Resistance and utilisation pattern of antibacterial agents in outpatient settings in two Teaching Hospitals in Colombo

Abstract

Objectives Antibacterial resistance (ABR) is a public threat. Sri Lanka is a country with limited surveillance of ABR in the community. The WHO methodology was adapted to identify ABR in outpatient settings (nonhospitalised patients) and its link to consumption of antibiotics.Methods It was a cross-sectional descriptive community based study to collect ABR data from Out Patient Department (OPD) of two leading Teaching Hospitals in Colombo district. The indicator organism Escherichia coli (E. coli) was obtained from the urine specimens of patients who were suspected to have urinary tract infections. Antibiotic susceptibility testing was performed for commonly used oral antibiotics using disc diffusion method. The antibiotic consumption aggregate data were collected from the OPD pharmacies of the said hospitals and expressed as Defined Daily Doses (DDD) per 1000 inhabitants per 1000 day.Results Of the 2183 urine samples, pathogenic E. coli was isolated in 9.3% (204), and 8% (n=16) of them were Extended Spectrum Beta Lactamase (ESBL) producers. E.coli was most resistant to ampicillin (85%), followed by nalidixic acid (58.5%), trimethoprim/sulphamethoxazole (47.1%), ciprofloxacin (46.2%), norfloxacin (43.7%) amoxicillin /clavulanic acid (36.3%) and nitrofurantoin (15%). Multi-drug resistance was seen in 44%. Amoxicillin was the most frequently consumed antibacterial agent (2.65 DDD per 1000 inhabitants per day).Conclusions There is an alarmingly high antibiotic resistance in the non-hospitalised patients indicating high prevalence of E. coli resistance in the community.

Knowledge, Attitudes and Practices Related to Antibiotic Use Among Community and Hospital Pharmacists in Galle District, Sri Lanka

“…A series of statements which were intended to study the attitudes of the respondents related to antibiotic use and possible causes of AR were analysed by using a 5-point Likert scale, whose responses ranged from 'strongly agree' to 'strongly disagree'. (1) to assess the pharmacists' level of knowledge and attitudes related to antibiotic use and resistance; (2) to compare the knowledge, attitudes and practices related to antibiotic use between community and hospital pharmacists; (3) to assess the socio-demographic factors influencing on their knowledge and attitudes about antibiotics use and antibiotics resistance.…”

“…[2] AR was proved to be a healthcare concern in Sri Lanka by the high prevalance of resistant trains of Escherichia coli and Streptococcus pneumoniae found in patient isolates. [3,4] The increase of AR will result in failure of therapeutic effectiveness, leading to longer and more severe illness episodes with higher costs, mortality and morbidity rates. [5,6] The emergence of resistant microorganisms is a natural biological adaptation, it is exacerbated by the inappropriate use of antibiotics (e.g.…”

Update on antibacterial agents: current challenges and recent initiatives

“…E. coli was most resistant to ampicillin (85%), followed by nalidixic acid (58.5%), trimethoprim/sulphamethoxazole (47.1%), ciprofloxacin (46.2%), norfloxacin (43.7%) amoxicillin /clavulanic acid (36.3%), gentamicin (23%) and nitrofurantoin (9%). Multi-drug resistance was seen in 44% (18). In the private sector, of the 969 pathogenic E. coli, 28% were ESBL producers.…”

Strategies to be Implemented in Sri Lanka to Improve Appropriate Antibiotic Dispensing Practices: A Narrative Review

“…(17) Sri Lanka also has national therapeutic guidelines to support best practice in prescribing. (18) Recent reports from Sri Lanka indicated a high prevalence of community acquired infections, (19) a concerning spread of resistant bacteria in hospitals (20,21) and inappropriate antibiotic use in humans (22) and farm animals. (23) Importantly, Sri Lanka has introduced a national strategic plan for combating AMR.…”