Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana; Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands.
Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana.
J Glob Antimicrob Resist. 2022 Jun;29:259-274. doi: 10.1016/j.jgar.2022.03.009. Epub 2022 Mar 25.
Inappropriate antibiotic dispensing is one of the key drivers of antibiotic resistance. This review documents the effectiveness of interventions aimed at improving antibiotic dispensing practices at the community level by drug dispensers in low- and middle-income countries (LMIC).
We conducted a systematic search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science (11 November 2019). Studies were included if they reported data on the outcome measure: appropriate dispensing of medicine including antibiotics. The effectiveness of studies was assessed based on quantitative results reported in the studies included.
A total of 1158 articles were screened. Thirteen studies from Asia (six), Africa (five) and South America (one) and one study from both Africa and Asia were included in this review. Nine (69.2%) studies reported significant effectiveness of interventions on all or more than 50% of antibiotic-related outcomes. Cochrane Effective Practice and Organization of Care interventions frequently applied were educational meetings (9/13), distribution of educational materials (7/13), educational outreach meetings (7/13), reminders (6/13), local consensus processes (6/13), distribution of supplies (6/14) and clinical practice guidelines (4/14), Nine studies reported on stakeholder involvement.
This review shows that it is possible to improve antibiotic dispensing practices at the community level in LMIC. Stakeholders' involvement was key in the design and implementation of interventions.
不合理的抗生素配药是抗生素耐药性的主要驱动因素之一。本综述记录了旨在改善中低收入国家（LMIC）社区药剂师抗生素配药实践的干预措施的有效性。
我们在 PubMed、EMBASE、Cochrane 对照试验中心注册库和 Web of Science（2019 年 11 月 11 日）进行了系统检索。如果研究报告了以下结果测量的相关数据：包括抗生素在内的药物的合理配药，则将其纳入研究。根据纳入研究中报告的定量结果来评估研究的有效性。
共筛选出 1158 篇文章。纳入了来自亚洲（6 项）、非洲（5 项）和南美洲（1 项）的 13 项研究，以及一项来自非洲和亚洲的研究。9 项（69.2%）研究报告称，干预措施在所有或超过 50%的抗生素相关结果上具有显著效果。Cochrane 有效实践和组织关怀干预措施经常应用的是教育会议（9/13）、教育材料分发（7/13）、教育外展会议（7/13）、提醒（6/13）、当地共识流程（6/13）、供应品分发（6/14）和临床实践指南（4/14）。9 项研究报告了利益相关者的参与情况。
本综述表明，在 LMIC 中改善社区一级的抗生素配药实践是可行的。利益相关者的参与是干预措施设计和实施的关键。
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