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Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature.
Murray, Jennifer L; Leung, Daniel T; Hanson, Olivia R; Ahmed, Sharia M; Pavia, Andrew T; Khan, Ashraful I; Szymczak, Julia E; Vaughn, Valerie M; Patel, Payal K; Biswas, Debashish; Watt, Melissa H.
Afiliación
  • Murray JL; Department of Population Health Sciences, University of Utah, Salt Lake City, UT USA.
  • Leung DT; School of Medicine, University of Utah, Salt Lake City, UT USA.
  • Hanson OR; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Ahmed SM; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Pavia AT; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Khan AI; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Szymczak JE; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
  • Vaughn VM; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Patel PK; Department of Internal Medicine, University of Utah, Salt Lake City, UT USA.
  • Biswas D; Department of Internal Medicine, Intermountain Health, Murray, UT.
  • Watt MH; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
medRxiv ; 2023 Sep 29.
Article en En | MEDLINE | ID: mdl-37808732
Antimicrobial resistance is a global public health crisis. Effective antimicrobial stewardship requires an understanding of the factors and context that contribute to inappropriate use of antimicrobials. The goal of this qualitative systematic review was to synthesize themes across levels of the social ecological framework that drive inappropriate use of antimicrobials in South Asia. In September 2023, we conducted a systematic search using the electronic databases PubMed and Embase. Search terms, identified a priori, were related to research methods, topic, and geographic location. We identified 165 articles from the initial search and 8 upon reference review (n=173); after removing duplicates and preprints (n=12) and excluding those that did not meet eligibility criteria (n=115), 46 articles were included in the review. We assessed methodological quality using the qualitative Critical Appraisal Skills Program checklist. The studies represented 6 countries in South Asia, and included data from patients, health care providers, community members, and policy makers. For each manuscript, we wrote a summary memo to extract the factors that impede antimicrobial stewardship. We coded memos using NVivo software; codes were organized by levels of the social ecological framework. Barriers were identified at multiple levels including the patient (self-treatment with antimicrobials; perceived value of antimicrobials), the provider (antimicrobials as a universal therapy; gaps in knowledge and skills; financial or reputational incentives), the clinical setting (lack of resources; poor regulation of the facility), the community (access to formal health care; informal drug vendors; social norms), and policy (absence of a regulatory framework; poor implementation of existing policies). The findings highlight the importance of working across multiple sectors to design and implement approaches to antimicrobial stewardship in South Asia.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Prognostic_studies / Qualitative_research / Systematic_reviews Idioma: En Revista: MedRxiv Año: 2023 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Tipo de estudio: Prognostic_studies / Qualitative_research / Systematic_reviews Idioma: En Revista: MedRxiv Año: 2023 Tipo del documento: Article