Antimicrobial consumption in a hospital environment before and after restrictive commercialization measures in Brazil
DOI:
https://doi.org/10.26694/repis.v9i1.3644Palabras clave:
Anti-Infective Agents, Drug Resistance, Pharmacovigilance, Drug UtilizationResumen
Introduction: The consumption of antimicrobials (ATB) has been described as one of the causes of Bacterial Resistance. In 2010, RDC 44 was published in Brazil, which restricts the free sale of ATB to reduce antimicrobial resistance in hospitals. Aim: to identify the consumption of ATB in a teaching hospital before and after the implementation of the restrictive measure on the commercialization of antimicrobials in Brazil. Outlining: Cross sectional study carried out in a general hospital. Analyzes were carried out in two phases, using the variables ATB consumption, expressed in defined daily dose (DDD), average use of different ATB per patient and the frequency of resistant microorganisms in the period. Results: The average use of ATB per patient was 2.56 (Standard Deviation (SD) ± 2.02) and2.40 (SD ± 1.89) in phases I and II, respectively (p=0.0007). The general variation in defined daily dose was 1.89%, however drugs with negative variation were observed. A higher frequency of resistant microorganisms isolated in phase I was observed compared to phase II (OR=1.48, CI: 1.13-1.93, respectively). Implications: A difference was identified in the consumption of ATB between the periods, with an increase in general consumption, in DDD, but a lower average number of different ATBs per patient and a lower occurrence of resistant microorganisms.
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World Health Organization. Antimicrobial resistance: global report on surveillance. Genebra: World Health Organization; 2014. Available from: https://apps.who.int/iris/handle/10665/112642
Senadheera GP, Sri Ranganathan S, Patabendige G, Fernando GH, Gamage D, Maneke RM, et al. Resistance and utilisation pattern of antibacterial agents in outpatient settings in two Teaching Hospitals in Colombo. Ceylon Med J [Internet]. 2016 [cited 2022 nov 5];61(3):113-7. Available from: https://doi.org/10.4038/cmj.v61i3.8346
Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S, et al. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect [Internet]. 2015 [cited 2022 nov 5];6:22-9. Available from: https://doi.org/10.1016/j.nmni.2015.02.007
Huerta-Gutierrez R, Braga L, Camacho-Ortiz A, Diaz-Ponce H, Garcia-Mollinedo L, Guzman-Blanco M, et al. One-day point prevalence of healthcare-associated infections and antimicrobial use in four countries in Latin America. Int J Infect Dis [Internet]. 2019 [cited 2022 nov 5];86:157-66. Available from: https://doi.org/10.1016/j.ijid.2019.06.016
Zimerman R. Uso indiscriminado de antimicrobianos e resistência microbiana. Brasília, DF: OPAS Brasil; 2010. Available from: https://www.paho.org/bra/index.php?option=com_docman&view=document&slug=uso-indiscriminado-antimicrobianos-e-resistencia-microbiana-boletim-n-03-8&layout=default&alias=1348-uso-indiscriminado-antimicrobianos-e-resistencia-microbiana-boletim-n-03-8&category_slug=uso-racional-medicamentos-685&Itemid=965
Sati HF, Bruinsma N, Galas M, Hsieh J, Sanhueza A, Ramon Pardo P, et al. Characterizing Shigella species distribution and antimicrobial susceptibility to ciprofloxacin and nalidixic acid in Latin America between 2000-2015. PLoS One [Internet]. 2019 [cited 2022 nov 5];14(8):1-12. Available from: https://doi.org/10.1371/journal.pone.0220445
Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, et al. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infec [Internet]. 2017 [cited 2022 nov 5];23:812-8. Available from: https://doi.org/10.1016/j.cmi.2017.07.010
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução da Diretoria Colegiada-RDC nº 44, de 26 de outubro de 2010. Dispõe sobre o controle de medicamentos à base de substâncias classificadas como antimicrobianos, de uso sob prescrição médica, isoladas ou em associação e dá outras providências. DOU 28/10/2010 p. 76.
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução da Diretoria Colegiada-RDC nº 20, de 5 de maio de 2011. Dispõe sobre o controle de medicamentos à base de substâncias classificadas como antimicrobianos, de uso sob prescrição, isolado ou em associação. DOU de 09/05/2011, p. 39.
Moura ML, Boszczowski I, Mortari N, Barrozo LV, Chiaravalloti Neto F, Lobo RD, et al. The Impact of Restricting Over-the-Counter Sales of Antimicrobial Drugs: Preliminary Analysis of National Data. Medicine (Baltimore) [Internet]. 2015 [cited 2022 nov 5];94(38):e1605. Available from: https://doi.org/10.1097/MD.0000000000001605
Mattos KPH, Visacri MB, Quintanilha JCF, Lloret GR, Cursino MA, Levin AS, et al. Brazil's resolutions to regulate the sale of antibiotics: Impact on consumption and Escherichia coli resistance rates. J Glob Antimicrob Resist [Internet]. 2017 [cited 2022 nov 5];10:195-9. Available from: https://doi.org/10.1016/j.jgar.2017.05.023
Costa JM, Moura CS, Pádua CAM, Vegi ASF, Magalhães SMS, Rodrigues MB et al. Medida restritiva para comercialização de antimicrobianos no Brasil: resultados alcançados. Rev. Saúde Pública [Internet]. 2019 [cited 2022 nov 5];53:68. Available from: https://doi.org/10.11606/s1518-8787.2019053000879
Sakeena MHF, Bennett AA, McLachlan AJ. Enhancing pharmacists' role in developing countries to overcome the challenge of antimicrobial resistance: a narrative review. Antimicrob Resist Infect Control [Internet]. 2018 [cited 2022 nov 5];7:63. Available from: https://doi.org/10.1186/s13756-018-0351-z
Martinez JL. General principles of antibiotic resistance in bacteria. Drug Discov Today Technol. [Internet]. 2014 [cited 2022 nov 5];11:33-9. Available from: https://doi.org/10.1016/j.ddtec.2014.02.001
World Health Organization. WHO Collaborating Centre for Drug Statistics Methodology. Norwegian Institute of Public Health. ATC/DDD Index 2019. [Internet]. 2019. Available from: https://www.whocc.no/atc_ddd_index/
Levin AS, Kobata CHP, Litvoc MN. Princípios do uso de antimicrobianos: perguntas e respostas. Rev Med [Internet]. 2014 [cited 2022 nov 5];93(2):63–68. Available from: https://doi.org/10.11606/issn.1679-9836.v93i2p63-68
Lawes T, Lopez-Lozano JM, Nebot CA, Macartney G, Subbarao-Sharma R, Dare CR, et al. Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis [Internet]. 2015 [cited 2022 nov 5];15:1438-49. Available from: https://doi.org/10.1016/S1473-3099(15)00315-1
Kardas-Sloma L, Boelle PY, Opatowski L, Guillemot D, Temime L. Antibiotic reduction campaigns do not necessarily decrease bacterial resistance: the example of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother [Internet]. 2013 [cited 2022 nov 5];57(9):4410-6. Available from: https://doi.org/10.1128/AAC.00711-13
