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Antibiotics
Special Issues
Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries
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Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 12581

Special Issue Editors

Prof. Dr. Xiaolin Wei

E-Mail Website
Guest Editor
Fellow of Canadian Academy of Health Sciences (FCAHS), Dalla Lana Chair in Global Health Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
Interests: AMR; implementation science; complex interventions; reviews; health system; policy; one health
Special Issues, Collections and Topics in MDPI journals
Dr. Rebecca King

E-Mail Website
Guest Editor
Faculty of medicine and health, School of Medicine, University of Leeds, Leeds LS2 9JT, UK
Interests: prevention and control of antibiotic resistance; antibiotics use; antimicrobial resistance

Special Issue Information

Dear Colleagues,

Many interventions to reduce antimicrobial resistance (AMR) have been designed and implemented in high-income countries. However, the risk of antimicrobial resistance (AMR) emerging is substantial in low- and middle-income countries (LMICs), where the health systems and regulations are often weak, awareness is limited, and competing socioeconomic challenges are constantly emerging. The World Health Organization (WHO)’s Global Action Plan on AMR called for actions to improve the knowledge and awareness of AMR, and the rational use of antibiotics, and to develop national plans to build up antimicrobial stewardship programmes in both the human and animal health sectors. The current pandemic caused by the novel coronavirus SARS-CoV-2 reaffirms the importance of a one-health approach.

This Special Issue calls for studies regarding interventions to reduce AMR in LMICs. The theme includes interventions at the health-system and policy levels; stewardship programmes in hospitals, primary care facilities and pharmacies; and interventions at the community level, as well as interventions using the one-health concept that cover both human and animal health. Studies employing implementation science frameworks will be particularly interesting because they not only demonstrate what works (or not) but also show how the interventions are implemented and under which contexts. We welcome original studies, reviews, and comparative analyses conducted in LMICs or relevant to LMICs.

Prof. Dr. Xiaolin Wei
Dr. Rebecca King
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Antimicrobial resistance
  • antibiotic
  • interventions
  • low- and middle-income countries
  • one health
  • implementation science

Published Papers (4 papers)

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Research

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14 pages, 531 KiB  
Article
How Are We Educating Future Physicians and Pharmacists in Pakistan? A Survey of the Medical and Pharmacy Student’s Perception on Learning and Preparedness to Assume Future Roles in Antibiotic Use and Resistance
by Naeem Mubarak, Sara Arif, Mahnoor Irshad, Rana Muhammad Aqeel, Ayesha Khalid, Umm e Barirah Ijaz, Khalid Mahmood, Shazia Jamshed, Che Suraya Zin and Nasira Saif-ur-Rehman
Antibiotics 2021, 10(10), 1204; https://doi.org/10.3390/antibiotics10101204 - 03 Oct 2021
Cited by 5 | Viewed by 2064
Abstract
Background: Medical and pharmacy students are future healthcare professionals who will be on the forefront in dealing with antibiotics in hospitals or community settings. Whether the current medical and pharmacy education in Pakistan prepares students to take future roles in antibiotic use remains [...] Read more.
Background: Medical and pharmacy students are future healthcare professionals who will be on the forefront in dealing with antibiotics in hospitals or community settings. Whether the current medical and pharmacy education in Pakistan prepares students to take future roles in antibiotic use remains an under-researched area. Aim: This study aims to compare medical and pharmacy students’ perceived preparedness, learning practices and usefulness of the education and training on antibiotic use and resistance imparted during undergraduate studies in Pakistan. Design and Setting: It was amulti-centre cross-sectional survey of medical and pharmacy colleges in Punjab, Pakistan. Method: A self-administered questionnaire was used to collect data from final year medical and pharmacy students. Descriptive statistics were used for categorical variables while independent t-test and One-way ANOVA computed group differences. Result: Nine hundred forty-eight respondents (526 medical and 422 pharmacy students) completed the survey from 26 medical and 19 pharmacy colleges. Majority (76.1%) of the pharmacy students had not completed a clinical rotation in infectious diseases. The top three most often used sources of learning antibiotic use and resistance were the same among the medical and the pharmacy students; included textbooks, Wikipedia, and smart phone apps. Overall self-perceived preparedness scores showed no significant difference between pharmacy and medical students. The least prepared areas by medical and pharmacy students included transition from intravenous to oral antibiotics and interpretation of antibiograms. Both medical and pharmacy students found problem solving sessions attended by a small group of students to be the most useful (very useful) teaching methodology to learn antibiotic use and resistance. Conclusions: Differences exist between medical and pharmacy students in educational resources used, topics covered during undergraduate degree. To curb the growing antibiotic misuse and resistance, the concerned authorities should undertake targeted educational reforms to ensure that future physicians and pharmacists can play a pivotal role in rationalizing the use of antibiotics. Full article
(This article belongs to the Special Issue Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries)
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14 pages, 563 KiB  
Article
The Prevalence and Factors Associated with Prophylactic Antibiotic Use during Delivery: A Hospital-Based Retrospective Study in Palembang, Indonesia
by Ariesti Karmila, Mohammad Zulkarnain, Abarham Martadiansyah, Putri Mirani, Nuswil Bernolian, Joseph C. Gardiner and Lixin Zhang
Antibiotics 2021, 10(8), 1004; https://doi.org/10.3390/antibiotics10081004 - 19 Aug 2021
Cited by 3 | Viewed by 2551
Abstract
Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain [...] Read more.
Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence. Full article
(This article belongs to the Special Issue Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries)
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14 pages, 660 KiB  
Article
Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan
by Naeem Mubarak, Asma Sarwar Khan, Taheer Zahid, Umm e Barirah Ijaz, Muhammad Majid Aziz, Rabeel Khan, Khalid Mahmood, Nasira Saif-ur-Rehman and Che Suraya Zin
Antibiotics 2021, 10(8), 906; https://doi.org/10.3390/antibiotics10080906 - 24 Jul 2021
Cited by 10 | Viewed by 3355
Abstract
Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new [...] Read more.
Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of “YES”, “NO” or “Under Process” constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated “Perfect” adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were “Poor“ in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or ”Under Process”. The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan. Full article
(This article belongs to the Special Issue Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries)
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Review

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14 pages, 433 KiB  
Review
The Emergence of Multidrug-Resistant Helicobacter pylori in Southeast Asia: A Systematic Review on the Trends and Intervention Strategies Using Antimicrobial Peptides
by Asif Sukri, Bruno S. Lopes and Alfizah Hanafiah
Antibiotics 2021, 10(9), 1061; https://doi.org/10.3390/antibiotics10091061 - 01 Sep 2021
Cited by 22 | Viewed by 3533
Abstract
The emergence of multidrug-resistant H. pylori poses a public healthcare threat, particularly in low- and middle-income countries. Recently, the World Health Organization has classified clarithromycin-resistant H. pylori as high priority in the research and discovery of novel antibiotics. This study was aimed to [...] Read more.
The emergence of multidrug-resistant H. pylori poses a public healthcare threat, particularly in low- and middle-income countries. Recently, the World Health Organization has classified clarithromycin-resistant H. pylori as high priority in the research and discovery of novel antibiotics. This study was aimed to systematically review the prevalence of primary antibiotic resistance in H. pylori in Southeast Asian countries (SEAC) and to review current studies of antimicrobial peptides against H. pylori. We systematically searched through electronic databases of studies conducted on antimicrobial resistance of H. pylori in SEA countries. Furthermore, we searched articles that conducted studies on antimicrobial peptides, naturally occurring host’s defense molecules, against H. pylori. After a series of screening processes, 15 studies were included in our systematic review. Our analysis revealed that primary resistance of H. pylori to metronidazole, clarithromycin, and levofloxacin were high in SEAC, although the primary resistance to amoxicillin and tetracycline remains low. Multidrug-resistant H. pylori are emerging in SE Asian countries. The antimicrobial peptides show promising antibacterial and antibiofilm activity against drug-resistant H. pylori. The research and discovery of antimicrobial peptides against H. pylori in SEAC will help in limiting the spread of antimicrobial resistance of H. pylori. Full article
(This article belongs to the Special Issue Interventions to Reduce Antimicrobial Resistance in Low and Middle-Income Countries)
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