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Cited by 171Antibiotic Use and ResistanceHealthcare cost, quality, practicesPneumonia and Respiratory Infections

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

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Godman, Brian, Haque, Mainul, McKimm, Judy, Abu Bakar, Muhamad, Sneddon, Jacqueline, Wale, Janney, Campbell, Stephen, Martin, Antony P. +29 more·2020·Current Medical Research and Opinion
DOI 10.1080/03007995.2019.1700947
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Abstract

Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.

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  • Non-prescription sale of antibiotics is profoundly common practice in LMICs, as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire-based surveys.

    “The non-prescription sale of antibiotics is profoundly common practice in LMICs as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire based surveys [16, 17, 22–33].”

    From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [22]

    The Introduction (page unavailable) says non-prescription antibiotic purchasing is particularly problematic in LMICs, and section 3.3 reports substantial rates for some infections while noting past exceptions. The References list simulated-client and survey studies, but the passages found do not report high prevalence specifically from both methods, so that evidentiary detail is not established by this copy. (LLM, conf=0.83)

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  • Among the different channels from which patients in LMICs can access antibiotics, community drug retail outlets are a predominant source of antibiotics for the wider population.

    “Among the different channels from which patients in LMICs can access antibiotics, CDROs have been identified to be a predominant source of antibiotics for the wider population [19–22].”

    From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [22]

    Section 3.4.3 (page unavailable) says community pharmacists are often the first professionals patients consult for upper respiratory tract infections and notes substantial antibiotic self-purchasing in a number of LMICs. It does not establish that community drug retail outlets predominate over other antibiotic sources for the wider population across LMICs. (LLM, conf=0.83)

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  1. O'Neill J. Securing new drugs for future generations: the pipeline of antibiotics. The review of antimicrobial resistance. Available at URL: https://amr- review.org/sites/default/files/SECURING%20NEW%20DRUGS%20FOR%20FUTURE%20GENERATIONS %20FINAL%20WEB_0.pdf

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Authors
Godman, B., Haque, M., McKimm, J., Abu Bakar, M., Sneddon, J., Wale, J., Campbell, S., Martin, A. P., Hoxha, I., Abilova, V., Anand Paramadhas, B. D., Mpinda-Joseph, P., Matome, M., de Lemos, L. L. P., Sefah, I., Kurdi, A., Opanga, S., Jakupi, A., Saleem, Z., Hassali, M. A., Kibuule, D., Fadare, J., Bochenek, T., Rothe, C., Furst, J., Markovic-Pekovic, V., Bojanić, L., Schellack, N., Meyer, J. C., Matsebula, Z., Phuong, T. N. T., Thanh, B. N., Jan, S., Kalungia, A., Mtapuri-Zinyowera, S., Sartelli, M., & Hill, R.
Affiliations
  • Universiti Sains Malaysia (MY)
  • National Defence University of Malaysia (MY)
  • Swansea University (GB)
  • Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia)
  • Healthcare Improvement Scotland (GB)
  • Independent Consumer Advocate
  • University of Manchester (GB)
  • University of Liverpool (GB)
  • University of Medicine Tirana (AL)
  • Ministry of Health (IQ)
  • Department of Pharmacy, Nyangabgwe Hospital
  • Nyangabgwe Referral Hospital (BW)
  • Associated Fund Administrators (Botswana) (BW)
  • SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha
  • Ghana Health Service (GH)
  • Hawler Medical University (IQ)
  • University of Nairobi (KE)
  • University for Business and Technology (XK)
  • University of Namibia (NA)
  • Ekiti State University (NG)
  • Jagiellonian University (PL)
  • Health Insurance Institute
  • Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka
  • University of Banja Luka (BA)
  • Sefako Makgatho Health Sciences University (ZA)
  • Raleigh Fitkin Memorial Hospital
  • Hanoi University of Pharmacy (VN)
  • Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy
  • Rutgers, The State University of New Jersey (US)
  • University of Zambia (ZM)
  • National Microbiology Reference Laboratory
  • Ospedale di Macerata (IT)
Corresponding author
Haque, Mainul
ORCID
Venue
Current Medical Research and Opinion
Publisher
Informa UK Limited
Published
2019-12-30
Volume
36
Issue
2
Pages
301-327
ISSN
  • 0300-7995 (ISSN-L)
  • 1473-4877
DOI
10.1080/03007995.2019.1700947
OpenAlex
W2994473715
Cited by
171
References
330
Citations by year
2026: 7 · 2025: 27 · 2024: 15 · 2023: 28 · 2022: 26 · 2021: 41 · 2020: 26 · 2019: 1
FWCI
15.39
Type
journal article
Language
en
Open access
Locations
  • Current Medical Research and Opinion (publishedVersion)
  • PubMed (publishedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
  • Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
upper respiratory tract infection, inappropriate antibiotic use, antimicrobial resistance, self-medication, national action plans, antimicrobial stewardship, quality indicators, health education campaigns, low- and middle-income countries
MeSH terms
Anti-Bacterial Agents, Developing Countries, Health Education, Humans, Income, Respiratory Tract Infections, Inappropriate Prescribing

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