TITLE:
Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review
AUTHORS:
Godfrey S. Bbosa, Geoff Wong, David B. Kyegombe, Jasper Ogwal-Okeng
KEYWORDS:
Antibiotic/Antibacterial Drugs; Interventions; Misuse; Systematic Review; Developing Countries
JOURNAL NAME:
Health,
Vol.6 No.2,
January
26,
2014
ABSTRACT: Irrational antibiotics/antibacterial (AB) drug use is a
global problem, especially in developing countries. This results in an
increased emergence of resistance to most common bacteria, higher cost of
treatment, prolonged hospitalization and adverse drug reactions. Interventions
measures have been instituted to avert the problem but it still persists. A
systematic review was conducted to determine the effect of different
interventions (education, managerial, diagnostic tests, regulatory, economic
and multifaceted) on misuse of AB drugs in developing countries. A total of 722
articles were retrieved and 55 were reviewed. About 10.9% of the studies were
from Africa, 63.6% from Asia, 9.1% from Latin America, and 16.4% from
Southeastern Europe. A total of 52.7% of the studies were from hospital
settings, 5.5% from outpatient departments,
21.8% were from public health care facilities, 12.7% from private pharmacies/drug stores, and 7.3% from the communities. Education intervention had 27.3% studies, managerial had 20%,
managerial/education had 3.6%, regulatory had 9.1%, education/regulation had
9.1% and diagnostic had 3.6% studies. Multifaceted intervention had 27.3%
studies, with 63% improvement in appropriate AB doses prescribed, 2.6% mean
number of AB encounter reduction, 23% AB prescription reduction, 18.3% generic
AB prescription improvement, 32.1% reduction in AB use, 89% reduction in AB use
in acute respiratory infection, 82% in
surgery, 62.7% mean reduction in deliveries, 39% in STDs, 36.3% mean
reduction in diarrhea, 14.6% mean reduction AB use in malaria, and 6%-11% in the cost of treating bacteria-resistant organisms. Also
noted was 6.3% reductions in mean AB encounters after 1 month of intervention,
and then increased to 7.7% after 3 months
thus lacking sustainability. Multifaceted interventions were effective
in reducing irrational AB drug use in the various health facilities and
communities as well as reduction in the emergence of resistance to the
commonest bacteria in the developing countries though there was lack of sustainability
or continuity of rational drug use over the time.