Abstract:
BACKGROUND: Exposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is
critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use
in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved
Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported
antibiotic use in multiple sub-Saharan African countries.
METHODS: ANDEMIA included 12 urban and rural health facilities in Côte d’Ivoire, Burkina Faso, Democratic Republic
of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal
infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic,
socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA
data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study
enrolment were described by substance and by the WHO AWaRe classification (“Access”, “Watch”, “Reserve”, and “Not
recommended” antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual
patient factors.
RESULTS: Among 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were
reported, including 54.7% (n=5,299) from the WHO Access antibiotic group and 44.7% (n=4,330) from the WHO
Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n=3,071,
31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d’Ivoire urban facilities to
73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not
recommended antibiotics but no Reserve antibiotics.
CONCLUSIONS: Reported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high
proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including
further evaluation of accessibility and affordability of patient treatment.
Description:
ADDITIONAL FILE 1 : Table of relevant country data and study sites. ADDITIONAL FILE 2 : Figure on ANDEMIA case-definitions. ADDITIONAL FILE 3 : Question on antibiotics use, ANDEMIA case investigation form. ADDITIONAL FILE 4 : Table of the coding frameworks for the antibiotic formulation and WHO AWaRe criteria. ADDITIONAL FILE 5 : Table: Body Mass Index calculation. ADDITIONAL FILE 6 : Table of characteristics of ANDEMIA patients enrolled from 1 February 2018 till 26 May 2022 by country. ADDITIONAL FILE 7 : Table of reported antibiotic use in the ten days prior to study enrolment in the study population. ADDITIONAL FILE 8 : Table of syndrome enrolment of patients that reported antibiotic use in the ten days prior to study enrolment with row frequencies. ADDITIONAL FILE 9 : Figure on proportional antibiotic use according to WHO AWaRe classification by country, before and during COVID-19 pandemic. ADDITIONAL FILE 10 : Figure on total reported antibiotics regardless of date of last dose among ANDEMIA total as well as by country. ADDITIONAL FILE 11 : Table on the number of different antibiotic substances reported in the ANDEMIA study by country and by location.
DATA AVAILABILITY STATEMENT : All data generated or analysed during this study are included in this published article and its supplementary information files. Datasets used during the current study are available from the corresponding author on reasonable request.
