Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries : findings and implications for the future

Godman, Brian and Haque, Mainul and McKimm, Judy and Abu Bakar, Muhamad and Sneddon, Jacqueline and Wale, Janney and Campbell, Stephen and Martin, Antony P and Hoxha, Iris and Abilova, Vafa and Paramadhas, Bene D Anand and Mpinda-Joseph, Pinkie and Matome, Matshediso and Lovato Pires de Lemos, Livia and Sefah, Israel and Kurdi, Amanj and Opanga, Sylvia and Jakupi, Arianit and Saleem, Zikria and Hassali, Mohamed Azmi and Kibuule, Dan and Fadare, Joseph and Bochenek, Tomasz and Rothe, Celia and Fürst, Jurij and Markovic-Pekovic, Vanda and Bojanić, Ljubica and Schellack, Natalie and Meyer, Johanna C and Matsebula, Zinhle and Phuong, Thuy Nguyen Thi and Thanh, Binh Nguyen and Jan, Saira and Kalungia, Aubrey and Mtapuri-Zinyowera, Sekesai and Sartelli, Massimo and Hill, Ruaraidh (2020) Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries : findings and implications for the future. Current Medical Research and Opinion, 36 (2). pp. 301-327. ISSN 0300-7995 (

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Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use. Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known. Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals. Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.


Godman, Brian, Haque, Mainul, McKimm, Judy, Abu Bakar, Muhamad, Sneddon, Jacqueline, Wale, Janney, Campbell, Stephen, Martin, Antony P, Hoxha, Iris, Abilova, Vafa, Paramadhas, Bene D Anand, Mpinda-Joseph, Pinkie, Matome, Matshediso, Lovato Pires de Lemos, Livia, Sefah, Israel, Kurdi, Amanj ORCID logoORCID:, Opanga, Sylvia, Jakupi, Arianit, Saleem, Zikria, Hassali, Mohamed Azmi, Kibuule, Dan, Fadare, Joseph, Bochenek, Tomasz, Rothe, Celia, Fürst, Jurij, Markovic-Pekovic, Vanda, Bojanić, Ljubica, Schellack, Natalie, Meyer, Johanna C, Matsebula, Zinhle, Phuong, Thuy Nguyen Thi, Thanh, Binh Nguyen, Jan, Saira, Kalungia, Aubrey, Mtapuri-Zinyowera, Sekesai, Sartelli, Massimo and Hill, Ruaraidh;