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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Measuring antibiotic availability and use in 20 low- and middle-income countries

Rebecca Knowles1, Mike Sharland2, Yingfen Hsia2

  • 1Nuffield Department of Population Health, University of Oxford, Oxford, England.

Bulletin of the World Health Organization
|March 6, 2020
PubMed

Insights

Many essential antibiotics are unavailable in low- and middle-income countries. Routine surveys reveal significant gaps in access to vital medicines, impacting healthcare.

Area of Science:

  • Global Health
  • Pharmaceutical Policy
  • Health Systems Research

Background:

  • Antibiotic availability and use are critical for effective healthcare, particularly in low- and middle-income countries (LMICs).
  • Assessing these factors is essential for understanding treatment access and antimicrobial stewardship.
  • Previous assessments have often relied on limited data, necessitating comprehensive surveys.

Purpose of the Study:

  • To evaluate the availability and patterns of antibiotic use in healthcare facilities across LMICs.
  • To identify disparities in access to essential antibiotics based on the World Health Organization's AWaRe classification.
  • To leverage routine health facility surveys for robust data collection on antibiotic availability and utilization.

Main Methods:

  • Utilized data from 13,561 health facilities across 13 Service Provision Assessment (SPA) and 8 Service Availability and Readiness Assessment (SARA) surveys.
  • Observed antibiotic use in 22,699 child consultations across 10 SPA surveys, classifying antibiotics by WHO AWaRe categories (Access, Watch, Reserve).
  • Estimated the availability of 27 antibiotics and the proportion of children receiving antibiotics for common clinical syndromes.

Main Results:

  • Co-trimoxazole (89.5%) and metronidazole (87.1%) were the most consistently available antibiotics.
  • Seventeen other access and watch antibiotics were stocked in fewer than 50% of facilities.
  • Antibiotics were prescribed to 60.1% of observed children, with respiratory conditions (76.1%) most frequently treated.

Conclusions:

  • Routine health facility surveys offer a valuable, scalable data source for monitoring antibiotic availability and use in LMICs.
  • A significant proportion of essential 'access' antibiotics are not readily available in many healthcare facilities, highlighting critical supply chain and policy challenges.
  • Findings underscore the need for improved antibiotic access and stewardship programs in LMICs to combat antimicrobial resistance and ensure effective treatment.
Abstract

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