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Antibiotic Prescribing Patterns in Adult Patients According to the WHO aware classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

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Pharmacology & Pharmacy 2022年第10期13卷 379-392页

作者： Steward Mudenda Mary Chomba Billy Chabalenge Christabel Nang’andu Hikaambo Michelo Banda Victor Daka Annie Zulu Abraham Mukesela Maxwell Kasonde Peter Lukonde Enock Chikatula Lloyd Matowe Ronald Kampamba Mutati Tyson Lungwani Muungo Tobela Mudenda Shafiq Mohamed Scott Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Bell Pharmacy Kabulonga Centro Mall Lusaka Zambia Ministry of Health Headquarters Ndeke House Lusaka Zambia Department of Pharmacy Levy Mwanawasa University Teaching Hospital Lusaka Zambia Faculty of Pharmacy School of Pharmacy Eden University Lusaka Zambia Department of Pathology Ndola Teaching Hospital Ndola Zambia Remedium Pharmaceuticals Limited Lusaka Zambia Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (aware) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the aware protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.

关键词： Antibiotic Prescribing Antimicrobial Resistance Antimicrobial Stewardship aware classification Prescribing Patterns Primary Healthcare Surveillance Zambia

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Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India

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World Journal of Experimental Medicine 2023年第5期13卷 123-133页

作者： Gunjita Negi Arjun KB Prasan Kumar Panda Department of Medicine All India Institute of Medical SciencesRishikeshRishikesh 249203India

BACKGROUND The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance(AMR),which is a global public health *** has particularly high rates of AMR,posing a threat to effective *** World Health Or-ganization(WHO)Access,Watch,Reserve(aware)classification system was introduced to address this issue and guide appropriate antibiotic ***,there is a lack of studies examining the prescribing patterns of antimi-crobials using the aware classification,especially in North ***,this study aimed to assess the prescribing patterns of antimicrobials using the WHO aware classification in a tertiary care centre in North ***,Obstetrics and Gynecology).Metronidazole and ceftriaxone were the most prescribed *** to the aware classification,57.61%of antibiotics fell under the Access category,38.27%in Watch,and 4.11%in *** Access antibiotics were prescribed within the Medicine department,and the same department also exhibited a higher frequency of Watch antibiotics *** questionnaire survey showed that only a third of participants were aware of the aware classification,and there was a lack of knowledge regarding AMR and the potential impact of aware *** The research was carried out in accordance with the methodology presented in Figure 1.A total of n=123 patients were enrolled in this study,with each of them receiving antibiotic *** majority of these prescriptions were issued to inpatients(75.4%),and both the Medicine and Surgical departments were equally represented,accounting for 49.6%and 50.4%,*** the healthcare providers responsible for prescribing antibiotics,72%were Junior Residents,18.7%were Senior Residents,and 9.3%were *** findings have been summarized in Table *** prescriptions included 27 different antibiotics,with metronidazole being the most prescribed(19%)followed by ceftriaxone(17%).Th

关键词： Antimicrobial resistance aware classification Access Watch Reserve Daily defined dose Questionnaire based survey

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Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

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Pharmacology & Pharmacy 2023年第8期14卷 271-328页

作者： Steward Mudenda Billy Chabalenge Victor Daka Ruth Lindizyani Mfune Kyembe Ignitius Salachi Shafiq Mohamed Webrod Mufwambi Maisa Kasanga Scott Kaba Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Medicines Management and Pharmacy Services St James University Hospital Leeds Teaching Hospitals NHS Trust Leeds UK Department of Epidemiology and Biostatistics School of Public Health Zhengzhou University Zhengzhou China Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the aware classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevale

关键词： Antimicrobial Resistance Antimicrobial Stewardship aware classification One Health Approach One Health Perspective Strategies Surveillance

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