Cox Horace, Roeder Friederike, Okell Lucy, Niles-Robin Reza, James Kashana, Valz Olivia, Hauck Katharina, Sicuri Elisa
Caribbean Public Health Agency Port of Spain Trinidad and Tobago Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
ISGlobal Barcelona Spain ISGlobal, Barcelona, Spain.
Rev Panam Salud Publica. 2024 Oct 30;48:e109. doi: 10.26633/RPSP.2024.109. eCollection 2024.
To identify challenges that may raise pathogens' resistance to antimicrobial drugs by exploring the private market for antimicrobials in two selected mining and frontier areas of Guyana.
The private sector supply was mapped by approaching all authorized pharmacies and informal outlets, e.g., street vendors and grocery stores, around the two selected towns. Interviews were conducted with a) sellers on the availability of drugs, expiration dates, prices, and main producers; and b) customers on purchased drugs, diagnoses, and prescriptions received before purchasing drugs, and intention to complete the treatment. The information collected was described, and the determinants of the self-reported intention of customers to complete the whole treatment were identified.
From the perspective of the supply of antimicrobials, essential medicines faced low and insecure availability, and prescriptions frequently deviated from diagnoses. From the perspective of the demand for antimicrobials, one-third of purchased antibiotics had a high potential for antimicrobial resistance as per the World Health Organization AWaRe classification. A high price reduced the self-reported intention to complete the treatment among those who had a prescription, while buying the medication in a licensed pharmacy increased such intention.
In Guyana, there persists a need to establish and revise policies addressing both supply and demand, such as restricting the sale of antimicrobials to licensed pharmacies and upon prescription, improving prescription practices while reducing the financial burden to patients, guaranteeing access to first-line treatment drugs, and instructing patients on appropriate use of antimicrobials. Revising such policies is an essential step to contain antimicrobial resistance in the analyzed areas and across Guyana.
通过探索圭亚那两个选定的矿区和边境地区的抗菌药物私营市场，确定可能提高病原体对抗菌药物耐药性的挑战。
通过走访两个选定城镇周围的所有授权药店和非正式销售点，如街头小贩和杂货店，来绘制私营部门的供应情况图。对以下人员进行了访谈：a）药品销售商，了解药品的供应情况、有效期、价格和主要生产商；b）顾客，了解购买的药品、诊断情况、购药前收到的处方以及完成治疗的意愿。对收集到的信息进行了描述，并确定了顾客自我报告的完成整个治疗意愿的决定因素。
从抗菌药物供应的角度来看，基本药物供应不足且不稳定，处方常常与诊断不符。从抗菌药物需求的角度来看，根据世界卫生组织的AWaRe分类，三分之一购买的抗生素具有较高的抗菌药物耐药性潜力。高价降低了有处方者自我报告的完成治疗的意愿，而在持牌药店购买药物则增加了这种意愿。
在圭亚那，仍然需要制定和修订针对供需双方的政策，例如将抗菌药物的销售限制在持牌药店并凭处方销售，改善处方开具做法，同时减轻患者的经济负担，确保获得一线治疗药物，并指导患者正确使用抗菌药物。修订这些政策是在分析地区及整个圭亚那控制抗菌药物耐药性的重要一步。
