Re: antibiotic (mis)use
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Dear David.
Unnecessary prescribing of antibiotics is clearly a major problem in all
countries, resulting in wasted resources and contributing to the development
of antibiotic resistance. Our recent review of evidence from developing
countries completed for the International Conference on Improving Use of
Medicines has shown that strategies like (1) focused, problem-oriented
training on treatment for diarrhea and respiratory infections, (2)
supervision or self-monitoring using simple indicators, and (3) peer
group-oriented guideline development can all reduce unnecessary use.
However, less is not always better. I suggest that from a developing
country viewpoint, you do not want to limit your attention to problems of
overuse. Failure to prescribe antibiotics correctly when they are needed,
and failure to obtain and complete a full course of therapy, may be much
more significant in their immediate clinical effects. For example, studies
in a number of countries in Africa and Asia focused on improved community
case management for pneumonia (better prescribing of recommended therapies)
have demonstrated dramatic reductions in child mortality.
Dennis Ross-Degnan
Drug Policy Research Group
Dept. of Ambulatory Care & Prevention
Harvard Medical School Tel: +1 617-421-2631
126 Brookline Avenue, Suite 200 Fax: +1 617-859-8112
Boston, MA 02215 USA E:mail: drossdeg@warren.med.harvard.edu
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