The use of non-prescribed antibiotics; prevalence estimates in low-and-middle-income countries. A systematic review and meta-analysis

Abstract

Background The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs. Methods The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65–89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics. Conclusion This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.

Education level and misuse of antibiotics in the general population: a systematic review and dose–response meta-analysis

“…The use of antibiotics without prescription is salient worldwide, with a pooled prevalence exceeding 75% in low- and middle-income countries [ 5 ], and reaching 66% in some regions of high-wealth countries such as the United States [ 6 ].…”

Understanding parental self-medication with antibiotics among parents of different nationalities: a cross-sectional study

“…Unlike high-income countries, non-prescribed antibiotics (NPA) (i.e., the use of leftover antibiotics, the use of antibiotics recommended by pharmacy staffs, sharing antibiotics with families or friends [ 24 ]) are easy to access in LMICs [ 18 , 25 ], associated with the lack of robust mechanisms of health education and enforcement measures to control the unnecessary and unreasonable use of antibiotics [ 24 , 26 ]. Moreover, insufficient and inconsistent knowledge and attitudes toward antibiotic use, high expectations on the curative effect of antibiotics, and poor quality of healthcare facilities, are factors driving inappropriate use of antibiotics [ 24 ]. Regarding the above gaps in the prevalence of PSMA around the world and various factors influencing the utilization of antibiotics, we therefore hypothesis that the practices of PSMA may differ among parents of different nationalities in China.…”

Income level and antibiotic misuse: a systematic review and dose–response meta-analysis

“…Another review estimated that the mean use of leftover antibiotics worldwide is 29%, and that of compliance with antibiotic therapy is only 62% [5]. A recent meta-analysis of studies from low-and middle-income countries found that the pooled prevalence of non-prescribed use of antibiotics is considerably high (78%) in these countries [6]. Antibiotic misuse is also frequent in high-income countries, including the United States where the prevalence of antibiotic use without prescription is as high as 66% in some instances, and that of storage of antibiotics for future use ranges between 14 and 48% [7].…”