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.
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 |