Global Point Prevalence Study of Antibiotic Consumptions and Resistance in Iran Why and How Challenges and Solutions

Antibiotic resistance is one of the most critical issues in global health. According to the World Health Organization (WHO) estimate, in 2050, the majority of bacteria in current antibiotics become resistant. In third world countries, the irrational use of antibiotics considered as one of the major causes of antibiotic resistance. WHO seeks to plan training in the field of reducing antibiotic consumption. The antibiotic stewardship programs investigate hospitals and outpatient settings. In the outpatient setting, the irrational use of antibiotics by patients as well as irrational prescribing of antibiotics by physicians noted. Based on the available data in our country, the amount of outpatient use of antibiotics is very high. The irrational use of antibiotics in hospital wards is very significant. Physicians and practitioners do not mention the cause of prescription antibiotics in many cases, and sometimes there found no reason for it (reason in notes). Even in educational and academic departments, most patient files are incomplete. In other words, the diagnosis of infectious disease is not precise, and the only reason that leads to antibiotic prescriptions is illogical fearing of infectious disease despite lack of clinical or laboratory evidence for infection. When antibiotics prescribed for infectious disease, frequently, there are no charge individuals who discontinue the drug in the absence of clinical and laboratory evidence of infections. Thus, the patients are undergoing long-term antibiotic therapy, and the story of antibiotic abuse become formed.In some clinical wards, irrational use of antibiotics might be due to diagnostic complexities. For example, in the newborns and oncology wards, frequently rapid microbiological diagnosis is not possible. The morbidity and mortality in these wards are frequently due to infectious disease, so in the case of any systemic symptoms, the patient immediately is undergoing antibiotic treatment that continues for a long time. A part of the irrational use of antibiotics is in surgical wards. The primary use of antibiotics in surgical wards is due to the prophylaxis before and after surgery. In many cases, the Guidelines for prophylaxis and prevention of infection of antibiotics is not available or not followed, and the patient receives prophylaxis for a long time. Practitioners missed clinical guidelines on how to use antibiotics prophylactically, and many of them have no incentive to study them or update their information on these guidelines. Whatever the cause of overuse of antibiotics, it can have dire consequences. Few studies have conducted in our country about the rate of antibiotic resistances indicating the rate of antibiotic resistance is increasing progressively. The depth of the disaster appears when that irrational administration of antibiotics in university hospital wards that should play a leading and educational role in reducing antibiotic use, is more than any other wards. Unfortunately, many executive officials have no information about the importance of the issue, or they ignore it if they are. The WHO and CDC have adopted several actions plans to increase awareness and control the further emergence of resistant bacteria, considering the high risk of AR on a global scale. Implementing antibiotic stewardship programs based on a well-defined surveillance system, promoting sensitive diagnostic indicators and prescription practices, and adopting strict preventive measures against infectious diseases are among the expected measures to limit the hazards of AR. AR surveillance should organize three levels including local, intermediate, and national according to the WHO guidelines.The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (GLOBAL-PPS) developed at the University of Antwerp (www.global-PPS.com) provides a standardized and straightforward online tool for assessing antibiotic prescription and resistance from participating hospitals at all levels. This tool developed following previous PPS conducted among children. The Global-PPS is instrumental in planning and supporting local and national stewardship interventions in a range of resource and geographical settings. Governments can use the Global-PPS tool to improve antimicrobial prescribing as part of their national action plan, which they are expected to draw up, with limited cost and investments in hospital staff.