Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance, and stewardship among low- and middle-income countries

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Saleem, Zikria and Moore, Catrin E. and Kalungia, Aubrey and Schellack, Natalie and Ogunleye, Olayinka and Chigome, Audrey and Chowdhury, Kona and Kitutu, Freddy Eric and Massele, Amos and Ramdas, Nishana and Cook, Aislinn and Khuluza, Felix and Zaranyika, Trust and Funiciello, Elisa and Lorenzetti, Giulia and Nantamu, Miriam and Parajuli, Ayuska and Kurdi, Amanj and Nabayiga, Hellen and Jairoun, Ammar Abdulrahman and Haque, Mainul and Campbell, Stephen M. and van der Bergh, Dena and Godman, Brian and Sharland, Mike (2025) Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance, and stewardship among low- and middle-income countries. JAC-Antimicrobial Resistance. ISSN 2632-1823 (In Press) (https://doi.org/10.1093/jacamr/dlaf033)

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Abstract

Introduction: There are concerns globally with rising rates of antimicrobial resistance (AMR) particularly in low- and middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs. Method: Narrative review of published papers among 4 WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarised to identify pertinent future activities for all key stakeholder groups. Results: 459 papers were sourced, with a large number coming from Africa (42.7%). An appreciable number dealt with patients’ KAP (33.1%), reflecting their influence on prescribing and dispensing of antibiotics. There was marked consistency of findings among key stakeholder groups across the 4 WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics and AMR. There were similar issues among dispensers. Patients’ beliefs regarding the effectiveness of antibiotics for self-limiting infectious diseases was a major challenge, although educational programmes did improve knowledge. The development of the AWaRe system, including practical prescribing guidance, provides a future opportunity for the standardisation of educational inputs. Conclusion: Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder groups presents clear opportunities for standardisation of educational input and practical training programs based on the AWaRe system.

ORCID iDs

Saleem, Zikria, Moore, Catrin E., Kalungia, Aubrey, Schellack, Natalie, Ogunleye, Olayinka, Chigome, Audrey, Chowdhury, Kona, Kitutu, Freddy Eric, Massele, Amos, Ramdas, Nishana, Cook, Aislinn, Khuluza, Felix, Zaranyika, Trust, Funiciello, Elisa, Lorenzetti, Giulia, Nantamu, Miriam, Parajuli, Ayuska, Kurdi, Amanj ORCID logoORCID: https://orcid.org/0000-0001-5036-1988, Nabayiga, Hellen, Jairoun, Ammar Abdulrahman, Haque, Mainul, Campbell, Stephen M., van der Bergh, Dena, Godman, Brian and Sharland, Mike;
CORE (COnnecting REpositories)