A recent study by Wieters, et al. (2024) titled “Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-Saharan Africa,” published in Antimicrobial Resistance & Infection Control by Springer Link, examines that the use of Watch antibiotics increased during the COVID-19 pandemic, especially among patients with acute febrile disease of unknown cause (AFDUC).
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Patients with respiratory conditions showed different usage patterns compared to those with gastrointestinal or febrile diseases– Wieters, et al. 2024
The study examines antibiotic use patterns among patients in sub-Saharan Africa, emphasizing its significant role in contributing to the growing problem of antimicrobial resistance (AMR). Conducted across 12 health facilities located in Côte d’Ivoire, Burkina Faso, the Democratic Republic of the Congo, and South Africa, the research focused on individuals presenting with acute respiratory infections, gastrointestinal illnesses, and febrile conditions. Among a total cohort of 19,700 patients, 36.8% reported having used antibiotics, with a concerning prevalence of antibiotics listed in the World Health Organization’s (WHO) “Watch” category, such as ceftriaxone. These antibiotics are classified as those with a higher risk of leading to AMR, necessitating careful monitoring and restricted use. The study found notable variations in antibiotic consumption based on both the type of illness and geographic location. For example, patients with respiratory conditions showed different usage patterns compared to those with gastrointestinal or febrile diseases, and the accessibility and type of antibiotics used varied significantly across the countries involved in the study. The over-reliance on broad-spectrum antibiotics like ceftriaxone raises concerns about inappropriate prescribing practices and the broader implications for AMR in the region.
How the Study was Conducted
The study employed a descriptive analysis of data from the ANDEMIA infectious disease surveillance network, covering 12 urban and rural health facilities in Côte d’Ivoire, Burkina Faso, the Democratic Republic of Congo, and the Republic of South Africa from February 2018 to May 2022. Clinical, demographic, socio-economic, and behavioral data were collected using standardized questionnaires. The data included patient demographics, symptoms, medical history, hospitalization, medication, and other relevant factors. Antibiotic use was defined as self-reported use in the ten days prior to study enrollment. Antibiotics were categorized according to the WHO AWaRe classification and analyzed by location, disease syndrome, and patient factors. Data were cleaned and analyzed using Stata software. Variables such as climatic region, pandemic period, and biometric measures were also considered in the analysis.
What the Authors Found
The author found that among 19,700 patients, 36.8% reported antibiotic use, with a significant portion using WHO Watch antibiotics like ceftriaxone, and antibiotic use varied by country, health facility location, and disease syndrome, highlighting the need for tailored interventions. No reserve antibiotics were reported, but some recommended antibiotics were used, particularly in the Democratic Republic of Congo. In addition, the use of Watch antibiotics increased during the COVID-19 pandemic, especially among patients with acute febrile disease of unknown cause (AFDUC).
Why is this important?
Antimicrobial Resistance (AMR): High antibiotic use, especially of WHO Watch antibiotics, can drive the development of AMR, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
Tailored Interventions: The variation in antibiotic use by location and disease syndrome suggests that interventions need to be customized to specific contexts to be effective. This can help in designing better policies and practices for antibiotic use.
Public Health Policies: Understanding the patterns of antibiotic use can inform public health policies and strategies to promote the rational use of antibiotics, ensuring they remain effective for future generations.
Impact of COVID-19: The increase in antibiotic use during the COVID-19 pandemic highlights the need for careful monitoring and management of antibiotic prescriptions during health crises to prevent unnecessary use and resistance.
What the Authors Recommended
- The authors advocate that tailored antibiotic use interventions are needed to address the specific patterns of use observed in different locations and among different disease syndromes.
- Enhanced monitoring and regulation of antibiotic use, especially WHO Watch antibiotics, to prevent the development and spread of antimicrobial resistance (AMR).
- The study emphasizes further evaluation of the accessibility and affordability of antibiotics to ensure that patients can obtain the necessary treatments without contributing to misuse or overuse.
- Furthermore, the development of public health strategies that promote rational antibiotic use, particularly during health crises like the COVID-19 pandemic, to avoid unnecessary prescriptions and resistance.
In conclusion, the study by Wieters et al. underscores the critical need for tailored interventions and stricter regulation of antibiotic use in sub-Saharan Africa, particularly during health crises like the COVID-19 pandemic. The overuse of WHO Watch antibiotics, such as ceftriaxone, poses a significant risk in accelerating antimicrobial resistance (AMR), which could severely undermine global public health efforts. To combat this, enhanced monitoring, responsible prescribing practices, and context-specific strategies are essential to preserving the effectiveness of antibiotics for future generations.
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