Stakeholder Involvement Helps Ensure Success of Antibiotic Dispensing Interventions in Low- and Middle-Income Countries

antibiotics, stewardship
antibiotics, stewardship
Researchers conducted a systematic review of studies that reported on interventions to increase the rate of appropriate antibiotic dispensing in low- and middle-income countries.

Stakeholder involvement was important in the success of interventions to improve appropriate antibiotic dispensing at the community level in low- and middle-income countries (LMIC), according to findings published in the Journal of Global Antimicrobial Resistance.

In November of 2019, researchers conducted a systematic review of studies that reported on the rate of appropriate antibiotic dispensing. The goal of this review was to determine the effectiveness of interventions used to improve antibiotic dispensing practices in LMIC to prevent the emergence of antibiotic resistant bacteria.

Among 13 studies included in the analysis, 6 were from Asia, 5 were from Africa, 1 was from South America, and 1 was from both Africa and Asia. The review included 7 randomized controlled trials, 2 quasi-experimental studies, 1 longitudinal time series study, and 6 observational studies, of which 3 were of poor quality with an increased risk of bias.

Among the 13 studies, interventions to improve antibiotic dispensing were at least 50% effective on all outcomes measured in 9. Of these 9 studies, the most common interventions were educational meetings in 7; educational outreach in 6; educational materials in 5; procurement and distribution of supplies in 5; clinical treatment guidelines in 4; and reminders in 4.

The researchers noted 4 studies reported that interventions were effective for 100% all outcomes measured, of which the most commonly used intervention was educational meetings in 3. Of note, 8 studies reported that stakeholders were involved in the development of the interventions, of which 4 reported an effectiveness score of 100% and 5 reported effectiveness scores between 55% and 87%.

Limitations of this review included the small number of included studies, and the inability to conduct a meta-analysis due to heterogeneity among the studies.

According to the researchers, “this review also shows the need for standardization in the conduct of intervention[s] aimed at improving [antibiotic] dispending at the community level.”


Afari-Asiedu S, Abdulai M, Tostmann A, et al. Interventions to improve dispensing of antibiotics at the community level in lower and middle income countries: a systematic review. J Glob Antimicrob Resist. Published online March 14 2022. doi: 10.1016/j.jgar.2022.03.009