Community-Based Surveillance of Antimicrobial Use and ...

Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsExtended‐spectrum penicillins appeared to be used almost equally by private and publicfacilities at all sites. However, the number of DDDs prescribed for these ABMs appears to bemuch higher in South Africa than in India.The utility of expressing ABM use in DDD terms was shown, particularly with reference tothe fluoroquinolones and cephalosporins. These ABMs seemed to be used more in theprivate sector at all sites. However, in both India and South Africa, the difference was showneven more starkly when use was expressed as DDD prescribed per 100 patients.The private‐public difference was reflected in the rural versus urban use at the one site(Vellore) where this was looked for. In the rural areas where government‐run facilities areresponsible for a major part of health care, inexpensive ABMs like cotrimoxazole andextended‐spectrum penicillins supplied by the government were mostly used. In the urbanareas where private practitioners provide a good proportion of health care, newer groups ofABM such as fluoroquinolones were used more frequently. As noted for AMR, overall therewas no significant trend in ABM use over time.Different methods were used to assess bulk use in the Vellore and Delhi sites, which didallow for some comparison of trends in use with methods involving exiting patientinterviews. However, due to differences in numerators and denominators, no comparison ofabsolute use could be made using these two methods. Indeed, as will be explored in moredepth in Chapter 8, determination of an appropriate denominator was always a challenge inmeasuring ABMs, especially when attempting to depict exposure per unit population.Only a limited number of studies have reported on ABM use. The results of 35 countrystudies from 1988 to 2002, which followed the standard WHO/INRUD methodology, aresummarized in Table 7.4 39 . In general, it would appear that surveys performed in Africancountries showed lower ABM use than did those performed in parts of Asia. A similar trendwas seen between the three Indian and two South African sites.Table 7.4: Percentage of patients receiving ABMsPercentage of patientsCountriesreceiving ABMs20‐40% Malawi, Bangladesh, Zimbabwe, Tanzania, Ecuador, Guatemala,Cameron, Macedonia40‐60% Yemen, Uganda, Indonesia, India (Karnataka), Niger, Uzbekistan,Namibia, Mozambique, Ghana, Eritrea, Oman>60% Indonesia, Sudan, Pakistan, Niger, India (West Bengal)84