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The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics

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  • Kathleen Anne Holloway
  • Laura Rosella
  • David Henry

Abstract

Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. Materials and Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. Results: Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of ≥20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiotic use data from linited surveys. Conclusions: Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.

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  • Kathleen Anne Holloway & Laura Rosella & David Henry, 2016. "The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-12, March.
    • Handle: RePEc:plo:pone00:0152020
    DOI: 10.1371/journal.pone.0152020
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    References listed on IDEAS

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    1. Kathleen Anne Holloway & David Henry, 2014. "WHO Essential Medicines Policies and Use in Developing and Transitional Countries: An Analysis of Reported Policy Implementation and Medicines Use Surveys," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-16, September.
    2. Radyowijati, Aryanti & Haak, Hilbrand, 2003. "Improving antibiotic use in low-income countries: an overview of evidence on determinants," Social Science & Medicine, Elsevier, vol. 57(4), pages 733-744, August.
    3. Rowe, A.K. & Onikpo, F. & Lama, M. & Osterholt, D.M. & Rowe, S.Y. & Deming, M.S., 2009. "A multifaceted intervention to improve health worker adherence to integrated management of childhood illness guidelines in Benin," American Journal of Public Health, American Public Health Association, vol. 99(5), pages 837-846.
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    1. Guan, Xiaodong & Tian, Ye & Song, Jiafang & Zhu, Dawei & Shi, Luwen, 2019. "Effect of physicians' knowledge on antibiotics rational use in China's county hospitals," Social Science & Medicine, Elsevier, vol. 224(C), pages 149-155.
    2. Katrina Perehudoff & Ivan Demchenko & Nikita V. Alexandrov & David Brutsaert & Angela Ackon & Carlos E. Durán & Faris El-Dahiyat & Firdaus Hafidz & Rezwan Haque & Rabia Hussain & Roderick Salenga & Fa, 2020. "Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries," IJERPH, MDPI, vol. 17(24), pages 1-30, December.
    3. Kathleen Anne Holloway & Verica Ivanovska & Solaiappan Manikandan & Mathaiyan Jayanthi & Anbarasan Mohan & Gilles Forte & David Henry, 2020. "Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-16, February.
    4. S Katrina Perehudoff & Nikita V Alexandrov & Hans V Hogerzeil, 2019. "The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-15, June.

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