Antibiotics Misuse: A National Awareness Campaign

Transcription

1 Antibiotics Misuse: A National Awareness Campaign The Pre-campaign Survey Nathalie Lahoud, Pharm.D., MPH, Ph.D. OPL 24 th Congress November 18, 2016

2 Introduction: The Rationale Behind The Campaign If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine" David Cameron

3 1. Antimicrobial Resistance (AMR) is a serious global threat: Time lag between an ATB being introduced to clinical use and the first appearance of resistance Source: Pray L (Antibiotic R&D), Cambridge Healthtech institute, Needham, MA, 2008.

4 CDC. Antimicrobial Resistance Threats in the United States, Available at: Kelly CP, LaMont JT. Clostridium difficile more difficult than ever. N Engl J Med 2008; 359: Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008; 6: In the United States: Multidrug-resistant pathogens (and C. difficile) Over 2.5 million infections each year Increase the cost of medical care ($6000 $ per patient)

5 Chamoun K et al., Surveillance of antimicrobial resistance in Lebanese Hospitals: Retrospective nationwide compiled data. International Journal of Infectious disease 46 (2016): In Lebanon: Important threats: MRSA, penicillin- and erythromycin-resistant S. pneumoniae, and differentially resistant Enterobacteriaceae, Pseudomonas, and Acinetobacter. MRSA Prevalence Lebanon 27.60% 3% 1971 (Araj et al.) (Chamoun et al.)

6 Chamoun K et al., Surveillance of antimicrobial resistance in Lebanese Hospitals: Retrospective nationwide compiled data. International Journal of Infectious disease 46 (2016): In Lebanon: Penicillin-resistant S. pneumoniae Lebanon 50% 52% 53.80% ESBL-producing E. coli Lebanon 30% 32.30% 12.50% 2.00% (Uwaydah et al., Shaar et al.) (Daoud et al.) 2011 (Daoud et al.) (Chamoun et al.) 2003 (Daoud et al.) 2011 (Daoud et al.) (Chamoun et al.)

7 1.3. If not tackled, rising AMR could have a devastating impact: Source: Jim O Neill, The review on antimicrobial resistance, May 2016

8 2. Factors related to the AMR crisis: ATBs Use Multivariate model of risk factors for colonization or infection due to ESBL producing E. coli in hospitalized patients. Source: Jesús Rodríguez-Baño et al. Clin Infect Dis. 2006;42: Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005; 365(9459):

9 2.1. The selection pressure: When the ATB does not kill all the pathogenic bacteria (choice, dose, duration) This selection pressure ends up skewing the bacterial population to become more resistant Some bacteria can replicate in 20 min

10 Michael CA, Dominey-Howes D, Labbate M. The antimicrobial resistance crisis: causes, consequences, and management. Front Public Health 2014; 2:1 8. Carter L, Sun J, Jump R. A Survey and Analysis of the American Public s Perceptions and Knowledge About Antibiotic Resistance. Open Forum Infectious Diseases 3(3): of w 112, June Factors behind the excessive and incorrect use of ATBs: Human causes: increased total population, increasing urbanization, and connection. Clinical usage: lack of effective and rapid diagnostic tools, empirical prescriptions (hospitalized and outpatients), unnecessary long regimens. Public perception and behavior: Hoarding, Non-prescription purchase, and demands for antibiotics. Agricultural applications Commercial pressures Vaccination reluctance

11 2.3. In the United States: Out of 40 Million people who are taking ATBs for respiratory issues annually 27 Million are taking ATBs unnecessarily Source: Jim O Neill, The review on antimicrobial resistance, May 2016

12 2.3. In the United States: Out of 10 people Are neutral or disagree that ATB resistance is a problem Think that people can build immunity against ATBs Still believe that ATBs treat viral infections Still believe that ATBs work on coughs and colds Carter L, Sun J, Jump R. A Survey and Analysis of the American Public s Perceptions and Knowledge About Antibiotic Resistance. Open Forum Infectious Diseases 3(3): of w 112, June 2016

13 2.4. In Lebanon (2014): Out of 10 people Self-medicate with ATBs Never or rarely consult a doctor when they are sick Because of money issues Still believe that ATBs treat viral infections Believe they can stop earlier the treatment course whenever they feel better Cheaito, L., Azizi, S., Saleh, N., et al. (2014). Assessment of self-medication in population buying antibiotics in pharmacies: a pilot study from Beirut and its suburbs. International journal of public health, 59(2), Mouhieddine T et al., Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage Journal of Infection and Public Health (2015) 8, 20 31

14 2.4. In Lebanon: Out of 10 Pharmacists Receive inappropriate ATB prescriptions (5 inaccurate for the dose and 6 for the duration) Are asked many times a day for an ATB prescription Prescribe injectable and combined ATBs Farah, R., Lahoud, N., Salameh, P., et al. (2015). Antibiotic dispensation by Lebanese pharmacists: A comparison of higher and lower socio-economic levels. Journal of infection and public health, 8(1), Saleh, N., Awada, S., Awwad, R., et al. (2015). Evaluation of antibiotic prescription in the Lebanese community: a pilot study. Infection Ecology & Epidemiology, 5, /iee.v

15 3. The world is taking action: 2003: The CDC launched its national Get Smart: Know When Antibiotics Work campaign. 2008: The European CDC publicized an annual European Antibiotic Awareness Day. 2015: The WHO announced the first World Antibiotic Awareness Week. These campaigns encourage the public to ask for fewer antibiotics. Plus other interventions (Hospital Antimicrobial Stewardship Programs).

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17 We should take action as well At the end of the day, it s all about the patient and at some point each and everyone one of us is a patient Dr. Charlie Curilan

18 Methods and Materials (1) The Pre-campaign Survey It is the mark of a truly intelligent person to be moved by statistics - George Bernard Shaw

19 1. Objectives: Define our target population Assess the level of poor ATB/AMR knowledge Assess the effects of our campaign (Difference after-before)

20 2. Measure tool and data collection: A questionnaire established by the WHO in 2015: The multi-country public awareness survey. The questionnaire has been filled in by 9772 respondents across 12 WHO member states in September-October The survey is being conducted now in Lebanon and participants are being randomly chosen from community pharmacies (Target = 1000 participants).

21 3. Preliminary Results: Until the present day, we reached 526 participants Our results will be systematically compared to all 12 countries

22 3.1. Characteristics of respondents: Characteristics Respondents N = 526 (%) Sex Female 252 (47.9) Male 273 (51.9) Age (years); Median = 38 [14-95] (12.2) The North is not enough represented in the sample Results may be overestimating the true level of awareness! (27.9) (20.3) (19.6) (11.2) (7.4) Living in Urban 287 (54.6) Suburban 144 (27.4) Rural 90 (17.1) Level of education No schooling completed 63 (12) 12 th grade or less 60 (11.4) High school graduate 66 (12.5) Some college credit 71 (13.5) Technical/Vocational training 33 (6.3) Bachelor s degree 138 (26.2) Master s 76 (14.4) Doctorate 14 (2.7) Monthly income < (8.4) (23) (31.2) (21.5) > (7) Household with children No 297 (56.5) Yes 214 (40.7)

23 3.2. When did you last take ATBs? Can t remember 80 Never More than a year ago Last year Last 6 months Last month 0

24 3.2. When did you last take ATBs? Around 50% of respondents have taken an ATB in the last 6 months! It demonstrates how many people AMR could impact in a short time frame if the ATBs they are taking become increasingly ineffective.

25 3.3. On that occasion, did you get the ATB from a doctor or nurse? Can't remember No Yes 0

26 3.4. On that occasion, where did you get the ATB from? 100 Can t remember Somewhere/someone else Previous time Friend or family 75 Internet 70 Pharmacy

27 3.5. When do you think you should stop taking ATBs once you have begun treatment? Don t know When you feel better When you ve taken all the ATB as directed 10 0

28 3.6. Do you think these conditions can be treated with ATBs? Yes No Don t know Lebanon The other 12 countries

29 3.7. Can Cold and Flu be treated with ATBs? Don't know No Yes 0.0

30 3.8. Have you heard of any of the following terms? ANTIBIOTIC RESISTANCE DRUG RESISTANCE ANTIBIOTIC RESISTANT BACTERIA SUPERBUGS AMR NONE OF THE ABOVE 0 Lebanon The other 12 countries

31 3.9. Where did you hear about the term "ATB resistance"? Lebanon The other 12 countries

32 3.10. Percentage of responses to statements designed to determine knowledge of ATB resistance: TRUE FALSE Don t know Lebanon The other 12 countries

33 3.11. For the global score of knowledge: 20 items (False answer= 0, correct answer = 1) Cronbach s alpha = Minimum score = 0 Maximum score = 20 Poor knowledge: Score <12 Good Knowledge: Score > 12 Good Knowledge [PERCENTAGE] Poor Knowledge [PERCENTAGE]

34 3.12. Independent predictors of a good knowledge score: Variables entered to the model: Gender, Age, Residence type, Education, Income, Household with children, ATB with prescription, ATB with advice, ATB source, and Heard of ATB resistance. Adjusted OR 95% CI p-value Age Education th grade or less High school graduate Some college credit Technical/Vocational training Bachelor s degree Master s/doctorate ATB with Prescription Yes Can t remember ATB source Pharmacy Ever heard of ATB Resistance Yes from a Pharmacist Yes from another source Logistic regression, Backward LR, Nagelkerke R 2 =0.244, Omnibus test p=0.000, Hosmer and Lemeshow p= 0.958, Overall percentage of classification = 69.6%.

35 Methods and Materials (2) The Campaign

36 1. Key messages: Why should I take antibiotics responsibly (AMR)? AMR threatens each and everyone of us! Antibiotics won t work in case of cold and flu! How should I take antibiotics (Adherence)? We should protect our ATBs!

37 2. Message Dissemination Tools: As the campaign will target the general population: Brochures (pharmacies) Posters (pharmacies, universities, malls, etc.) Television spot T-shirts and pins We are currently designing our tools

38 3. Help us make a difference: The survey showed how much community pharmacists play a role in disseminating awareness! Get directly involved in the campaign!

39 Conclusion

40 Team work: Pascale Salameh Hind El Hajj Anna Maria Hneineh Ruba Shdeed Jihan Safwan Marwan Akel Nadine Saleh Rachel Abdo Chadi Maroun Rony Zeenny OPL inspectors (Mohamad Yamout) And President Georges Sili

41 Thank You If we are going to win this fight we have to be much more sophisticated