Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications
Zikria Saleem, Biset Asrade Mekonnen, E Sam Orubu, Md. Ariful Islam, Thuy Nguyen Thi Phuong, Chukwuemeka Michael Ubaka, Deus Buma, Nga Do Thi Thuy, Yashasvi Sant, Tiyani Milta Sono, Tomasz Bochenek, Aubrey Chichonyi Kalungia, Saad Abdullah, Nenad Miljković, Eugene Vernyuy Yeika, Loveline Lum Niba, George Akafity, Israel Abebrese Sefah, Sylvia Opanga, Freddy Eric Kitutu, Felix Khuluza, Trust Zaranyika, Ayuska Parajuli, Omeed Darweesh, Salequl Islam, Santosh Kumar, Hellen Nabayiga, Ammar Abdulrahman Jairoun, Audrey Chigome, Olayinka O. Ogunleye, Joseph Fadare, Amos Massele, Aislinn Cook, Ana Golić Jelic, Isabella Piassi Dias Godói, Anja Phillip, Johanna C. Meyer, Elisa Funiciello, Giulia Lorenzetti, Amanj Kurdi, Abdul Haseeb, Catrin E. Moore, Stephen Campbell, Brian Godman, Mike Sharland
Abstract
INTRODUCTION: 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. AREAS COVERED: This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. EXPERT OPINION: 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. CONCLUSIONS: 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.