Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets

Abstract

Background

Policy implementation to reduce overuse of antibiotics remains weak in many low/middle-income countries (LMIC).

Aim

Identify the most effective policies for reducing inappropriate use of antibiotics.

Methods

Data on four standard indicators of antibiotic use (lower values indicating less inappropriate use) from surveys (2006–12) and implementation of 23 policies (2007–11) were analysed. Differences in indicator scores between countries implementing and not implementing policies were calculated. The impacts of multiple policies were assessed by regression analysis. Results were combined with two previous studies, one using global data 2003–7, the other South-East Asia data 2010–2015.

Results

Data were available for 44 countries. Beneficial effects were seen in several analyses showing more active policy implementation was associated with lower antibiotic use. The number of effective policies were negatively correlated with % patients prescribed antibiotics (r -0.5, p = 0.002) and % upper respiratory tract infections prescribed antibiotics (r -0.6, p = 0.002). Correlation of average policy ranking effectiveness between this study and the earlier global study was significant (r 0.69, p < 0.001). The top six policies from average rankings across the three studies were: national body responsible for quality use of medicines; public education programs; undergraduate training of doctors on clinical guidelines; antibiotics unavailable without prescription; hospital drug and therapeutics committees; and medicines free at the point of care.

Conclusion

Essential medicines policies consistently found to be associated with lower antibiotic use should be implemented urgently.