Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

Gutema, Girma; Ali, Seid; Suleman, Sultan

doi:10.1371/journal.pone.0251400

Cited by 5 publications

(11 citation statements)

References 37 publications

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“… 37 These high rates of resistance could be related to the high prevalence of irrational antibiotic use and self-prescription practices in Ethiopia. 38 , 39 , 40 , 41 , 42 As a result, these antimicrobials may no longer be considered effective treatment options for infections caused by E. coli and K. pneumoniae . This, in turn, underlines the importance of developing bacteriology laboratory capacity in healthcare facilities to ensure that isolate identification and antimicrobial susceptibility testing results are made available for clinicians.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia

Kitaba,

Bonger,

Beyene

et al. 2024

African Journal of Laboratory Medicine

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Background: Clinicians rely on local antimicrobial resistance pattern data to guide empiric treatment for seriously ill patients when culture and antimicrobial susceptibility testing results are not immediately available.Objective: This study aimed to analyse 5-year trends in antimicrobial resistance profiles of Escherichia coli and Klebsiella pneumoniae isolates.Methods: Bacteriology reports from 2017 to 2021 at the Ethiopian Public Health Institute were analysed retrospectively. Isolates were identified using either the VITEK 2 Compact system, the BD Phoenix M50 instrument, or conventional biochemical tests. Antimicrobial susceptibility testing was conducted using either the Kirby-Bauer disk diffusion method or the VITEK 2 Compact system and BD Phoenix M50 systems available at the time of testing. The Cochran Armitage trend test was employed to test the significance of antimicrobial resistance trends over time. P-values less than 0.05 were considered statistically significant.Results: Of the 5382 bacteriology reports examined, 458 (9%) were on E. coli and 266 (5%) were on K. pneumoniae. Both K. pneumoniae (88%) and E. coli (65%) demonstrated high resistance to extended-spectrum cephalosporins. However, both K. pneumoniae (14%) and E. coli (5%) showed lower rates of resistance to carbapenems compared to other antimicrobials. In K. pneumoniae, resistance to carbapenems (from 0% to 38%; p 0.001) and ciprofloxacin (from 41% to 90%; p 0.001) increased significantly between 2017 and 2021.Conclusion: Both organisms showed very high resistance to broad-spectrum antibiotics. Additionally, K. pneumoniae demonstrated a statistically significant rise in ciprofloxacin and carbapenem resistance.What this study adds: This study emphasises the significance of regular reporting of local antimicrobial resistance patterns as this information can guide appropriate empiric therapy and efforts to address antimicrobial resistance issues.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia

Kitaba,

Bonger,

Beyene

et al. 2024

African Journal of Laboratory Medicine

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“…From 2000 to 2015, the consumption of Watch antibiotics increased by 165.0% in [ 4 ]. In LMICs, antibiotic consumption in Sub-Saharan Africa is very low [ 3 ] and varies across countries, in Tanzania it was 1 54.51 DIDs from 2010–2016 [ 10 ] and 241.41 DIDs from 2017 to 2019 [ 11 ], 58.41 DIDs in Ethiopia from 2016 to 2020 [ 12 ], 104,791,827 DDD in Uganda from 2017 to 2019 [ 13 ], and 19 DIDs in Sierra Leone from 2017 to 2019 [ 14 ]. Overall, antibiotic expenditures are increasing in public healthcare institutions [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Ethiopia, data on antibiotic consumption using standard measures like DIDs is limited [ 12 , 17 , 18 ], particularly in the study area. On the other hand, the consumption of antibiotics in outpatient departments was reported to be high [ 17 ], and in inpatient wards, three out of four patients were prescribed antibiotics [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

A six years trend analysis of systemic antibiotic consumption in Northwest Ethiopia

Abejew,

Wubetu,

Fenta

2024

PLoS ONE

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Background Consumption of antibiotics, a major global threat to public health, is perhaps the key driver of antibiotic resistance. Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. This study assessed antibiotic consumption trends during the last six years in the Bahir Dar branch of the Ethiopian pharmaceutical supply agency (EPSA), Northwest Ethiopia, in 2022. Methods Retrospective data were collected in August 2022 based on antibiotic distribution data from the Bahir Dar Brach of EPSA from July 2016 to June 2022. Data were analyzed according to the Anatomic Therapeutic Classification (ATC) developed by the World Health Organization (WHO). We measured antibiotic consumption using a defined daily dose per 1000 inhabitants per day (DIDs) based on the Agency’s catchment population. Descriptive statistics and trend analyses were conducted. Results About 30.34 DIDs of antibiotics were consumed during the six years. The consumption of antibiotics decreased by 87.4%, from 6.9 DIDs in 2016/17 to 0.9 DIDs in 2021/22. Based on the WHO AWaRe classification, 23.39 DIDs (77.1%) of the consumed antibiotics were from the Access category. Consumption of Access category antibiotics was decreased by 72.7% (from 5 to 0.5 DIDs) but Watch antibiotics decreased by 54.3% (from 1.8 to 0.4 DIDs). Oral antibiotics accounted for 29.19 DIDs (96.2%) of all consumed systemic antibiotics. The average cost expenditure per DDD for all antibiotics was 54.1 birr/DDD (0.4–482.3 birr/DDD). Only seven antibiotics accounted for DU90% and the cost expenditure per DDD for the DU90% antibiotics ranged from 0.4/DDD for Doxycycline to 232.8 birr/DDD for Piperacillin/tazobactam. Overall, during the last six years, the most commonly used antibiotic was Amoxicillin (10.1 DIDs), followed by Doxycycline (5.3 DIDs) and Ciprofloxacin (3.4 DIDs). Conclusion In this study, we found that antibiotic usage was low and continuously declining over time. Minimizing unnecessary antibiotic usage is one possible approach to reduced AMR. However, a shortage of access to important medicines can compromise the quality of treatment and patient outcomes. A prospective study is needed to evaluate the balance of patient outcomes and reduce AMR by optimizing the community consumption of systemic antibiotics.

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“…The fact that antimicrobial resistance is currently thought to be a factor in more than 700,000 deaths annually and that it is anticipated to claim 10 million lives and cost $100 trillion by 2050 is not surprising 19,20 . Because community-based antibiotic usage is a signi cant component of overall antibiotic use, prudent antibiotic use in the ambulatory context aids in the rational use of antibiotics as a whole 21 .…”

Section: Introductionmentioning

confidence: 99%

Prescribing pattern and associated factors in community pharmacies: A cross-sectional study using AWaRe classification and WHO antibiotic prescribing indicators at Dire Dawa, Ethiopia

Dereje

Workneh

Megersa

et al. 2023

Preprint

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Background: Antibiotics are more likely to trigger the development of antimicrobial resistance than other medications. Thus, they need to be prescribed, dispensed, and administered with greater caution. Timely evidence on medicine use, prescribing patterns, and the factors affecting the prescribing of an antibiotic would help decision-makers draft guidelines that would enable a more rational use of medicines. Methods: Prospective and cross-sectional study was conducted in seven community pharmacies in Dire Dawa to assess current prescribing practices, including antibiotic use and associated factors. Using stratified random sampling techniques, 1200 encounters were reviewed between October 1 and October 31, 2022 and SPSS version 27 was used for descriptive statistics and logistic regression. Results: The average medications per prescription was 1.96 and antibiotics were included in 47.83% of encounters while 43.03% were prescribed from Watch group. In 13.5% of the encounters, injections were administered. In multivariate models, patient age, gender, and the number of medications prescribed were all substantially related to the prescription of antibiotics. Antibiotics were about 2.5 times more likely to be prescribed to patients under the age of 18 than to subjects 65 and older (AOR: 2.51, 95% CI: 1.62-2.52; P <.001). Men were also more likely than women to receive an antibiotic prescription (AOR: 1.74, 95%CI: 1.18–2.33; P = 0.011). Subjects who those who received more than two drugs were 2.96 times more likely to receive an antibiotic (AOR: 2.96, 95%CI: 1.77–6.55; P = 0.003). The probabilities of prescribing antibiotics increased by 2.57 units for every unit increase in the number of medications (COR: 2.57; 95%CI: 2.16-3.47; P = 0.002). Conclusions: According to this study, the amount of prescriptions with antibiotics at community pharmacies much higher than the WHO standard (20–26.2%). Additionally, 13.5% of encounters involved an injection, which is comparable to the World Health Organization standard of 13.4-24.1%. The prescribing of antibiotics was significantly correlated with the patient's age, gender, and number of medications.

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Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

Cited by 5 publications

References 37 publications

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia

A six years trend analysis of systemic antibiotic consumption in Northwest Ethiopia

Prescribing pattern and associated factors in community pharmacies: A cross-sectional study using AWaRe classification and WHO antibiotic prescribing indicators at Dire Dawa, Ethiopia

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