
The first known global systematic review and meta-analysis of antibiotic prescribing in primary care estimates 42 of every 100 primary care prescriptions contain antibiotics, and more than half are inappropriate, Chinese researchers reported late last week in the American Journal of Infection Control.
The study, led by researchers with Huazhong University of Science and Technology, examined data on primary care prescribing from 174 studies from 51 countries published from January 2000 through September 2023. Sixty-nine of the studies were conducted in high-income countries. The authors note that while primary care settings are recognized as a significant driver of antibiotic use, there are no global estimates of antibiotic prescribing in primary care.
"The absence of comprehensive estimates of global antibiotic prescriptions in primary care could be an important obstacle to the development and implementation of efficient antimicrobial stewardship," they wrote.
High rate of inappropriate antibiotics
The overall pooled prevalence of antibiotic prescriptions in primary care was 42.1% (95% confidence interval [CI], 39.2% to 45.1%), with a significantly higher prevalence observed in lower-middle-income countries (54.0%; 95% CI, 48.7% to 59.2%) and low-income countries (49.1%; 95% CI, 34.0% to 64.3%). The prevalence of antibiotic prescriptions was notably high in primary care in South Asia (54%), the Middle East and North Africa (46.7%), and sub-Saharan Africa (57.2%), and higher in rural areas than in urban areas (51.6% vs 48.0%).
The pooled prevalence of inappropriate antibiotic prescriptions was 57.6%.
Among the 37 studies that reported on factors associated with antibiotic prescriptions in primary care, the only significant association observed was with higher educational levels of patients (odds ratio [OR], 0.76; 95% CI, 0.71 to 0.82).
The analysis also found no significant decline in antibiotic prescribing over 20 years, a finding the authors say suggests that current antimicrobial stewardship strategies need to be re-evaluated.
"Future research should focus on the feasibility of antimicrobial stewardship patterns to identify important aspects of effective policy implementation," they wrote.