Community-Based Surveillance of Antimicrobial Use and ...

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5. Brits, South AfricaFig. 5.10 (A-B): Monthly use of specific ABM calculated at the individual and cluster levels (April2004 to March 2005)% prescriptions with ABM20151050A1. Percentage of prescriptions with specific ABM analysed atthe individual levelMacroTetraESPCotrimApr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar% prescriptions with ABM20181614121086420A2. Percentage of prescriptions with specific ABM analysed atthe cluster levelMacroTetraApr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarESPCotrimNo.DDDs ABM / 100 patients5004003002001000B1. No.DDDs of specific ABM prescribed per 100 patientsanalysed at the individual levelMacroTetraApr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarESPCotrimNo.DDDs ABM / 100 patientsB2. No.DDDs of specific ABM prescribed per 100 patientsanalysed at the cluster level Macro ESP500400Tetra Cotrim3002001000Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar5.3.3 Effect of ABM on AMRNo trends in AMR were expected to be seen, nor was it anticipated that these would beassociated with any changes in ABM use during the duration of the pilot study.5.3.4 Compliance with the Standard Treatment GuidelinesAt this site, the investigators also assessed compliance with the relevant Standard TreatmentGuidelines (STGs) included with the South African Essential Drugs List (EDL), applicable toPHC facilities in the public sector. As shown in Table 5.4, about one third of totalprescriptions did not comply with STG/EDL guidelines for choice of therapy. Potentiallyinappropriate use was identified most commonly in relation to extended‐spectrum and β‐lactamase‐resistant penicillins. Compliance was most common in relation to fluoroquinoloneuse. ABMs were prescribed for several indications, but most commonly for symptoms andsigns related to respiratory infections. Of the 544 patients receiving ABM therapy for thisindication, 334 reportedly had upper respiratory tract infections. Other diagnoses/presentingcomplaints recorded were sexually transmitted infections (in 534 patients), urinary tractinfections (291), skin infections (203), retroviral disease (345), otitis media (84),gastrointestinal infections (93) and dental conditions (36). Several other indications wererecorded and these included viral and fungal infections.65
Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsTable 5.4: Compliance with STG/EDL in choice of therapyNot compliant No. of prescriptions withinformation availableNumber %β‐lactamase‐resistant penicillin 59 44.4 133β‐lactamase‐susceptible penicillin 48 25.1 191Fluoroquinolones 26 10.0 259Macrolide 44 33.6 131Metronidazole 87 38.2 228Extended‐spectrum penicillin 281 47.7 589Tetracycline 56 21.1 265Cotrimoxazole 174 30.3 574Total 775 32.7 23705.4 Lessons learnt from this site5.4.1 AMRThis pilot site based its surveillance method only on women suspected of having a UTI, inorder to obtain E. coli isolates. The feasibility of this method is in question, as it failed todeliver the required numbers to allow for time series analysis. The number of urinespecimens collected was not enough to obtain the required number of isolates. It would haveproven too costly to increase the number of specimens by incorporating more clinics andcollecting specimens on a daily basis. Specimen collection was also dependent on the clinicalacumen of the trained field workers, who might have included patients other than those withUTIs. The high rate of sexually transmitted infections in the population visiting the clinicsalso led to the exclusion of many such patients as being possible UTIs.The investigators identified a number of other constraints that may be specific to the site,rather than the method, including:• difficulties in negotiating collaboration from sites that have never before been included inany surveillance efforts;• the involvement of community partners, which also required extensive and lengthynegotiations, but also resulted in a high turnover of data collectors;• the long distances between the different facilities, some remote, and the lack of regularpublic transport;• health management changes and sensitivity towards research, due to South Africa’ssocial past, which significantly delayed the programme approval and start, andoccasioned an initial retraction of support due to staff shortages.5.4.2 ABM useSome differences were seen in the ABM use in the PHC clinics and the OPD of the districthospital. This emphasized the need to obtain data from a range of facilities. Importantly, thissite could provide no data on ABM use in the for‐profit private sector. Data on66
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WHO/EMP/MAR/2009.2Community-Based S
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CONTENTSProject members ...........
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8.4 Lessons learnt concerning imple
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How this report is organizedHow thi
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Executive summaryExecutive summaryI
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Executive summaryAlthough ABM use a
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1. Background, aims and general met
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