Surveillance of community antimicrobial use in resource‐constrained settings – experience from five pilot projects

• Published in: Tropical medicine & international health 2011-02, Vol.16 (2), p.152-161
• Main Authors: Holloway, Kathleen, Mathai, Elisabeth, Gray, Andy
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Antibacterial agents; antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; antibiotiques; Antibióticos; Antimicrobial agents; antimicrobial resistance; Biological and medical sciences; communauté; community; comunidad; Developing Countries; Drug Prescriptions - statistics & numerical data; Drug resistance; Drug Resistance, Microbial; Drug therapy; drug use; Drug Utilization - statistics & numerical data; Drug Utilization - trends; Drug Utilization Review; Epidemiologic Methods; Feasibility studies; General aspects; Humans; India; Medical sciences; Medically Underserved Area; pays en développement; países en vías de desarrollo; Pharmacology. Drug treatments; resistencia a antimicrobianos; résistance aux antimicrobiens; Seasons; South Africa; Surveillance; uso de medicamentos; utilisation des médicaments; vigilancia
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2010.02695.x

Summary Objective  To investigate the feasibility of surveillance of antimicrobial use in the community in resource‐constrained settings. Overuse and misuse of antimicrobial medicines is contributing to the development of resistance. The WHO Global Strategy for Containment of Antimicrobial Resistance recommends surveillance of use at all levels of the health sector but this is not done in most low and middle income countries. Methods  Pilot projects were established in three sites in India (Delhi, Mumbai and Vellore) and 2 in South Africa (Brits and Durban). Antimicrobial use data were collected monthly from both public and private facilities. Each pilot site sought to document 30 patient encounters where antimicrobials were provided from 7 to 30 facilities per month. Antimicrobial use was expressed as the percentage of patients receiving a specific antimicrobial and as the number of defined daily doses of each specific antibiotic per 100 patients attending the facility per month. Results  In all sites, there was extensive use of antimicrobials, with older agents being used more in the public sector and newer agents in the private sector. Although methodological differences limit the comparability of data, use appeared to be higher in India than in South Africa. Expressing antimicrobial use as the percentage of patients receiving a specific antimicrobial was more easily computed. Defined daily dose measure was useful in demonstrating differences in dosing and duration. Conclusion  All pilot sites provided data on antimicrobial use but also raised several issues related to methodology and logistics of long‐term surveillance in community settings under resource constraints. Use measured as percentage of prescriptions is easier and more reliable in these settings. Objectif:  Investiguer la faisabilité de la surveillance de l’utilisation des antimicrobiens dans la communauté dans les endroits à ressources limitées. Méthodes:  Des projets pilotes ont été mis en place dans 3 sites en Inde (Delhi, Mumbai, Vellore) et 2 en Afrique du Sud (Brits, Durban). Les données sur l’utilisation des antimicrobiens ont été collectées chaque mois à la fois dans les établissements publics et privés. Chaque site pilote avait pour objectif de documenter 30 rencontres avec patients à qui des antimicrobiens ont été fournis dans 7 à 30 services par mois. L’utilisation d’antimicrobiens a été exprimée comme le pourcentage de patients recevant un antibiotique spécifique et comme le nomb