Edessa Dumessa, Assefa Nega, Dessie Yadeta, Asefa Fekede, Dinsa Girmaye, Oljira Lemessa
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
J Pharm Policy Pract. 2022 Sep 30;15(1):57. doi: 10.1186/s40545-022-00454-8.
Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries.
A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage.
In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets.
We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries.
CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
在全球范围内，非处方使用抗生素正成为一种新出现的危险行为。涉及非处方获取的不当使用是抗生素耐药性迅速增加的一个原因。儿童经常患许多自限性疾病，他们经常在没有处方的情况下使用抗生素。然而，目前尚无具体的确凿证据来指导针对这种不安全行为采取行动。因此，我们旨在估计低收入和中等收入国家社区层面儿童非处方使用抗生素的合并比例。
从PubMed/Medline、Embase、Scopus、CINAHL和谷歌学术搜索记录。符合条件的英文出版物是报道低收入和中等收入国家基于社区的儿童非处方使用抗生素的原创文章。提取研究特征和无处方使用的抗生素数量，并采用随机效应模型合并效应大小。非处方使用抗生素的合并比例以百分比估计。
在本分析中，我们共纳入39篇文章，涉及40450名参与者。其中，16315名参与者使用了非处方抗生素。非处方使用抗生素的合并百分比为45%（95%置信区间：40 - 50%）。在涉及模拟患者方法的研究中（56%；95%置信区间：49 - 62%），该估计值显著高于社区调查研究（40%；95%置信区间：34 - 46%）（P = 0.001）。它还因抗生素使用的回忆期而异——即时观察到的行为为56%（95%置信区间：50 - 62%），两周内回忆为36%（95%置信区间：22 - 50%），1 - 6个月回忆为35%（95%置信区间：26 - 45%），超过六个月回忆为46%（95%置信区间：37 - 54%）（P = 0.001）。非处方使用抗生素的主要获取途径是零售药店。
我们发现，在社区环境中用于儿童的抗生素近一半是无处方使用的。对于这些不安全行为，看护人主要从药店获取抗生素。因此，针对这些药店和社区层面开展因地制宜的教育和监管干预措施，是改善低收入和中等收入国家儿童抗生素使用情况的首要步骤。
CRD42021288971（PROSPERO）。https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 。
