The first thing that strikes the reader of this review is the age of the national antimicrobial treatment guidelines cited within it. There should be at least annual processes in place to review and update in every country.
It is also notable that there is no indication of how well used these sources are by clinical professionals in making treatment decisions, and by governments in making policy decisions. This would be a useful future piece of research.
There has been a discussion by a number of global specialists in healthcare information, including WHO colleagues, about the possibility of working with professional bodies across the continent to provide a base set of guidelines for local amendment, and/or to help establish teams to maintain such work across Africa (this may provide a model for work all around the world).
A frontline guide to antibiotic resistance may provide a counter to information that encourages use of antibiotics without regard to stewardship issues. The guide should be a shortcut to treatment, organised by infection site or type. It could also provide a guide to developing a policy for antimicrobial stewardship.
Any proposal for an information resource would need to address measures to ensure accuracy, independence from non-evidence-based influence, process for regular updating, and measures to drive universal use of such a resource.
It would be good to know if there is still interest at WHO in supporting something like this.
Overprescription of antibiotics is high in sub-Saharan Africa, due partly to perverse financial incentives for prescribers and partly to ready availability associated with self-medication. Another important factor is the availability of robust clinical guidelines. This new paper in WHO Bulletin concludes that African countries 'lack antimicrobial treatment guidelines that meet internationally accepted methods'. Citation and abstract below.
CITATION: Comparison of national antimicrobial treatment guidelines, African Union
Jessica Craig et al.
Bull World Health Organ. 2022 Jan 1; 100(1): 50-59.
Published online 2021 Nov 26. doi: 10.24771/BLT.21.286689
Objective: To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.
Methods: We reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States...
Findings: We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes.
Conclusion: AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.
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HIFA profile: Duncan Enright is Managing Director at Evidence-based Networks Ltd in the UK. Professional interests: Building point of care knowledge tools to improve outcomes for patients, professionals and governments. He is a member of the HIFA working group on Prescribers and Users of Medicines.