2004 and 2009,16 whereas numbers of antibiotic prescriptions and sales increased by 25% and 57%, respectively, between 2008 and 2011 in Namibia 36…”

“…While preferences for different types of antibiotics vary between settings,16 37–39 amoxicillin, with or without clavulanic acid, is frequently reported to be one of the most commonly used, particularly in community prescribing 6 36–38 40 41. Although recommended as a first-choice treatment only for specific indications,27 CAFs of amoxicillin with clavulanic acid were sold in volumes similar to those of amoxicillin alone in LMICs.…”

Antibiotic Use in Agriculture and Its Consequential Resistance in Environmental Sources: Potential Public Health Implications

“…Antibiotic surveillance is regarded as the keystone in endorsing antibiotic stewardship, and eases the control of antibiotic resistance. It is also considered as the force behind the programmes geared towards antimicrobial resistance, since it generates reliable and crucial data that can be used to formulate policies on antibiotic use to promote accurate prescriptions of drugs [ 160 ]. According to the Global Antibiotic Resistance Partnership—India [ 161 ], real changes in antibiotic consumption or dissemination of resistant bacteria can only be appreciated and/or supported when the resistance level is known and tracked over time, unlike undergoing any type of surveillance.…”

“…The World Health Organisation [ 164 ] and the Global Action Plan [ 165 ] advocated that the quantity and pattern of antibiotics consumed should be monitored as part of surveillance. Pereko and colleagues [ 160 ] analyzed prescription claims data and sales data from 2008 to 2011 in the private sector in Namibia to obtain the number of prescriptions that contained antibiotics and the volume of units sold. The findings highlighted the highest antibiotic consumption by females (53%), followed by individuals of age, 18–45 years (41%) and 34% in Windhoek, with combined therapy of amoxicillin/clavulanic acid as the post prevalent agents used which belong to the family of penicillins.…”

Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

“…There is considerable variability in the access to and use of antibiotics across various LMICs with a pilot site review from India and Africa demonstrating that public sector facilities used older agents and private sector facilities more often accessed newer agents, while the usage appeared higher per-capita in India than South Africa, possibly due to more restrictive prescribing in the latter country or access to “over the counter purchase” in the former [ 24 ]. Antibiotic usage, examined in a utilisation review in Namibia, appears to be higher in females, in the large cities and the economically active age-groups (18–45 years), with broad-spectrum penicillins, cephalosporins and macrolides constituting over 80% of the usage, which potentially contributes strongly to resistance patterns [ 25 ]. In the context of this review the surgical services in many LMICs will be offered primarily in the large cities and this may reflect part of the problem of AMR in the surgical population.…”