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Antibiotics
Special Issues
Antibiotics Stewardship in Low and Middle-Income Countries
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Antibiotics Stewardship in Low and Middle-Income Countries

A Special Issue of Antibiotics (ISSN 2079-6382) belonging to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 13435

Editors

Dr. Tania Ayllón

E-Mail Website
Guest Editor
Department of Animal Health, Faculty of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain
Interests: (re)emerging infections; vector-borne diseases; antibiotic resistance; microbiology
Special Issues, Collections and Topics in MDPI journals
Dr. Gustavo Ortiz-Díez

E-Mail Website
Guest Editor
Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain
Interests: nosocomial infections; surgical site infection; antibiotic resistance; oncological surgery; preventive medicine; statistics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is an escalating global crisis that significantly impacts public health, animal health, and the environment. This issue is particularly severe in low and middle-income countries (LMICs), where the high burden of communicable diseases and limited access to appropriate antimicrobials result in a 1.5 times higher likelihood of death from AMR. Health systems in LMICs often struggle with resource constraints, especially in rural areas, making universal access to primary healthcare a major challenge. Additionally, the misuse of antibiotics, inadequate water and waste management, poor sanitation and hygiene services, and climate factors have accelerated the development of multidrug-resistant (MDR) strains in these countries.

Addressing AMR requires a comprehensive and integrated approach, particularly under the "One Health" concept, which recognizes the interconnectedness of human and animal health and ecosystems. Preventive measures, such as improving hygiene and sanitation, implementing robust disinfection protocols, and enhancing infection control practices, are critical in both hospital and community settings to reduce the reliance on antibiotics. Furthermore, strengthening epidemiological surveillance and regulatory frameworks can help monitor and control the spread of resistant strains.

Surveys play a crucial role in understanding antibiotic use patterns and assessing the implementation and effectiveness of surveillance measures. They provide valuable data on prescribing practices, compliance with stewardship protocols, and the awareness and attitudes of healthcare providers and the public towards AMR.

This Special Issue aims to present recent research and reviews on Antibiotics Stewardship in LMICs, covering epidemiological surveillance, regulatory improvements, and effective stewardship practices. It will also explore innovative prevention strategies, hygiene and disinfection measures, community-based interventions, and the role of surveys in evaluating antibiotic use and surveillance efforts. By highlighting these multifaceted approaches, this issue seeks to provide valuable insights and actionable recommendations to curb AMR in resource-limited settings.

We invite contributions that enhance our understanding and propose solutions to this pressing issue.

Dr. Tania Ayllón
Dr. Gustavo Ortiz-Díez
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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized 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 (AMR)
  • low and middle-income countries (LMICs)
  • multidrug-resistant (MDR) strains
  • One Health
  • public health
  • animal health
  • environmental impact
  • healthcare
  • sanitation and hygiene
  • preventive medine
  • epidemiological surveillance

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Published Papers (4 papers)

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12 pages, 229 KB  
Communication
Development of the Zambian Standard Treatment Guidelines in the Animal Health Sector: A Key Step in Advancing Antimicrobial Stewardship
by Chikwanda Chileshe, Fusya Goma, Ntombi B. Mudenda, Steward Mudenda, Taona Sinyawa, Mwendalubi Hadunka, Geoffrey Mainda, Namukolo Muyamwa, Chrisborn Mubamba, Niwael Jesse Mtui Malamsha, Suze Percy Filippini, Maisa Kasanga, Victor Daka, Webrod Mufwambi, Amon Siame, Aubrey C. Kalungia, Zoran Muhimba, Mercy Mukuma, Sandra Diana Mwadesta, Shikanga O-Tipo, Jimmy Hangoma, John Bwalya Muma, Joseph Yamweka Chizimu, Charles Maseka and Roma Chilengiadd Show full author list remove Hide full author list
Antibiotics 2025, 14(11), 1093; https://doi.org/10.3390/antibiotics14111093 - 1 Nov 2025
Cited by 3 | Viewed by 1649
Abstract
Background: Zambia, like many low- and middle-income countries, faces a growing burden of antimicrobial resistance (AMR), driven by the misuse of antimicrobials in both human and animal health, a limited diagnostic capacity, and weak regulatory enforcement. To address this challenge, Standard Treatment [...] Read more.
Background: Zambia, like many low- and middle-income countries, faces a growing burden of antimicrobial resistance (AMR), driven by the misuse of antimicrobials in both human and animal health, a limited diagnostic capacity, and weak regulatory enforcement. To address this challenge, Standard Treatment Guidelines (STGs) were developed for the veterinary sector, which represents a major milestone in the country’s AMR containment strategy. STGs are evidence-based protocols that guide veterinary professionals in consistently and appropriately diagnosing and treating animal diseases. They promote the rational use of veterinary medicines, and can mitigate AMR and improve animal health outcomes. By translating the best evidence into best practices, STGs also provide a practical foundation for antimicrobial stewardship (AMS) programs. Until 2023, Zambia lacked nationally adopted STGs for the veterinary sector. The introduction and standardization of these guidelines are expected to promote prudent antimicrobial use and raise the standard of care delivered to animal patients across the country. Objective: The aim of this paper is to provide a practical reference for future revisions of STGs and outline the successful methodology used to create STGs in the Zambian animal sector. Methods: A situational analysis was conducted to identify priority animal health conditions and existing treatment gaps within the veterinary sector. A multidisciplinary expert committee was then formed, comprising veterinarians, veterinary paraprofessionals, academics, regulatory authorities, and private sector stakeholders, to lead the development of the STGs. The process was guided by the WHO methodology for developing treatment guidelines, including a comprehensive review of the clinical evidence, local disease patterns, antimicrobial resistance data, and existing treatment practices. Draft STGs were developed with clearly defined, species-specific treatment protocols tailored to the Zambian context. For the validation process, the AGREE II instrument was used to assess the quality, clarity, and applicability of the guidelines. Structured stakeholder consultations with practitioners, policy-makers, and technical experts were held to ensure that the guidelines were practical, evidence-based, and aligned with national priorities. The validated drafts were then disseminated and piloted in selected districts. Conclusions: The development of the species-specific STGs represents an essential turning point in the country’s efforts to promote responsible veterinary care and contain AMR. STGs have become a prominent key support in the delivery of quality animal care. Further, the guidelines will assist in the optimization of antimicrobial use in animal health in Zambia. Full article
(This article belongs to the Special Issue Antibiotics Stewardship in Low and Middle-Income Countries)
10 pages, 358 KB  
Article
Evaluation of a Hub-and-Spoke Model to Enhance Healthcare Professionals’ Practice of Antimicrobial Stewardship (AMS) Programmes in the Volta Region of Ghana
by Mairead McErlean, Eneyi Kpokiri, Preet Panesar, Emily E. Cooper, Jonathan Jato, Emmanuel Orman, Hayford Odoi, Araba Hutton-Nyameaye, Samuel O. Somuah, Isaac Folitse, Thelma A. Aku, Inemesit O. Ben, Melissa Farragher, Leila Hail, Cornelius C. Dodoo and Yogini H. Jani
Antibiotics 2025, 14(7), 672; https://doi.org/10.3390/antibiotics14070672 - 2 Jul 2025
Cited by 3 | Viewed by 1964
Abstract
Background: Antimicrobial resistance (AMR) poses a critical global health challenge, particularly in resource-limited settings. A hub-and-spoke model, decentralising expertise and distributing resources to peripheral facilities, has been proposed as a strategy to enhance the antimicrobial stewardship (AMS) capacity in low- and middle-income [...] Read more.
Background: Antimicrobial resistance (AMR) poses a critical global health challenge, particularly in resource-limited settings. A hub-and-spoke model, decentralising expertise and distributing resources to peripheral facilities, has been proposed as a strategy to enhance the antimicrobial stewardship (AMS) capacity in low- and middle-income countries. Aim: This study sought to understand healthcare professionals’ experiences of a hub-and-spoke AMS model in the Volta Region of Ghana and its influence on clinical practice, leadership, and collaborative endeavours to address AMR. Methods: A qualitative descriptive design was adopted. In-depth interviews were conducted with 11 healthcare professionals who participated in the AMS program. Thematic analysis was used to identify key themes related to the knowledge and skills that were gained, clinical and leadership practice changes, capacity building, and challenges. Results: Participants reported an increased awareness of AMR, particularly regarding the scale and clinical implications of antimicrobial misuse. The clinical practice improvements included more judicious prescribing and enhanced adherence to infection prevention and control measures. Many respondents highlighted stronger leadership skills and a commitment to capacity building through AMS committees, multidisciplinary collaboration, and cross-organisational knowledge exchange. Despite resource constraints and logistical hurdles, participants expressed optimism, citing data-driven approaches such as point prevalence surveys to track progress and inform policy. Engagement with hospital management and public outreach were viewed as essential to sustaining AMS efforts and curbing over-the-counter antibiotic misuse. Conclusions: The hub-and-spoke model caused observable improvements in AMS knowledge, clinical practice, and leadership capacity among healthcare professionals in Ghana. While challenges remain, particularly in securing sustainable resources and shifting community behaviours, these findings underscore the potential of network-based programs to catalyse systemic changes in tackling AMR. Future research should explore long-term outcomes and strategies for embedding AMS practices more deeply within healthcare systems and communities. Full article
(This article belongs to the Special Issue Antibiotics Stewardship in Low and Middle-Income Countries)
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18 pages, 2844 KB  
Article
A Regional Approach to Strengthening the Implementation of Sustainable Antimicrobial Stewardship Programs in Five Countries in East, Central, and Southern Africa
by Evelyn Wesangula, Joseph Yamweka Chizimu, Siana Mapunjo, Steward Mudenda, Jeremiah Seni, Collins Mitambo, Kaunda Yamba, Misbah Gashegu, Aquino Nhantumbo, Emiliana Francis, Nyambura Moremi, Henry Athiany and Martin Matu
Antibiotics 2025, 14(3), 266; https://doi.org/10.3390/antibiotics14030266 - 5 Mar 2025
Cited by 11 | Viewed by 6320
Abstract
Background: Antimicrobial stewardship (AMS) programs optimize the use of antimicrobials and reduce antimicrobial resistance (AMR). This study evaluated the implementation of AMS programs in Africa using a harmonized regional approach. Methods: This was an exploratory cross-sectional study across five countries involving 32 hospitals [...] Read more.
Background: Antimicrobial stewardship (AMS) programs optimize the use of antimicrobials and reduce antimicrobial resistance (AMR). This study evaluated the implementation of AMS programs in Africa using a harmonized regional approach. Methods: This was an exploratory cross-sectional study across five countries involving 32 hospitals using an adapted Periodic National and Hospitals Assessment Tool from the World Health Organization (WHO) policy guidance on integrated AMS activities in human health. Results: This study found baseline scores for AMS core elements ranging from 34% to 79% at the baseline which improved to 58% to 92% at the endline. At baseline, Drugs and Therapeutics Committee (DTC) functionality in updating facility-specific medicines and medical devices ranged from 58% to 100%, and this ranged from 79 to 100% at endline. Classifying antibiotics by WHO AWaRe, classification ranged from 33% to 83% at baseline and 64% to 100% at endline. Leadership commitment scores were 47% at baseline and 66% at endline. Education and training scores were 42% and 63% at baseline and endline, respectively. Reporting and feedback scores were 34% at baseline and 58% at endline. Conclusions: Our study showed that understanding context and standardizing regional stewardship approaches enhanced cross-country learning and improved AMS implementation. Although the challenges in Low- and Middle-Income Countries (LMICs) are similar, they vary by country and can be addressed by strengthening AMS regulatory frameworks and surveillance systems. Full article
(This article belongs to the Special Issue Antibiotics Stewardship in Low and Middle-Income Countries)
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Other

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13 pages, 1427 KB  
Project Report
Development of an Information and Communication Technology (ICT) Tool for Monitoring of Antimicrobial Use, Animal Disease and Treatment Outcome in Low-Income Countries
by Susanna Sternberg-Lewerin, Joshua Orungo Onono, Sofia Boqvist, Lawrence Mugisha, Wangoru Kihara, Linnea Lindfors, Kajsa Strandell and Florence Mutua
Antibiotics 2025, 14(3), 285; https://doi.org/10.3390/antibiotics14030285 - 10 Mar 2025
Cited by 5 | Viewed by 2585
Abstract
Background/Objectives: Surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) is needed to understand risks and implement policies. Collecting AMU data in the context of disease prevalence and therapeutic outcomes has been suggested for improving AMU. We describe the process of developing an [...] Read more.
Background/Objectives: Surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) is needed to understand risks and implement policies. Collecting AMU data in the context of disease prevalence and therapeutic outcomes has been suggested for improving AMU. We describe the process of developing an information and communication technology (ICT) system to monitor AMU, diseases and treatment outcomes in poultry in East Africa. Methods: A prototype system to register drug sales in veterinary pharmacies, a mobile application for farmers to report their AMU, and a database for monitoring was developed. Contact information for participating veterinarians was included as well as information about poultry diseases, husbandry, AMR and prudent use of antibiotics. The system was pilot-tested for a 6-month period in Kenya. Results: A total of 15,725 records were submitted by the 14 participating pharmacies and 91 records were entered by the 15 participating farmers. Overall, the participants were positive about the system and were able to use it. The information available was appreciated by the farmers. The pharmacy representatives appreciated getting an overview of their sales and stated that it had given them new insights. Conclusions: Despite some challenges, the concept of the developed ICT system could be useful for future monitoring of animal health and the use of pharmaceuticals in animals, and connecting farmers with veterinarians to improve animal health management. Our results underline the importance of close collaboration with stakeholders so that developed tools can be transferred to national ownership after the finalization of externally funded projects. Full article
(This article belongs to the Special Issue Antibiotics Stewardship in Low and Middle-Income Countries)
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