Analysis of policies for use of medically important antibiotics in animals in Namibia: implications for antimicrobial stewardship

ABSTRACT

Background

In Namibia, overuse of medically important antibiotics in animals is common and is a considerable driver of antimicrobial resistance. The study aims to analyze policies, resistance patterns, and consumption of these antibiotics used in animals in Namibia.

Research design and methods

A scoping review and retrospective descriptive analysis of policies, resistance patterns, and use of these antibiotics in Namibia was conducted, and assessed against the Access, Watch and Reserve (AWaRe) antimicrobial use guidance.

Results

Of the forty-five antibiotic products registered for use in animals, 77.8% are Access antibiotics, 68.9% are broad-spectrum and 60% are over-the-counter antibiotics – mainly tetracyclines, penicillins and sulfonamides. There is misalignment of antibiotic use policies for animals and humans and currently no guideline for antibiotic use in animals. Most medically important antibiotics are indicated for control of gastrointestinal (77.7%), musculoskeletal (71.1%), and respiratory (46.7%) infections, and for growth promotion (4.4%). There is high resistance to AWaRe Access antibiotics- sulfonamides (19.5–100%), tetracyclines (56–100%), and penicillin (13.5–100%).

Conclusion

Whilst Namibia banned the use of antibiotics in farming, current policy frameworks are inconsistent across sectors, and promote overuse of broad-spectrum important antibiotics in animals. A multi-sectoral one health approach is required to harmonize antibiotic use policies and reduce resistance.

KEYWORDS:

• Antibiotics
• antibiotic resistance
• antimicrobial stewardship
• AWaRe
• Namibia
• policies
• veterinary medicine

Acknowledgments

Dr. Funso Adenuga and staff at the Namibian Medicine Regulatory Council for aiding data collection processes.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors substantially contributed to the conception and design of the article and interpreting the relevant literature, and were involved in writing the revised article for its intellectual content. J Kaupitwa, S Nowaseb, B Godman and D Kibuule contributed to the conceptualization and design of the study. J Kaupitwa and D Kibuule analyzed the data. J Kaupitwa, S Nowaseb, B Godman and D Kibuule contributed to the writing and revision of the manuscript through all stages of its development. All authors consented to submission of the article for publication in this journal.

List of Abbreviations

AMR	=	Antimicrobial Resistance
AMS	=	Antimicrobial Stewardship Program
ATC	=	Anatomical Therapeutic Classification
AWaRe	=	Access, Watch and Restricted antibiotics
CLSI	=	Clinical and Laboratory Standards Institute
DDD	=	Daily Defined Dose
DID	=	DDD per 1000 inhabitants per day
ESAC	=	European Surveillance of Antimicrobial Consumption
EUCAST	=	European Committee for Antimicrobial Susceptibility Testing
FDA	=	Food and Drug Administration
FDC	=	Fixed Dose Combination
GAP	=	Global Action Plan
LMIC	=	Low and Middle Income Countries
MIA	=	Medically important Antibiotics
MIVA	=	Medically important Veterinary Antibiotics
MoHSS	=	Ministry of Health and Social Services
NAP	=	National Action P
Nemlist	=	Namibia Essential Medicine List
NSTG	=	Namibia Standard Treatment Guideline
NMRC	=	Namibia Medicine Regulatory Council
NPC	=	National
OIE	=	World Organization for Animal Health
PICO	=	Population Intervention Comparator and Outcome
WHO	=	World Health Organization

Additional information

Funding

This paper was not funded.