AWaRe antibiotic prescribing for common acute infections in private primary care in low-middle-income countries: a patient-level analysis using IQVIA prescriber surveys from Pakistan, Egypt and Indonesia.
There is limited high-quality data on antibiotic prescribing in low and middle-income countries, particularly in the private sector. Here, we use large-scale healthcare surveys to assess antibiotic prescribing levels and the factors influencing prescribing decisions for common infections in primary care and outpatient settings, predominantly within the private sector, in Pakistan, Egypt and Indonesia.
We analysed surveys completed by prescribers in Pakistan, Egypt and Indonesia, collected in primary care and outpatient settings, predominantly within the private sector, by IQVIA between 2017 and 2021, namely IQVIA's proprietary Medical Data Index (Medical Index of Pakistan (MIP), Egypt Medical Data Index (EMDI) and Indonesia Medical Data Index (IMDI)). IQVIA market research information reflects estimates of real-world activity and should be treated accordingly. We evaluated antibiotic prescribing categorised by WHO AWaRe and Essential Medicines List (EML) classifications for common infections. We used mixed-effects regression analyses to identify factors influencing prescribing decisions.
Among the 384 975 infection-related health consultation records analysed, antibiotics were prescribed in 82.0% of consultations in Pakistan, 81.2% in Egypt and 69.1% in Indonesia. Watch antibiotics accounted for 70.2% of antibiotic prescriptions in Pakistan, 52.9% in Egypt and 53.6% in Indonesia. Non-WHO EML antibiotics accounted for 26.8% of prescriptions in Pakistan, 39.9% in Egypt and 33.0% in Indonesia. Consultations for patients presenting with lower respiratory tract infections, urinary tract infections, multiple infections or differentiated fever had higher odds of receiving any or a Watch antibiotic. Consultations by respiratory-related specialists in Pakistan and Egypt and by most specialities in Indonesia were more likely to receive Watch antibiotics.
Similar patterns of high levels of total and Watch antibiotic prescribing for common infections-including those that generally do not require any antibiotics-were identified among prescribers in primary care and outpatient settings within the private sector in Pakistan, Egypt and Indonesia.
We analysed surveys completed by prescribers in Pakistan, Egypt and Indonesia, collected in primary care and outpatient settings, predominantly within the private sector, by IQVIA between 2017 and 2021, namely IQVIA's proprietary Medical Data Index (Medical Index of Pakistan (MIP), Egypt Medical Data Index (EMDI) and Indonesia Medical Data Index (IMDI)). IQVIA market research information reflects estimates of real-world activity and should be treated accordingly. We evaluated antibiotic prescribing categorised by WHO AWaRe and Essential Medicines List (EML) classifications for common infections. We used mixed-effects regression analyses to identify factors influencing prescribing decisions.
Among the 384 975 infection-related health consultation records analysed, antibiotics were prescribed in 82.0% of consultations in Pakistan, 81.2% in Egypt and 69.1% in Indonesia. Watch antibiotics accounted for 70.2% of antibiotic prescriptions in Pakistan, 52.9% in Egypt and 53.6% in Indonesia. Non-WHO EML antibiotics accounted for 26.8% of prescriptions in Pakistan, 39.9% in Egypt and 33.0% in Indonesia. Consultations for patients presenting with lower respiratory tract infections, urinary tract infections, multiple infections or differentiated fever had higher odds of receiving any or a Watch antibiotic. Consultations by respiratory-related specialists in Pakistan and Egypt and by most specialities in Indonesia were more likely to receive Watch antibiotics.
Similar patterns of high levels of total and Watch antibiotic prescribing for common infections-including those that generally do not require any antibiotics-were identified among prescribers in primary care and outpatient settings within the private sector in Pakistan, Egypt and Indonesia.
Authors
Nguyen Nguyen, Mangla Mangla, Stephens Stephens, Cook Cook, Thorn Thorn, Saleem Saleem, Wilopo Wilopo, Tayler Tayler, Sharland Sharland, Pouwels Pouwels
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