Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications

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Saleem, Zikria and Mekonnen, Biset Asrade and Orubu, E. Sam and Islam, Md. Ariful and Nguyen, Thuy Thi Phuong and Ubaka, Chukwuemeka Michael and Buma, Deus and Thuy, Nga Do Thi and Sant, Yashasvi and Sono, Tiyani Milta and Bochenek, Tomasz and Kalungia, Aubrey C. and Abdullah, Saad and Miljković, Nenad and Yeika, Eugene and Lum Niba, Loveline and Akafity, George and Sefah, Israel Abebrese and Opanga, Sylvia A. and Kitutu, Freddy Eric and Khuluza, Felix and Zaranyika, Trust and Parajuli, Ayuska and Darweesh, Omeed and Islam, Salequl and Kumar, Santosh and Nabayiga, Hellen and Jairoun, Ammar Abdulrahman and Chigome, Audrey and Ogunleye, Olayinka and Fadare, Joseph and Massele, Amos and Cook, Aislinn and Jelić, Ana Golić and Godói, Isabella Piassi Dias and Phillip, Amani and Meyer, Johanna C. and Funiciello, Elisa and Lorenzetti, Giulia and Kurdi, Amanj and Haseeb, Abdul and Moore, Catrin E. and Campbell, Stephen M. and Godman, Brian and Sharland, Mike (2025) Current access, availability and use of antibiotics in primary care among key low- and middle-income countries and the policy implications. Expert Review of Anti-infective Therapy. ISSN 1744-8336 (In Press) (https://doi.org/10.1080/14787210.2025.2477198)

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Abstract

Introduction: Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. Areas covered: Narrative review analyzing publications from 2018 to 2024 regarding access, availability and use of appropriate antibiotics. Expert opinion: There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impacts on their use resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps, affects sustainable development goals to provide routine access to safe, effective and appropriate antibiotics. Conclusions: There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

ORCID iDs

Saleem, Zikria, Mekonnen, Biset Asrade, Orubu, E. Sam, Islam, Md. Ariful, Nguyen, Thuy Thi Phuong, Ubaka, Chukwuemeka Michael, Buma, Deus, Thuy, Nga Do Thi, Sant, Yashasvi, Sono, Tiyani Milta, Bochenek, Tomasz, Kalungia, Aubrey C., Abdullah, Saad, Miljković, Nenad, Yeika, Eugene, Lum Niba, Loveline, Akafity, George, Sefah, Israel Abebrese, Opanga, Sylvia A., Kitutu, Freddy Eric, Khuluza, Felix, Zaranyika, Trust, Parajuli, Ayuska, Darweesh, Omeed, Islam, Salequl, Kumar, Santosh, Nabayiga, Hellen ORCID logoORCID: https://orcid.org/0000-0002-2213-0418, Jairoun, Ammar Abdulrahman, Chigome, Audrey, Ogunleye, Olayinka, Fadare, Joseph, Massele, Amos, Cook, Aislinn, Jelić, Ana Golić, Godói, Isabella Piassi Dias, Phillip, Amani, Meyer, Johanna C., Funiciello, Elisa, Lorenzetti, Giulia, Kurdi, Amanj ORCID logoORCID: https://orcid.org/0000-0001-5036-1988, Haseeb, Abdul, Moore, Catrin E., Campbell, Stephen M., Godman, Brian and Sharland, Mike;
CORE (COnnecting REpositories)