Stewardship / Resistance Scan for Jan 15, 2021

Non-prescription antibiotic dispensing in Africa
Antibiotic prescribing in Iran

Study finds antibiotics commonly dispensed without prescription in Africa

A systematic review and meta-analysis of 23 studies has found that dispensing of non-prescribed antibiotics outside of hospital settings is common in Sub-Saharan African countries, researchers reported yesterday in Antimicrobial Resistance and Infection Control.

To estimate the proportion of non-prescription antibiotic requests or consults that resulted in provision of antibiotics from community drug retail outlets (CDROs) in Sub-Saharan Africa, researchers from the University of Queensland, Australia, and the University of Gondar in Ethiopia conducted a literature search that yielded 23 studies, including 7 cross-sectional questionnaire-based surveys and 16 cross-sectional client-based studies. The studies were conducted in Ethiopia, Tanzania, Kenya, Sudan, Zimbabwe, Zambia, Ghana, Eritrea, Cameroon, and Uganda. The CDROs investigated included pharmacies, drug stores or shop, rural drug vendors, and accredited drug dispensing outlets.

A random-effect model meta-analysis of the data from these studies found that the overall pooled proportion of non-prescription antibiotic requests that resulted in the supply of antibiotics was 69%, ranging from 8% in Zimbabwe to 94% in Uganda. Upper respiratory tract infections and acute diarrhea were the most frequently presented case scenarios, and amoxicillin (26.5%) and co-trimoxazole (19.8%) were the most frequently dispensed antibiotics to treat those symptoms.

The study also found that non-prescription sale of antibiotics increased in Ethiopia, Kenya, Tanzania, and Zimbabwe even after those countries had adopted national action plans to combat antimicrobial resistance.

"Ease of access to and overuse can potentially accelerate the emergence of antibiotic resistance to few yet lifesaving antibiotics available in the region," the authors concluded. "Our review highlights the need for stringent enforcement of existing policies and/or enacting new regulatory frameworks that would regulate antibiotic supply, and continuous training and educational support for pharmacy personnel (e.g. pharmacists, pharmacy assistants) regarding judicious use of antibiotics and the importance of antimicrobial stewardship."
Jan 14 Antimicrob Resist Infect Control study


Study finds high rate of inpatient, outpatient antibiotic prescribing in Iran

In another study published yesterday in Antimicrobial Resistance and Infection Control, researchers reported high rates of inpatient and outpatient antibiotic prescribing in Iran.

The review and meta-analysis by Iranian and Dutch researchers looked at 54 studies published from 1995 through 2016, including 39 on outpatient prescribing and 15 on inpatient prescribing. The median rate of antibiotic prescribing in inpatient settings was 68.2%, with antibiotics prescribed for 39.5% of patients on all wards, 66% of patients on pediatric wards, and 75.3% of patients in intensive care units. The most commonly prescribed inpatient antibiotics were cephalosporins, penicillins, and carbapenems.

The median rate of antibiotic prescribing in outpatient settings was 45.3%. The mostly commonly prescribed outpatient antibiotics were penicillins, cephalosporins, macrolides, and aminoglycosides.

The study also found that traditional educational interventions to promote judicious antibiotic prescribing showed no significant effect on reducing the antibiotic prescribing rate.

The authors of the study say their findings highlight the need for Iranian policymakers to develop a national plan to improve antibiotic prescribing and consider the use of information technology–based interventions, such as clinical decision support systems, electronic health records, and electronic-based feedback on physician prescribing habits.
Jan 14 Antimicrob Resist Infect Control study

Newsletter Sign-up

Get CIDRAP news and other free newsletters.

Sign up now»


Unrestricted financial support provided by

Bentson Foundation Unorthodox Philanthropy logo and text 'Leading Underwriter'3M logoGilead 
Grant support for ASP provided by


  Become an underwriter»