Main Article Content
antimicrobials, consumption, Latin America, Hospital, AWaRe, WHO
One of the main problems for health service around the world is the antimicrobial resistance (AMR).
Objective: to describe the antimicrobial consumption (AMC) at hospital level in Latin American countries and compare the amount and type of antibiotics usage among them in order to guide local public health actions towards AMR prevention.
Design: A descriptive study of antimicrobial consumption at hospital level among six health institution in Latin America with an analytical comparative stage. Antimicrobials included corresponded to the WHO Anatomical Therapeutic Chemical (ATC) classification system subgroups: J01, A07A and P01AB.
Methods: WHO GLASS methodology was applied for surveillance of AMC, using the ATC classification based on Defined Daily Dose (DDD) and DDD/100 hospital discharges as standard unit of measurement. Antimicrobials consumed were also classified according to the WHO Access-Watch-Reserve (AWaRe) classification.
Results: The quantitative data, measured in DDD/100 hospital discharges, showed a wide range of consumption (182.48 - 2260.95). Qualitative analysis according to the AWaRe classification also showed a wide range in terms of consumption of Access (38.14% - 73.64%), Watch (24.93% - 60 .53%) and Reserve (0.31% - 3.55%) groups expressed as a percentage of the total consumption.
Conclusion: Great heterogeneity and arbitrariness exist in the selection of antimicrobials for hospital use. Although this situation might be explained on local antimicrobial resistance, the history of prescription, local pharmaceutical promotion, and pharmacological education of health professional in each country, particular habits and distinctive culture may justify the differential consumption patterns observed in each institution in this study.
2. World Health Organization. Combat drug resistance: no action today means no cure tomorrow. Statement WHO Director General, Dr Margaret Chan. Geneva; 2011. Available from: http://www. who.int/mediacentre/news/statements/2011/whd_20110407/en/ index. Accessed August 3rd2022.
3. Hecker MT, Aron Dc, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse. Arch Intern Med. 2003;163(8):972-8.
4. President’s Council of Advisors on Science and Technology. Report to the President on Combating Antibiotic Resistance. Washington D.C.: Executive Office of the President: 2014. Available from: https://shea-online.org/images//ThePolicyResourceCenter/SupporttheSTAARAct/president.pdf. Accessed August 3rd2022.
5. Nathan C, Cars O. Antibiotic resistance-problems, progress, and prospects. N Engl J Med. 2014; 6;371(19):1761-3. 5. Chellat MF, Raguz L, Riedl R. Targeting antibiotic resistance. Angew Chem Int Ed Engl 2016; 55(23):6600-26
6. World Health Organization. Worldwide country situation analysis: response to antimicrobial resistance. Geneva: WHO; 2015. Available from: http://www.who.int/drugresistance/e. . Accessed 30th July, 2022.
7. Pan American Health Organization. 54th Directing Council 67th Session of the Regional Committee of WHO for the Americas. Plan of Action on Antimicrobial Resistance. Washington, DC: PAHO; 2015. Available from: https://www.paho.org/hq/dmdocuments/2015/ CD54-12-e.pdf. Accessed August 1st, 2022.
8.Sharland M, Pulcini C, Harbarth S, et al. Classifying antibiotics in the WHO Essential Medicines List for optimal use—be AWaRe. Lancet Infect Dis 2018; 18: 18–20.
9. GLASS guide for national surveillance systems for monitoring antimicrobial consumption in hospitals”. Available in https://apps.who.int/iris/handle/10665/336182.
10. WHO. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment, Word Health Organization. 2022 https://wwwwhoccno/atc_ddd_index/ Accessed 18th July 2022.
11. European Surveillance of Antimicrobial Consumption Network (ESAC-Net). European Centre for Disease Prevention and Control (ECDC) Available at: https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/esac-net Accessed August 1st, 2022.
12. Hsia Y, Lee B.R, Versporten A. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. Lancet GlobHealth 2019; 7: e861–71
13. Marin GH, Giangreco L, Dorati C, el al. Antimicrobial Consumption in Latin American Countries: First Steps of a Long Road Ahead. J Prim Care Community Health. 2022; 13:21501319221082346. doi: 10.1177/21501319221082346. Accessed August 1st, 2022.
14. World Health Organization. Strengthening health system governance: better policies, stronger performance. World Health Organization. Regional Office for Europe; 2016.
15. Fabre V, Cosgrove S, Secaira C, Tapia Torrez JC, , Lessa F, Patel T, Quiros R. Antimicrobial stewardship in Latin America: Past, present, and future. Antimicrobial Stewardship & Healthcare Epidemiology 2022; 2,1: e68 DOI: https://doi.org/10.1017/ash.2022.47