Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000–15: an analysis of pharmaceutical sales data

Klein, Eili Y.; Milkowska-Shibata, Maja; Tseng, Katie K; Sharland, Mike; Gandra, Sumanth; Pulcini, Céline; Laxminarayan, Ramanan

doi:10.1016/s1473-3099(20)30332-7

Cited by 306 publications

(254 citation statements)

References 22 publications

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“…In 2019, WHO classified antibiotic resistance as one of the top ten threats to global health (World Health Organization, 2019). A recent study investigating the use of antibiotics in 76 countries over 15 years revealed that antimicrobial resistance is increasing worldwide (Klein et al, 2021), and a major driver of antibiotic resistance is overuse and misuse of antibiotics. The currently ongoing COVID-19 pandemic is linked to higher use of antibiotics which may lead to an increase of antibiotic resistance (Bengoechea and Bamford, 2020;Canton et al, 2020;Dona et al, 2020;Getahun et al, 2020;Murray, 2020).…”

Section: The Clinical Situation-coinfections In Cap and Hapmentioning

confidence: 99%

“…Another study analyzing the antibiotic use in patients with COVID-19 revealed that the prevalence of antibiotic prescribing was around 75% and it was higher with increasing patient age and with increasing proportion of patients requiring mechanical ventilation (Langford et al, 2021). In general, antimicrobial resistance is increasing worldwide (Klein et al, 2021) and a major driver is overuse and misuse of antibiotics. Thus, the ongoing pandemic of antimicrobial resistance may further increase, urging us to develop new strategies that help to prevent and treat viralbacterial coinfection.…”

Section: Similarities and Differences Between Influenza A Virus (Iav)mentioning

confidence: 99%

See 1 more Smart Citation

Virus-Induced Changes of the Respiratory Tract Environment Promote Secondary Infections With Streptococcus pneumoniae

Sender

Hentrich

Henriques‐Normark

2021

Front. Cell. Infect. Microbiol.

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Secondary bacterial infections enhance the disease burden of influenza infections substantially. Streptococcus pneumoniae (the pneumococcus) plays a major role in the synergism between bacterial and viral pathogens, which is based on complex interactions between the pathogen and the host immune response. Here, we discuss mechanisms that drive the pathogenesis of a secondary pneumococcal infection after an influenza infection with a focus on how pneumococci senses and adapts to the influenza-modified environment. We briefly summarize what is known regarding secondary bacterial infection in relation to COVID-19 and highlight the need to improve our current strategies to prevent and treat viral bacterial coinfections.

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Section: The Clinical Situation-coinfections In Cap and Hapmentioning

confidence: 99%

Section: Similarities and Differences Between Influenza A Virus (Iav)mentioning

confidence: 99%

Virus-Induced Changes of the Respiratory Tract Environment Promote Secondary Infections With Streptococcus pneumoniae

Sender

Hentrich

Henriques‐Normark

2021

Front. Cell. Infect. Microbiol.

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“…To monitor the antibiotic use, WHO proposed a classification of antibiotics for human use in three groups, “Access”, “Watch” and “Reserve”, according to their clinical importance, specific recommendations for their appropriate use, and resistance potential [5]. Antibiotic sales data during 2000-2015 showed that the human use of so-called Watch antibiotics, critically important antibiotics particularly at risk of AMR emergence, was declining in high-income countries, while importantly growing in middle income countries for which data were available [6,7].…”

Section: Introductionmentioning

confidence: 99%

Use of WATCH antibiotics prior to presentation to the hospital in rural Burkina Faso

Valia¹,

Ingelbeen

Kaboré³

et al. 2021

Preprint

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Background: In low- and middle-income countries (LMIC), the prevalence of antimicrobial resistance (AMR) is increasing. WHO recommends monitoring antibiotic use, in particular Watch antibiotics, clinical important but at risk of becoming ineffective due to increasing AMR. We investigated antibiotic use at primary care or community-level in rural Burkina Faso. Methods: During 2016-2017, patients aged >3 months admitted with severe acute fever to the rural hospital of Nanoro Health District, Burkina Faso, reported antibiotic use in the two weeks prior to consultation or hospitalization, which we analysed using the WHO Access, Watch, Reserve (AWaRe) classification. Most Watch antibiotics, e.g. ceftriaxone, are not recommended at primary health center level, as is also the case for ciprofloxacin in children. Results: Of 920 participants (63.0% ≤14 years), pre-admission antibiotic use was reported by 363 (39.5%) of whom 58 (16.0%) reported more than one antibiotic. Use was more frequent among health center referrals (231, 54.0%) than among self-referred patients (131, 26.7%, p<0.001). Of 424 antibiotics, 261 (61.6%) were Access and 159 (37.5%) Watch antibiotics. Watch antibiotics use was more frequent among >14 year olds (72, 51.1%) than 0-14 year olds (87, 30.7%) and among referrals (41, 28.1%) compared to self-referred patients (117, 42.2%). Most frequently used Watch antibiotics were ceftriaxone (114, 26.9%) and ciprofloxacin (32, 7.5%). Among antibiotics reported by referral patients, ceftriaxone and ciprofloxacin were respectively recorded 100 (36.1%) and 12 times (4.3%). Conclusion: The frequent use of Watch group antibiotics prior to presentation to the hospital in rural Burkina Faso highlights the need to address primary care, over-the-counter and informal community-level antibiotic use as part of antibiotic stewardship in LMIC, facilitating referral, access to qualified prescribers, or improving diagnostic tools in health centers.

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“…13,14 The recently introduced WHO AWaRe (Access, Watch, Reserve) antibiotic classification framework, based on accessibility versus AMR potential, is a useful metric to provide an indication of the appropriateness of antibiotic consumption. 15,16…”

Section: Introductionmentioning

confidence: 99%

A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals

Limato¹,

Nelwan²,

Mudia³

et al. 2021

Preprint

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Background Antibiotic misuse and overuse are a major driver of antimicrobial resistance, but systematic data in Indonesia are scarce. Objectives To evaluate patterns and quality indicators of antibiotic prescribing in six acute-care hospitals in Jakarta, Indonesia. Methods We conducted a hospital-wide point prevalence survey (PPS) between March and August 2019, using Global-PPS and WHO-PPS protocols. The analysis focused on antibacterials for systemic use (antibiotics). Results Of 1602 inpatients, 993 (62.0%) received ≥1 antimicrobials. Of 1666 antimicrobial prescriptions, 1273 (76.4%) were antibiotics. Most common reasons for prescribing were pneumonia (27.7%), skin and soft tissue infections (8.3%), gastrointestinal prophylaxis (7.9%), and gastrointestinal infections (5.4%). The most common indication was community-acquired infection (42.6%), followed by surgical prophylaxis (22.6%), hospital-acquired infection (18.5%), medical prophylaxis (9.6%), unknown (4.6%) and other indications (2.1%). The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), penicillins with B-lactamase inhibitor (6.8%) and aminoglycosides (6.0%). According to the WHO AWaRe classification, Watch antibiotics accounted for 67.4%, followed by 28.0% Access, 2.4% Reserve, and 2.2% Unclassified. Reason for prescribing, stop/review date and planned duration were poorly documented. Hospital antibiotic guidelines were not available for 28.1% of prescriptions, and guideline compliance was 52.2% (478/915). Parenteral administration was high (85.1%). Targeted (non-empirical) prescriptions comprised 8.1% (44/542) for community-acquired infections and 26.8% (63/235) for hospital-acquired infections. Conclusions Our data indicate a high rate of parenteral, empiric use of broad-spectrum antibiotics in Indonesian hospitals, coupled with poor documentation and guideline adherence. The findings suggest important areas for antimicrobial stewardship interventions.

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Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000–15: an analysis of pharmaceutical sales data

Cited by 306 publications

References 22 publications

Virus-Induced Changes of the Respiratory Tract Environment Promote Secondary Infections With Streptococcus pneumoniae

Virus-Induced Changes of the Respiratory Tract Environment Promote Secondary Infections With Streptococcus pneumoniae

Use of WATCH antibiotics prior to presentation to the hospital in rural Burkina Faso

A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals

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