European Antibiotic Awareness Day and access to antibiotics (original) (raw)

Consumers and providers - Could they make better use of antibiotics?

2005

Antibiotic use is seen as a critical factor in the emergence of resistant bacteria. The impact of irra- tional use, including inadequate dosing and poor adherence to therapy, is potentially just as important as high consumption (28). At the same time, limited access to antibiotics in many parts of the world is contributing to high mortality from bacterial infections. Often, irrational behaviour from a biomedical perspective may be perfectly logical for the human being and in the context of the cultural sphere surrounding her. Understanding the reasons that individuals use antibiotics in a particular way is crucial if one is to influence their actions. Containment of antibiotic resistance has been established as a 'Global Public Good for Health' and the rationalising of consumer and provider behaviour is an essential component in achieving this goal (19). In this article, the aim has been to examine the interplay between prescribers, dispensers and consumers, to visualise i...

Overuse of antibiotics in primary health care: a practitioner or patient induced problem?

JAMA Internal Medicine 2015;175(5):863 , 2015

Antibiotic resistance secondary to medical misuse represents a worldwide phenomenon with far-reaching ramifications. Thus, we read with interest the study by Wang and colleagues1 describing trends of antibiotic overuse and misuse across primary health care (PHC) settings in China. According to the authors, up to 93% of respiratory tract infections (RTIs) were treated with antibiotics, with more than 6 of 10 prescriptions reported as inappropriate.1 Inadequate education and training of PHC personnel were also among the key findings. It is estimated that more than 90% of antibiotics in PHC are prescribed by general practitioners, with approximately 70% given for RTIs.2 Greece is among the countries with the highest antibiotic consumption and antimicrobial resistance rates in Europe.3,4 In Greece, access may be offered directly from pharmacists without medical prescription, with the exception of fluoroquinolones and third-generation cephalosporins. Therefore, antibiotic misuse iswidespread and often underreported. Inappropriate antibiotic prescription writing should be approached as a multifactorial problem where social norms play an important role.5 Primary care physicians frequently encounter non specific RTIs at the early stages. Faced with diagnostic uncertainty and potential complications, as well as patients’ ill-founded demands and expectations, primary care physicians are known to adopt a defensive medicine approach, prescribing antibiotics to ease fears. Despite absence of evidence-based need, physicians may choose a “clinically proactive” behavior through prescription writing in order to satisfy patients’ expectations. Anecdotal data from PHC settings in Greece show that a prescription is viewed by clients as a “substantial” and “tangible” consultation outcome, adding extra value to thephysician-patient encounter. Hence, “patient-induced” antibiotic prescription is seen as an essential intervention, potentially leading toward a faster recovery. Education about antibiotic resistance and prudent use of antimicrobials, initiated at the undergraduate level for all health care professions, has to target both patients as well as practitioners. Increasing awareness of primary care personnel is of great importance. In this direction, multifaceted educational programs for primary care physicians on antibiotic use for RTI treatment are showing mixed results, with varying reduction in prescription rates.2,4 The necessity for culturally sensitive public health campaigns in helping lay people recognize that antibiotic resistance presents a serious problem, not only for the affected individuals but also for a country, is clearly evident. Adopting a holistic and interdisciplinary approach could be a new way to manage an old problem before it becomes too late. References 1. Wang J,Wang P,Wang X, Zheng Y, Xiao Y. Use and prescription of antibiotics in primary health care settings in China. JAMA Intern Med. 2014;174(12):1914-1920. 2. Bjerrum L, Munck A, Gahrn-Hansen B, et al. Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT)—impact of a non-randomised multifaceted intervention programme. BMC FamPract. 2011;12:52. 3. European Centre for Disease Prevention and Control. Annual epidemiological report: reporting on 2010 surveillance data and 2011 epidemiological data. 2012. http://ecdc.europa.eu/en/publications/Publications/Annual-Epidemiological-Report-2012.pdf. Accessed August 13, 2014. 4. Plachouras D, Antoniadou A, Giannitsioti E, et al. Promoting prudent use of antibiotics: the experience from a multifaceted regional campaign in Greece. BMC Public Health. 2014;14:866. 5. McDonnell Norms Group. Antibiotic overuse: the influence of social norms. J AmColl Surg. 2008;207(2):265-275.

Rational Use of Antibiotics: An Area of Concern

Journal of Young Pharmacists

Most of the IPD (Inpatient department) and OPD (Outpatient department) patients receive a course of antibiotics either for treatment or prevention of infection or during discharge. The therapeutic outcome with an antibiotic depends mostly on choice of appropriate agent. The selection of antibiotic depends on causative agent, patient factors, clinical pharmacology of antibiotics and its cost effectiveness. Antimicrobial resistance (AMR) occurs when microbes like bacteria, parasites, viruses and fungi become resistant to antimicrobial drugs that are used for treatment of various diseases leading to decreased effectiveness, difficulty in treatment of disease and hence requiring multiple therapeutic options. Antimicrobial stewardship is a coordinated intervention, designed to improve and measure the appropriate use of antimicrobial agents, by promoting the selection of optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration. To strengthen the implementation of rational antibiotic use and reduction of antimicrobial resistance, WHO (World Health Organisation) in 2019 introduced "AWaRe" classification of antibiotics that includes details of 180 antibiotics classified as Access, Watch or Reserve, their pharmacological classes, Anatomical Therapeutic Chemical (ATC) codes and WHO Essential Medicines List status. One health approach is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and environment. Recently, WHO issued new guidelines regarding the use of antimicrobials in animals producing food, recommending the restricted use of such medicines in growth promotion or prevention of disease in healthy animals. Hence rational use of antibiotics is important for successful treatment outcome and prevention of emerging drug resistance for broader community.

An informed public's views on reducing antibiotic overuse

Health Services Research, 2019

Antibiotic overuse in health care is widespread and well-documented. Each year U.S. physicians write about 47 million unnecessary antibiotic prescriptions in outpatient settings and emergency departments. 1 Additionally, 30 percent of all oral antibiotics prescribed in outpatient settings may be inappropriate. 2 Most of these unnecessary prescriptions are for respiratory conditions (eg, colds or bronchitis), which are usually caused by viruses and cannot be treated with antibiotics. 1 About half of the antibiotics prescribed for acute respiratory conditions may be unnecessary. 1,2 Children, especially those under 2 years of age, are particularly likely to receive