High antibiotic prescription rates in low and middle-income countries may indicate misuse
Inappropriate use of antibiotics is an important driver of antimicrobial resistance, yet the extent of antibiotic prescribing in low and middle-income countries (LMICs) is unknown. A study published in PLOS Medicine by Madhukar Pai at McGill University and colleagues found that approximately 50% of patients at primary care clinics in LMICs received at least one antibiotic, exceeding the World Health Organization’s recommended proportion of 30%, suggesting widespread overprescribing of antibiotics in LMICs.
Antimicrobial resistance is a growing health issue and is expected to contribute to increased loss of life globally. To assess the magnitude and patterns of antibiotic prescribing in primary care settings across LMICs, researchers systematically reviewed over 10,000 published studies, focusing on 48 cross-sectional studies in their final analyses. Using available data from individual studies, they calculated the proportion of patients who received an antibiotic prescription from a LMIC healthcare facility or the proportion of all drug prescriptions containing any antibiotic. While the researchers were able to quantify widespread prescribing of antibiotics in primary care settings, the analysed studies did not report on the common practice of direct dispensation of unlabelled medicines, which may indicate an underestimation of the true antibiotic prescription proportion.
According to the authors, “this is the first comprehensive analysis of antibiotic prescriptions in primary care in LMIC”s. More high quality studies are needed to collect data on the types, clinical reasons, and appropriateness of antibiotics prescribed. However, having an initial estimation of antibiotic prescription rates may help LMICs implement effective policies and interventions to better address the problem of antimicrobial resistance.