Comparison of national antimicrobial treatment guidelines, African Union

Abstract

Objective To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States. Methods We reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines. Findings We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes. Conclusion AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.

Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies

“…A very low level of implementation of AMR guidelines has been reported in most African countries despite a surging AMR crisis on the continent. In a study, Craig and colleagues [ 11 ] have reported a lack of antimicrobial treatment guidelines that meet internationally established protocols across all African Union (AU) member states. This particularly sends a very bad signal in the aspect of AMR containment since the guidelines provide a chance to lessen the wrongful and excessive use of antibiotics in human health.…”

“…Similarly, the lack of sufficiently trained infection control personnel and the scarcity of robust and affordable point-of-care diagnostic facilities are some of the major factors identified as contributing to the problem of poor surveillance program implementation [ 10 , 12 ]. To tackle the AMR problem and minimize its impact, the rational use of antibiotics in compliance with the established clinical guidelines that describe the rudiments of antibiotic use is advocated by expert organizations [ 11 ]. These kinds of advocacy can indeed be implemented at both the facility and community levels through stewardship programs.…”

Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review

“…Notably, adherence to guidelines was the most improved intervention outcome in the human health sector; however, in many LMICs, local or national clinical treatment guidelines are often unavailable or outdated. A 2021 review of antimicrobial treatment guidelines in Africa found that only 20 of the 55 Africa Union member states had national guidelines at the time of the study, and only 10 member states had updated those guidelines since 2015 [ 49 ].…”

Antibiotic Use in Pregnancy: A Global Survey on Antibiotic Prescription Practices in Antenatal Care

“…However, in the African Region, professional education courses were the most used source, while professional conferences and education courses were among the top three sources in the Eastern Mediterranean Region. The lower utilization of national and institutional clinical guidelines in the African Region may be attributed to the limited availability of standardized treatment guidelines in many African Union member states [34]. Similarly, the lack of clear guidelines regarding dosage and duration of antibiotic treatment in Lebanon has been identified as a potential reason for the low reliance on national and institutional guidelines in the Eastern Mediterranean Region.…”