Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

doi:10.3390/life11060528

Review

. 2021 Jun 7;11(6):528.

doi: 10.3390/life11060528.

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Brian Godman^{1

2

3}, Abiodun Egwuenu⁴, Mainul Haque⁵, Oliver Ombeva Malande^{6

7}, Natalie Schellack⁸, Santosh Kumar⁹, Zikria Saleem¹⁰, Jacqueline Sneddon¹¹, Iris Hoxha¹², Salequl Islam¹³, Julius Mwita¹⁴, Renata Cristina Rezende Macedo do Nascimento¹⁵, Isabella Piassi Dias Godói^{16

17}, Loveline Lum Niba^{18

19}, Adefolarin A Amu²⁰, Joseph Acolatse²¹, Robert Incoom²¹, Israel Abebrese Sefah^{22

23}, Sylvia Opanga²⁴, Amanj Kurdi^{1

25}, Ibrahim Chikowe²⁶, Felix Khuluza²⁶, Dan Kibuule²⁷, Olayinka O Ogunleye^{28

29}, Adesola Olalekan^{30

31}, Vanda Markovic-Pekovic³², Johanna C Meyer², Abubakr Alfadl^{33

34}, Thuy Nguyen Thi Phuong³⁵, Aubrey C Kalungia³⁶, Stephen Campbell^{37

38}, Alice Pisana³⁹, Janney Wale⁴⁰, R Andrew Seaton^{11

41

42}

Affiliations

¹ Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
² Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.
³ School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia.
⁴ AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria.
⁵ Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia.
⁶ Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya.
⁷ East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda.
⁸ Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa.
⁹ Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India.
¹⁰ Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan.
¹¹ Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK.
¹² Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania.
¹³ Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh.
¹⁴ Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana.
¹⁵ Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil.
¹⁶ Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil.
¹⁷ Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil .
¹⁸ Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon.
¹⁹ Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon.
²⁰ Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini.
²¹ Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana.
²² Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana.
²³ Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
²⁴ Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya.
²⁵ Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq.
²⁶ Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi.
²⁷ Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia.
²⁸ Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria.
²⁹ Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria.
³⁰ Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria.
³¹ Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria.
³² Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina.
³³ National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan.
³⁴ Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia.
³⁵ Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam.
³⁶ Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia.
³⁷ Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
³⁸ NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
³⁹ Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden.
⁴⁰ Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia.
⁴¹ Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK.
⁴² Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK.

PMID: 34200116
PMCID: PMC8229985
DOI: 10.3390/life11060528

Review

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Brian Godman et al. Life (Basel). 2021.

. 2021 Jun 7;11(6):528.

doi: 10.3390/life11060528.

Authors

Affiliations

¹ Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
² Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.
³ School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia.
⁴ AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria.
⁵ Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia.
⁶ Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya.
⁷ East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda.
⁸ Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa.
⁹ Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India.
¹⁰ Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan.
¹¹ Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK.
¹² Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania.
¹³ Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh.
¹⁴ Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana.
¹⁵ Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil.
¹⁶ Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil.
¹⁷ Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil .
¹⁸ Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon.
¹⁹ Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon.
²⁰ Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini.
²¹ Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana.
²² Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana.
²³ Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
²⁴ Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya.
²⁵ Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq.
²⁶ Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi.
²⁷ Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia.
²⁸ Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria.
²⁹ Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria.
³⁰ Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria.
³¹ Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria.
³² Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina.
³³ National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan.
³⁴ Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia.
³⁵ Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam.
³⁶ Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia.
³⁷ Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
³⁸ NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
³⁹ Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden.
⁴⁰ Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia.
⁴¹ Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK.
⁴² Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK.

PMID: 34200116
PMCID: PMC8229985
DOI: 10.3390/life11060528

Abstract

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

Keywords: COVID-19; antimicrobial resistance; antimicrobial stewardship programs; antimicrobials; healthcare-associated infections; lower- and middle-income countries; misinformation; patient initiatives; surgical site infections; vaccines.

PubMed Disclaimer

Conflict of interest statement

The authors declare they have no conflict of interest although some do work for health authorities or are advisers to them.

Figures

**Figure 1**
Core elements of any antimicrobial stewardship program.

See this image and copyright information in PMC

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References

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[1] Cassini A., Högberg L.D., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G.S., Colomb-Cotinat M., Kretzschmar M.E., Devleesschauwer B., Cecchini M., et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. Lancet Infect. Dis. 2019;19:56–66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed

[2] Cassini A., Högberg L.D., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G.S., Colomb-Cotinat M., Kretzschmar M.E., Devleesschauwer B., Cecchini M., et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. Lancet Infect. Dis. 2019;19:56–66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed

[3] Hofer U. The cost of antimicrobial resistance. Nat. Rev. Genet. 2019;17:3. doi: 10.1038/s41579-018-0125-x. - DOI - PubMed

[4] Hofer U. The cost of antimicrobial resistance. Nat. Rev. Genet. 2019;17:3. doi: 10.1038/s41579-018-0125-x. - DOI - PubMed

[5] Majumder M.A., Rahman S., Cohall D., Bharatha A., Singh K., Haque M., Gittens-St Hilaire M. Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infect. Drug Resist. 2020;13:4713–4738. doi: 10.2147/IDR.S290835. - DOI - PMC - PubMed

[6] Majumder M.A., Rahman S., Cohall D., Bharatha A., Singh K., Haque M., Gittens-St Hilaire M. Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infect. Drug Resist. 2020;13:4713–4738. doi: 10.2147/IDR.S290835. - DOI - PMC - PubMed

[7] Founou R.C., Founou L.L., Essack S.Y. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189621. doi: 10.1371/journal.pone.0189621. - DOI - PMC - PubMed

[8] Founou R.C., Founou L.L., Essack S.Y. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189621. doi: 10.1371/journal.pone.0189621. - DOI - PMC - PubMed

[9] Ndir A., Diop A., Ka R., Faye P.M., Dia-Badiane N.M., Ndoye B., Astagneau P. Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae: Clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar, Senegal. Antimicrob. Resist. Infect. Control. 2016;5:13. doi: 10.1186/s13756-016-0114-7. - DOI - PMC - PubMed

[10] Ndir A., Diop A., Ka R., Faye P.M., Dia-Badiane N.M., Ndoye B., Astagneau P. Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae: Clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar, Senegal. Antimicrob. Resist. Infect. Control. 2016;5:13. doi: 10.1186/s13756-016-0114-7. - DOI - PMC - PubMed

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Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Affiliations

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

Authors

Affiliations

Abstract

Conflict of interest statement

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Cited by

References

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Abstract

Conflict of interest statement

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References

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