Determinants of Antimicrobial Use: Poorly Understood–Poorly Researched
Resistance of microbes against available antimicrobials has grown in past decades, and should be expected to continue to do so in the coming years, unless effective strategies are developed against it. This is especially the case in developing countries, where regulatory systems are less effective and health systems are weaker. Antimicrobials have been part of daily life for a long time in developing countries and local 'cultures' have been built around their indications, efficacy, dosing and duration of use. Hence, poor use of these agents cannot simply be ‘regulated’, ‘reformed’ or ‘trained’ away. Poor antimicrobial use requires careful study of its determinants and to use the findings to define promising interventions. Available literature on determinants is limited and, hence, there is a huge gap in our understanding of what actually drives poor antimicrobial use. Given this poor understanding, it should not come as a surprise that improving antimicrobial use in developing countries has had limited success. This chapter will explore the literature on factors that influence antimicrobial use by providers, dispensers and the general population in developing countries. Antimicrobial prescribing clearly received more research attention than antimicrobial dispensing, and antimicrobial use by populations. Especially the practices and perceptions of dispensers are little studied, despite the key role dispensers have in antimicrobial use. Based on the available information, proposals are made to improve our understanding of determinants, and to develop more effective interventions into antimicrobial use.
KeywordsWatery Diarrhoea Pharmacy Staff Economic Motive Powerful Image Antimicrobial Prescribe
The research behind this presentation was supported by a grant from the United States Agency for International Development through the Applied Research on Child Health Project.
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