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.

Strategies to improve antimicrobial utilization with a special focus on developing countries

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.

/pdf/ongoing-strategies-to-improve-the-management-of-upper-2m9m6sj6vg.pdf

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

/pdf/compliance-to-prescribing-guidelines-among-public-health-2l4dglovpw.pdf

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Background: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially...

/pdf/compliance-to-the-primary-health-care-treatment-guidelines-4z749vrj92.pdf

Compliance to the primary health care treatment guidelines and the essential medicines list in the management of sexually transmitted infections in correctional centres in South Africa : findings and implications

Background and objective: There are ongoing initiatives in Botswana to enhance appropriate antibiotic use. The objective of this meeting was to discuss ongoing initiatives in Botswana since...

/pdf/ongoing-initiatives-to-improve-the-use-of-antibiotics-in-3ex6a7rxu7.pdf

Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report.

This study aimed to determine the profile and availability of policies and guidelines as reference documents at Primary Health Care (PHC) facilities in Gaborone and its surrounding in Botswana using the World Health Organisation/Drug Action programme (WHO/DAP) Questionnaire. The Questionnaire is a standard recommended by WHO and therefore was not piloted. All 20 PHC facilities were included in the study, however, data from 18 clinics was collected and analysed. The Matron from each PHC facility was asked to name and produce as evidence, guidelines and policy documents available as reference in his/her PHC facility. Data was entered in an Excel spread sheet and percentages, averages and frequencies were used to describe the profile and availability of the documents at each facility. Fifty two different documents were available at the facilities, 50% of them were on treatment and management of diseases. The remaining 50% were distributed between general information/policy, Ante-Natal Clinic, obstetrics and gynaecological care, and family planning. Except for guidelines for treating sexually transmitted diseases (86%), availability of the other guidelines and policy documents was low (56%) or less. Policy and guideline reference information for disease immunisation and prevention were available at 4 and 13% PHC, respectively. This low availability of such important instruments may be compromising patient care in the studied PHC facilities and should be addressed. While the Ministry of Health has produced many policy documents and guidelines as reference documents for PHC providers, none of the clinics had all the documents, raising questions on what is available at the facilities as reference and guide in the prescription practices. It is recommended that ministries of health and PHC workers should ensure that necessary reference documents are available at the facilities and staff should be trained and retrained on the use of such documents.

	Key words: Rational drug use, general policy documents, medical guidelines, benefits of the guidelines, health facilities.

/pdf/availability-of-guidelines-and-policy-documents-for-5gojq44qhf.pdf

Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana

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Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana