An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector: findings and therapeutic implications

Dan Kibuule, Mwangana Mubita, Ester Naikaku, Francis Kalemeera, Brian B. Godman, Evans Sagwa

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%-96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.

AIM: To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia.

METHODS: Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic.

RESULTS: Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3%) antibiotics and ATC J01C/J01D (48%) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2%). Published policies (58.6%-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections.

CONCLUSIONS: Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.

LanguageEnglish
Number of pages10
JournalInternational Journal of Clinical Practice
Volume71
Issue number2
Early online date16 Jan 2017
DOIs
Publication statusPublished - 28 Feb 2017

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Namibia
Azithromycin
Public Sector
Policy Making
Amoxicillin
Sulfamethoxazole Drug Combination Trimethoprim
Anti-Bacterial Agents
Therapeutics
Guidelines
Drug and Narcotic Control
Respiratory Tract Infections

Keywords

  • antibiotic use
  • policies
  • cotrimoxazole
  • amoxicillin
  • azithromycin
  • Namibia

Cite this

@article{a8acd8909df34a1a8d44fbb2f68a3ed4,
title = "An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector: findings and therapeutic implications",
abstract = "BACKGROUND: Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9{\%}-96.7{\%}). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.AIM: To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia.METHODS: Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic.RESULTS: Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3{\%}) antibiotics and ATC J01C/J01D (48{\%}) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2{\%}). Published policies (58.6{\%}-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections.CONCLUSIONS: Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.",
keywords = "antibiotic use, policies, cotrimoxazole, amoxicillin, azithromycin, Namibia",
author = "Dan Kibuule and Mwangana Mubita and Ester Naikaku and Francis Kalemeera and Godman, {Brian B.} and Evans Sagwa",
note = "This is the peer reviewed version of the following article: Kibuule, D., Mubita, M., Naikaku, E., Kalemeera, F., Godman, B. B., & Sagwa, E. (2017). An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector: findings and therapeutic implications. International Journal of Clinical Practice, which has been published in final form at http://dx.doi.org/10.1111/ijcp.12918. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving",
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An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector : findings and therapeutic implications. / Kibuule, Dan; Mubita, Mwangana; Naikaku, Ester; Kalemeera, Francis; Godman, Brian B.; Sagwa, Evans.

In: International Journal of Clinical Practice, Vol. 71, No. 2, 28.02.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector

T2 - International Journal of Clinical Practice

AU - Kibuule, Dan

AU - Mubita, Mwangana

AU - Naikaku, Ester

AU - Kalemeera, Francis

AU - Godman, Brian B.

AU - Sagwa, Evans

N1 - This is the peer reviewed version of the following article: Kibuule, D., Mubita, M., Naikaku, E., Kalemeera, F., Godman, B. B., & Sagwa, E. (2017). An analysis of policies for cotrimoxazole, amoxicillin and azithromycin use in Namibia's public sector: findings and therapeutic implications. International Journal of Clinical Practice, which has been published in final form at http://dx.doi.org/10.1111/ijcp.12918. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving

PY - 2017/2/28

Y1 - 2017/2/28

N2 - BACKGROUND: Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%-96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.AIM: To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia.METHODS: Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic.RESULTS: Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3%) antibiotics and ATC J01C/J01D (48%) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2%). Published policies (58.6%-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections.CONCLUSIONS: Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.

AB - BACKGROUND: Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%-96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia.AIM: To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia.METHODS: Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic.RESULTS: Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3%) antibiotics and ATC J01C/J01D (48%) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2%). Published policies (58.6%-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections.CONCLUSIONS: Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.

KW - antibiotic use

KW - policies

KW - cotrimoxazole

KW - amoxicillin

KW - azithromycin

KW - Namibia

U2 - 10.1111/ijcp.12918

DO - 10.1111/ijcp.12918

M3 - Article

VL - 71

JO - International Journal of Clinical Practice

JF - International Journal of Clinical Practice

SN - 1368-5031

IS - 2

ER -