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Published on: August 30, 2018
The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics
Kathleen Anne Holloway1, Laura Rosella2, David Henry2
1Department of Health Systems Development, World Health Organization, Regional Office SouthEast Asia, New Delhi, India.
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 antibiotic use data from linited surveys.
Conclusions:
Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.
Insights
Implementing essential medicines policies in low- and middle-income countries is linked to reduced inappropriate antibiotic use. Specific policies showed significant decreases in antibiotic prescribing for common infections like URTI and diarrhea.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Policy
Background:
- Inappropriate antibiotic use fuels antimicrobial resistance (AMR), a critical global health threat.
- Policy implementation to curb antibiotic misuse is notably weak in low- and middle-income countries (LMICs).
Purpose of the Study:
- To assess if reporting the implementation of specific essential medicines policies correlates with lower inappropriate antibiotic use in the public sector.
- Investigate the association between policy implementation and antibiotic prescribing patterns in LMICs.
Main Methods:
- Compared antibiotic use survey data from countries reporting policy implementation versus those that did not.
- Analyzed data on four indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases.
- Utilized regression analysis to examine the relationship between the number of implemented policies and antibiotic use indicators.
Main Results:
- Four policies, including a national unit for rational medicine use and drug committees, were linked to over 20% reduction in antibiotic use for upper respiratory infections (URTI).
- A national strategy to combat antibiotic resistance correlated with a 30% decrease in antibiotic use for acute diarrhea.
- Significant negative correlations were observed between the number of implemented policies and antibiotic treatment rates for both acute diarrhea and URTI.
Conclusions:
- Implementation of selected essential medicines policies is associated with reduced inappropriate antibiotic consumption in LMICs.
- Targeted policies demonstrate potential for significant impact on antibiotic prescribing practices for common infections.
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