Antibiotic prescribing and resistance: Views from low- and middle-income prescribing and dispensing professionals

4 August, 2018

Dear HIFA colleagues,

My thanks to Clare Chandler of the London School of Hygiene and Tropical Medicine who pointed me to this new report via the AMR-NAP forum:

Antibiotic prescribing and resistance: Views from low- and middle-income prescribing and dispensing professionals

This is a report to the World Health Organization, researched and compiled by students and staff of the Antimicrobial Resistance Centre at the London School of Hygiene & Tropical Medicine

Citation: Maddy Pearson, Anne Doble, Rachel Glogowski, Stella Ibezim, Tom Lazenby, Ayda Haile-Redai, Nabila Shaikh, Ashley Treharne, Selin Yardakul, Rahel Yemanaberhan, Lucy Reynolds and Clare Chandler C.I.R. (2018) Antibiotic Prescribing and Resistance: Views from LMIC Prescribing and Dispensing Professionals. Report to World Health Organisation AMR Secretariat, available online at


'Antimicrobial resistance poses a threat to the future of human and animal health, compromising the treatment of basic infections and the capacity for routine medical procedures. Addressing prescribing and dispensing practice has been a focal point of strategies to decrease antimicrobial usage for many years, but implementers lack data on the current status of health care professionals’ understanding and experience of antimicrobial resistance that could guide interventions.

'This report draws together data from nine studies undertaken in April to August 2017 by Masters students at the London School of Hygiene & Tropical Medicine and the Royal Veterinary College. The students worked with 246 qualified health care professionals in six low and middle income country (LMIC) settings within India (3), Philippines (1), Vietnam (1), Sierra Leone (1), Nigeria (1), Ethiopia (2). The studies aimed to ascertain and situate awareness of AMR and knowledge of antibiotics within the lived experience of prescribing and dispensing across a range of LMIC settings...

'The following cross-site themes emerged:

- Health professionals had a higher level of knowledge surrounding antibiotics than expected.

- Health professionals had a greater awareness of AMR than expected, most often indicated through treatment failure rather than diagnostics.

- Health professionals’ prescribing and dispensing practices responded to continued challenges of access to information on resistance patterns, access to next line antibiotics, access to diagnostics and access to patient medical records.

- Health professionals’ prescribing and dispensing practices responded to concerns over the burden of infectious disease, attributed to poor infection control, sanitation, hygiene, nutrition and biosecurity.

- Health professionals reported prescribing in terms of the empirical weighing up of risks, on the one hand of not giving antibiotics, and on the other of which antibiotic to prescribe. Awareness of resistance, fake drugs and side effects of some types of drugs led to empirical tailoring of treatments.

- Health professionals’ prescribing and dispensing practices responded in many cases to shortages of human resources coupled with high patient load.

- Health professionals across settings reported that medical or pharmaceutical representatives visited frequently and influenced their prescribing of antibiotics.

- Health professionals in the veterinary sector additionally reported problems with adhering to withdrawal periods in livestock.

'Health professionals proposed their own solutions for addressing AMR, with a strong demand for more antibiotic medicines in order to respond to resistant infections; at the same time they asked for tighter regulations on the quality of those medicines and on the visits of representatives; there was a strong desire for a platform showing local patterns of resistance; and better infrastructure – in terms of medical records, human resources and basic hygiene inside and outside of health facilities...

'The findings across these studies echo the calls from multilateral agencies for a holistic approach to addressing AMR. Contrary to the expectation of the need for more education to improve knowledge of AMR, this report finds that awareness of resistance amongst these health professionals – who were qualified prescribers and dispensers – was high. An important distinction can be made between knowledge of AMR and of prudent use of antibiotics, and information about, or needed to address AMR, which was lacking in terms of local patterns.'


I was unable to find data on the level of the facilities (primary, secondary, tertiary) where the research was carried out in each case, but a search on the word 'primary' and 'hospital' found no references to primary care and several to hospitals.

HIFA is currently collaborating with researchers from Nagasaki University and the London School of Hygiene and Tropical Medicine to conduct a systematic review to learn about how primary healthcare workers in low and middle-income countries (LMICs) obtain information during consultations to aid prescribing.

Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (, which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: