January 13, 2022
The Question: In 2018, the Africa Centres for Disease Control and Prevention (Africa CDC) released its Framework for Antimicrobial Resistance, a strategy to improve surveillance, delay emergence, limit transmission and mitigate harm from antimicrobial-resistant pathogens in Africa. African Union (AU) Member States and stakeholders identified priority activities for implementing Africa CDC’s framework. To delay the emergence and mitigate harm of antimicrobial resistance (AMR), many expert organizations recommended that antimicrobials only be used in accordance with established clinical guidelines that outline when, what, and how to prescribe. However, representatives of AU Member States noted that, except for select diseases such as HIV infection, tuberculosis and malaria, many healthcare providers do not have country-specific treatment guidelines and must rely on individual judgement or guidelines developed outside of Africa. The aim of this study was to identify and compare antimicrobial treatment guidelines from AU Member States to identify evidence gaps and variations in recommended treatments to inform future intervention and policy.
What We Found: We identified only 31 treatment guidelines from 20 of the 55 (36%) AU Member States that included treatment recommendations for common bacterial infections or syndromes; several countries had more than one treatment guideline that met our inclusion criteria. Of those guidelines, only fifteen (48%) from 10 countries had been published or updated since 2015. No guidelines stated that they were based on local disease burden or resistance profiles; one explanation for this finding may be the lack of national laboratory and surveillance capacities leading to gaps in the local evidence base. Only a small number of guidelines cited published literature or other clinical evidence supporting the rationale for certain drug, dosage and duration recommendations. Few guidelines incorporated antimicrobial stewardship principles, culture or antimicrobial susceptibility testing results into treatment recommendations. Only about half of the bacterial infections and/or syndromes covered in existing standardized treatment guidelines from AU Member States across adult and paediatric patient populations were addressed in international guidelines such as the WHO Model Lists of Essential Medicines and WHO Pocket Book of Hospital Care for Children.
Why It Matters: The misuse and overuse of antimicrobials in the human health sector are major drivers of antimicrobial resistance (AMR) globally. Standardized treatment guidelines are an important tool to ensure the appropriate and optimal use of antimicrobials, particularly when informed by local data and combined with antimicrobial stewardship programmes. As one of many efforts needed to slow the emergence and spread of AMR, there is an urgent need to develop and implement treatment guidelines across healthcare settings in AU member states to ensure appropriate clinical therapy.
The study titled, “Comparison of national antimicrobial treatment guidelines, African Union” was published in November 2021 in the Bulletin of the World Health Organization and is available online here.