Torres Neusa F, Chibi Buyisile, Kuupiel Desmond, Solomon Vernon P, Mashamba-Thompson Tivani P, Middleton Lyn E
Instituto Superior de Ciências de Saúde (ISCISA), Maputo, Mozambique.
Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
Arch Public Health. 2021 Jan 3;79(1):2. doi: 10.1186/s13690-020-00517-9.
The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs.
The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool.
The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65-89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics.
This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.
非处方抗生素（NPA）在全球的使用呈上升趋势，令人担忧，在低收入和中等收入国家（LMICs）中持续存在率较高。NPA的使用对个人和社区健康产生负面影响，为超级细菌的传播铺平了道路，这可能会导致细菌耐药模式、抗生素耐药性（AR）和抗菌药物耐药性（AMR）的变化。本研究旨在通过系统评价和荟萃分析，估计LMICs中NPA的使用 prevalence，并描述其主要来源。
本研究是一项系统评价和荟萃分析，研究方案已在PROSPERO（CRD42017072954）注册。该评价使用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。如果数据库中搜索到的研究报告了来自LMICs的成年参与者中抗生素自我用药（SMA）的实践证据和NPA的使用 prevalence，则认为这些研究符合条件，这些研究发表于2007年至2017年之间。使用Meta XL统计软件进行汇总分析。计算汇总 prevalence 及其95%置信区间（CI）。使用预 后研究质量（QUIPS）工具评估纳入研究的偏倚风险。
该评价共纳入11项横断面研究，涉及5080名参与者，研究在亚洲（印度 Laos尼泊尔、巴基斯坦、斯里兰卡和也门）、拉丁美洲（危地马拉）、非洲（尼日利亚）的LMICs中进行。所有研究均报告了SMA的现有实践，报告的 prevalence 范围为50%至93.8%。SMA的汇总 prevalence 为78%（95%CI：65-89%）。NPA的主要来源是药店、家人和朋友、旧处方、家庭药柜和剩余抗生素。
本研究揭示了在所研究的LMICs中NPA的高使用率，发现女性的使用率是男性的两倍，且18至40岁的参与者使用率较高。该评价建议考虑更广泛的定性和全面的背景研究，以更好地理解NPA使用的细微差别。这将有助于发现灰色地带，为决策提供信息，支持在LMICs中重新设计和实施多方面的抗生素管理和保护干预措施。
