The impact of WHO essential medicines policies on inappropriate use of antibiotics

Kathleen Anne Holloway, Laura C. Rosella, David Henry

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20 Citations (Scopus)

Abstract

Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results: Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of >20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiot use data from linited surveys. Conclusions: Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.

Original languageEnglish
Article numbere0152020
JournalPLoS One
Volume11
Issue number3
DOIs
Publication statusPublished - 1 Mar 2016
Externally publishedYes

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medicine
antibiotics
Anti-Bacterial Agents
Pharmacy and Therapeutics Committee
Respiratory Tract Infections
diarrhea
antibiotic resistance
Diarrhea
income
Inappropriate Prescribing
infection
Information Centers
information services
drugs
public sector
Public Sector
Microbial Drug Resistance
Information services
committees
Pharmaceutical Preparations

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Holloway, Kathleen Anne ; Rosella, Laura C. ; Henry, David. / The impact of WHO essential medicines policies on inappropriate use of antibiotics. In: PLoS One. 2016 ; Vol. 11, No. 3.
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abstract = "Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results: Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of >20{\%} in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30{\%} reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiot use data from linited surveys. Conclusions: Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.",
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The impact of WHO essential medicines policies on inappropriate use of antibiotics. / Holloway, Kathleen Anne; Rosella, Laura C.; Henry, David.

In: PLoS One, Vol. 11, No. 3, e0152020, 01.03.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

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AU - Rosella, Laura C.

AU - Henry, David

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N2 - Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results: Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of >20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiot use data from linited surveys. Conclusions: Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.

AB - Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results: Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of >20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiot use data from linited surveys. Conclusions: Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.

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JO - PLoS One

JF - PLoS One

SN - 1932-6203

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