An analysis of primary care antibiotic use in Burkina Faso and the Democratic Republic of the Congo (DRC) suggests that a high proportion of broad-spectrum antibiotic use could be replaced by narrower-spectrum or no antibiotic use, researchers reported late last week in The Lancet Infectious Diseases.
In a letter to the journal, researchers from Burkina Faso, the DRC, and Belgium said they conducted the study to evaluate whether the antibiotic use targets identified in the World Health Organization's (WHO's) AWaRE (Access, Watch, and Reserve) Antibiotic Book are realistic and achievable for low- and middle-income countries. The book recommends that 90% of infections requiring an antibiotic in primary healthcare can be treated with oral Access antibiotics rather than broad-spectrum Watch antibiotics, and that more than 50% of minor infections can be treated without antibiotics.
The WHO AWaRe Antibiotic Book has great potential to optimise antibiotic use in primary care.
Analyzing data from patient surveys after visits to primary healthcare centers and over-the-counter medicine stores, the researchers found that 638 (60%) of 1,062 patients in Burkina Faso and 297 (80%) of 371 patients in the DRC used antibiotics, of which 8% and 30% were Watch antibiotics. Of the Watch antibiotic prescriptions, 8% were for gastrointestinal complaints without diarrhea, 8% were for skin infections, and 6% were for bronchitis—conditions for which Watch antibiotics are not indicated.
If the AWaRE Antibiotic Book were adhered to, the researchers estimate that 69% of Watch antibiotic use in Burkina Faso and 75% of Watch antibiotic use in the DRC could be replaced by Access antibiotics or no antibiotics, which suggests that the 90% Access target is "theoretically attainable in both countries," they wrote.
"The WHO AWaRe Antibiotic Book has great potential to optimise antibiotic use in primary care, foremost when at once regulating or guiding over-the-counter dispensing of Watch antibiotics, and facilitating follow-up of patients' clinical evolution," the researchers concluded.