Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications.

Journal: Expert Review Of Anti-Infective Therapy
Published:
Abstract

Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics. There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

Authors
Zikria Saleem, Biset Mekonnen, Ebiowei Orubu, Md Islam, Thuy Thi Nguyen, Chukwuemeka Ubaka, Deus Buma, Nga Thuy, Yashasvi Sant, Tiyani Sono, Tomasz Bochenek, Aubrey Kalungia, Saad Abdullah, Nenad Miljković, Eugene Yeika, Loveline Niba, George Akafity, Israel Sefah, Sylvia Opanga, Freddy Kitutu, Felix Khuluza, Trust Zaranyika, Ayuska Parajuli, Omeed Darweesh, Salequl Islam, Santosh Kumar, Hellen Nabayiga, Ammar Jairoun, Audrey Chigome, Olayinka Ogunleye, Joseph Fadare, Amos Massele, Aislinn Cook, Ana Jelić, Isabella Piassi Godói, Amani Phillip, Johanna Meyer, Elisa Funiciello, Giulia Lorenzetti, Amanj Kurdi, Abdul Haseeb, Catrin Moore, Stephen Campbell, Brian Godman, Mike Sharland