Dear Massimo and all,
"More than 80% of children with diarrhea or cough are treated with an antibiotic. poor pay twice, with the little money they have and the wrong medicine they receive."
This is 'the elephant in the room' with regards to antibiotic resistance. Antibiotics are prescribed inappropriately for a wide range of common childhood illnesses. And in the minority of cases where an antibiotic is needed, the wrong antibiotic is prescribed - typically a more expensive broad-spectrum antibiotic. All of this is a major driver of resistance. It dwarfs other ongoing discussions about antibiotic resistance.
Massimo points to the marketing of drugs and privatisation of health care. Both clearly have a negative impact. Pharmaceutical companies want to sell expensive broad-spectrum antibiotics and will push their products accordingly. As Massimo has pointed out previously, the income of health facilities is often largely dependent on the profits made from sale of antibiotics in pharmacies within the same facility. At times there may be direct financial incentives to the prescriber.
This paper illustrates the extent of the problem, but does not explore the reasons.
CITATION: Tekleab AM, Asfaw YM, Weldetsadik AY, Amaru GM. Antibiotic prescribing practice in the management of cough or diarrhea among children attending hospitals in Addis Ababa: a cross-sectional study. Pediatric Health Med Ther. 2017 Sep 19;8:93-98. doi: 10.2147/PHMT.S144796. PMID: 29388610; PMCID: PMC5774594.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5774594/#
SELECTED EXTRACTS
'This study aimed to assess the extent of inappropriate antibiotic prescription among children managed for cough and/or diarrhea. Our finding that antibiotic was prescribed for the majority of the children (74.0%) who visited hospital for cough and/or diarrhea was consistent with the reports of other investigators.'
'Of the inappropriate prescriptions, 631 (91.7%) were for prescribing antibiotics when not necessary and 57 (8.3%) were for prescribing the wrong spectrum of antibiotics.'
'The use of antibiotics is recommended by the Ethiopian National Guideline and WHO guideline for the management of bacterial causes of diarrhea and pneumonia but not for presumed viral causes of such illnesses. Health care providers are expected to adhere to the guideline when antibiotics are prescribed for the management of these illnesses.'
'The unexpected finding in our study was that the likelihood of inappropriate antibiotic prescription was more likely to be done by pediatricians compared to the other health professionals.'
'There was no significant difference with regard to inappropriateness of prescriptions given by health care providers who were working in the private-for-profit hospitals compared to those working in the public health facility'
COMMENT (NPW): We need to understand better the reasons why prescribers do not follow guidelines. If these reasons are primarily for the financial benefit of the prescriber and their health facility, it would be important to make the general public aware of this. There would be a campaign to raise awareness that some health workers are putting profits above individual and public health. A better informed public would also be aware that antibiotics are ineffective or even harmful in most childhood illnesses.
Also, it would be interesting to understand better the attitudes of prescribers to national guidelines. In Ethiopia, clearly they take little notice of the national guidelines - do they trust them? What strategies might be used to improve the uptake of guidelines?
CHIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org