Kibuule Dan, Mubita Mwangana, Naikaku Ester, Kalemeera Francis, Godman Brian B, Sagwa Evans
Department of Pharmacy practice & Policy, School of Pharmacy, University of Namibia, Windhoek, Namibia.
Department of Pharmacology and Therapeutics, School of Pharmacy, University of Namibia, Windhoek, Namibia.
Int J Clin Pract. 2017 Feb;71(2). doi: 10.1111/ijcp.12918. Epub 2017 Jan 16.
Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%-96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.
To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia.
Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic.
Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3%) antibiotics and ATC J01C/J01D (48%) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2%). Published policies (58.6%-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections.
Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.
尽管纳米比亚拥有健全的药品使用体系和政策，但抗生素使用指标仍不理想。近期的药品使用调查显示，复方新诺明、阿莫西林和阿奇霉素（CAA）位列使用最为广泛的药品之中。然而，对CAA的耐药性正在上升（55.9%-96.7%）。遗憾的是，迄今为止，评估纳米比亚改善抗生素使用政策的研究有限。
评估影响纳米比亚CAA抗生素治疗性使用的公共部门药品政策和指南。
通过定量文本分析评估纳米比亚关于CAA使用的药品政策和指南。主要结果变量包括抗生素政策的存在情况、每种抗生素的治疗适应症以及允许使用该抗生素的医疗机构类型/级别。
抗生素使用政策有限，仅有《纳米比亚药品政策草案》中有关于抗生素使用的声明。指南中未提及几种重要抗生素的治疗适应症。列出了29种抗生素用于69种治疗适应症；CAA（49.3%）抗生素和ATC J01C/J01D（48%）每种抗生素的适应症最多。对于CAA抗生素，这表明其主要用于急性呼吸道感染（n=22，37.2%）。已发布的政策（58.6%-17/29）推荐在初级卫生保健（PHC）层面使用抗生素，CAA抗生素主要推荐用于呼吸道感染和泌尿生殖系统感染。
纳米比亚抗生素使用的政策和指南并不全面，且偏向于初级卫生保健机构。现有政策促进了CAA抗生素的广泛使用，这可能会无意中导致其使用不当，从而提高耐药率。这就需要结合当地的抗菌药物耐药模式制定更全面的抗生素指南和基本药物清单。此外，还需要在所有关键利益相关者群体中开展教育活动。
