Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income...

Area of Science:

• Global Health
• Infectious Diseases
• Health Policy

Background:

• Antimicrobial resistance (AMR) and high antibiotic consumption pose significant challenges in low- and lower-middle-income countries (LMICs).
• Clinical guidelines are essential for optimizing antibiotic prescribing but face implementation and adherence barriers in LMICs.

Purpose of the Study:

• To systematically review strategies for implementing and promoting adherence to antibiotic clinical guidelines in LMICs.
• To identify effective approaches for improving antibiotic prescribing practices in resource-limited settings.

Main Methods:

• A comprehensive literature review was conducted across major databases (PubMed, Cochrane Library, SCOPUS) and WHO/ANU information systems.
• Studies were selected based on PRISMA guidelines and a PROSPERO protocol, with interventions categorized using the Cochrane Effective Practice and Organization of Care taxonomy.
• 33 studies from 16 countries, varying in design and focus, were analyzed.

Main Results:

• Most interventions were multifaceted, demonstrating a positive trend in effect, but study variability prevented identification of the most impactful strategies.
• Audit and feedback, combined with workshops or focus groups, were the most common intervention components.
• The reviewed strategies align with established antimicrobial stewardship practices in high-income countries.

Conclusions:

• Multifaceted interventions show potential for improving antibiotic guideline adherence in LMICs.
• Further research using interrupted time series designs and transparent guideline information is recommended.
• Investigating prescriber confidence is essential for successful implementation.