A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance

There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.

Automated summary

There are concerns regarding the prescribing of antibiotics in primary care settings in South Africa, both public and private. These concerns need to be addressed to combat rising antimicrobial resistance rates. Published studies indicate a high prescription rate of antibiotics for patients with acute respiratory infections, with varying levels of adherence to prescribing guidelines. The majority of prescribed antibiotics belong to the "Access" group rather than the "Watch" group, which is intended to limit antimicrobial resistance. Inappropriate prescribing in primary care is influenced by limited knowledge about antibiotics, antimicrobial resistance, and antimicrobial stewardship programs among prescribers and patients. Future recommendations include improving education, regularly monitoring prescribing practices, and using patient-friendly language during discussions about appropriate antibiotic use.