Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis

Autoři: Giorgia Sulis aff001;  Pierrick Adam aff001;  Vaidehi Nafade aff001;  Genevieve Gore aff003;  Benjamin Daniels aff004;  Amrita Daftary aff002;  Jishnu Das aff004;  Sumanth Gandra aff006;  Madhukar Pai aff001
Působiště autorů: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada aff001;  McGill International TB Centre, McGill University, Montreal, Quebec, Canada aff002;  Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Quebec, Canada aff003;  McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, United States of America aff004;  School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada aff005;  Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America aff006;  Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India aff007
Vyšlo v časopise: Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 17(6): e32767. doi:10.1371/journal.pmed.1003139
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003139



The widespread use of antibiotics plays a major role in the development and spread of antimicrobial resistance. However, important knowledge gaps still exist regarding the extent of their use in low- and middle-income countries (LMICs), particularly at the primary care level. We performed a systematic review and meta-analysis of studies conducted in primary care in LMICs to estimate the prevalence of antibiotic prescriptions as well as the proportion of such prescriptions that are inappropriate.

Methods and findings

We searched PubMed, Embase, Global Health, and CENTRAL for articles published between 1 January 2010 and 4 April 2019 without language restrictions. We subsequently updated our search on PubMed only to capture publications up to 11 March 2020. Studies conducted in LMICs (defined as per the World Bank criteria) reporting data on medicine use in primary care were included. Three reviewers independently screened citations by title and abstract, whereas the full-text evaluation of all selected records was performed by 2 reviewers, who also conducted data extraction and quality assessment. A modified version of a tool developed by Hoy and colleagues was utilized to evaluate the risk of bias of each included study. Meta-analyses using random-effects models were performed to identify the proportion of patients receiving antibiotics. The WHO Access, Watch, and Reserve (AWaRe) framework was used to classify prescribed antibiotics. We identified 48 studies from 27 LMICs, mostly conducted in the public sector and in urban areas, and predominantly based on medical records abstraction and/or drug prescription audits. The pooled prevalence proportion of antibiotic prescribing was 52% (95% CI: 51%–53%), with a prediction interval of 44%–60%. Individual studies’ estimates were consistent across settings. Only 9 studies assessed rationality, and the proportion of inappropriate prescription among patients with various conditions ranged from 8% to 100%. Among 16 studies in 15 countries that reported details on prescribed antibiotics, Access-group antibiotics accounted for more than 60% of the total in 12 countries. The interpretation of pooled estimates is limited by the considerable between-study heterogeneity. Also, most of the available studies suffer from methodological issues and report insufficient details to assess appropriateness of prescription.


Antibiotics are highly prescribed in primary care across LMICs. Although a subset of studies reported a high proportion of inappropriate use, the true extent could not be assessed due to methodological limitations. Yet, our findings highlight the need for urgent action to improve prescription practices, starting from the integration of WHO treatment recommendations and the AWaRe classification into national guidelines.

Trial registration

PROSPERO registration number: CRD42019123269.

Klíčová slova:

Antibiotic resistance – Antibiotics – China – Metaanalysis – Pediatrics – Primary care – Systematic reviews – Treatment guidelines


1. World Health Organization. Antimicrobial resistance and primary health care. Geneva: World Health Organization; 2018 [cited 2020 May 13]. Available from:

2. Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: final report and recommendations. London: Review on Antimicrobial Resistance; 2016 [cited 2020 May 13]. Available from:

3. de Kraker ME, Stewardson AJ, Harbarth S. Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med. 2016;13(11):e1002184. doi: 10.1371/journal.pmed.1002184 27898664

4. Chatterjee A, Modarai M, Naylor NR, Boyd SE, Atun R, Barlow J, et al. Quantifying drivers of antibiotic resistance in humans: a systematic review. Lancet Infect Dis. 2018;18(12):e368–78. doi: 10.1016/S1473-3099(18)30296-2 30172580

5. World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015 [cited 2020 May 13]. Available from:

6. Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A. 2018;115(15):E3463–70. doi: 10.1073/pnas.1717295115 29581252

7. Center for Disease Dynamics, Economics and Policy, Global Antibiotic Resistance Partnership. The state of the world’s antibiotics 2015. Washington (DC): Center for Disease Dynamics, Economics and Policy; 2015 [cited 2020 May 13]. Available from:

8. Auta A, Hadi MA, Oga E, Adewuyi EO, Abdu-Aguye SN, Adeloye D, et al. Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis. J Infect. 2019;78(1):8–18. doi: 10.1016/j.jinf.2018.07.001 29981773

9. Machowska A, Stalsby Lundborg C. Drivers of irrational use of antibiotics in Europe. Int J Environ Res Public Health. 2018;16(1):27. doi: 10.3390/ijerph16010027 30583571

10. Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019;364:k5092. doi: 10.1136/bmj.k5092 30651273

11. Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018;6(6):e619–29. doi: 10.1016/S2214-109X(18)30186-4 29681513

12. Kardas P, Devine S, Golembesky A, Roberts C. A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents. 2005;26(2):106–13. doi: 10.1016/j.ijantimicag.2005.04.017 16009535

13. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. doi: 10.1186/2046-4053-4-1 25554246

14. Beall’s list of potential predatory journals and publishers: Potential predatory scholarly open-access journals.; 2019 [cited 2020 May 13] Available from:

15. WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) classification system 2019. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2019.

16. World Bank. World Bank country and lending groups. Washington (DC): World Bank; 2020 [cited 2020 May 13]. Available from:

17. Uchida H, Nelson A. Agglomeration index: towards a new measure of urban concentration. Working Paper No. 2010/29. Helsinki: World Institute for Development Economics Research; 2010 [cited 2020 May 13]. Available from:

18. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9. doi: 10.1016/j.jclinepi.2011.11.014 22742910

19. Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67(8):897–903. doi: 10.1016/j.jclinepi.2014.03.003 24794697

20. Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26(4):404–13. doi: 10.1093/biomet/26.4.404

21. Sharland M, Gandra S, Huttner B, Moja L, Pulcini C, Zeng M, et al. Encouraging AWaRe-ness and discouraging inappropriate antibiotic use-the new 2019 Essential Medicines List becomes a global antibiotic stewardship tool. Lancet Infect Dis. 2019;19(12):1278–80. doi: 10.1016/S1473-3099(19)30532-8 31782385

22. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67(11):974–8. doi: 10.1136/jech-2013-203104 23963506

23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. doi: 10.1136/bmj.327.7414.557 12958120

24. IntHout J, Ioannidis JP, Rovers MM, Goeman JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6(7):e010247. doi: 10.1136/bmjopen-2015-010247 27406637

25. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72(1):39. doi: 10.1186/2049-3258-72-39 25810908

26. Harbord RM, Higgins JPT. Meta-regression in Stata. Stata J. 2008;8(4):493–519. doi: 10.1177/1536867x0800800403

27. Mukonzo JK, Namuwenge PM, Okure G, Mwesige B, Namusisi OK, Mukanga D. Over-the-counter suboptimal dispensing of antibiotics in Uganda. J Multidiscip Healthc. 2013;6:303–10. doi: 10.2147/JMDH.S49075 23990728

28. Savadogo LGB, Ilboudo B, Kinda M, Boubacar N, Hennart P, Dramaix M, et al. Antibiotics prescribed to febrile under-five children outpatients in urban public health services in Burkina Faso. Health. 2014;6(2):165–70. doi: 10.4236/health.2014.62026

29. Worku F, Tewahido D. Retrospective assessment of antibiotics prescribing at public primary healthcare facilities in Addis Ababa, Ethiopia. Interdiscip Perspect Infect Dis. 2018;2018:4323769. doi: 10.1155/2018/4323769 29681933

30. Yebyo H, Medhanyie AA, Spigt M, Hopstaken R. C-reactive protein point-of-care testing and antibiotic prescribing for acute respiratory tract infections in rural primary health centres of North Ethiopia: a cross-sectional study. NPJ Prim Care Respir Med. 2016;26:15076. doi: 10.1038/npjpcrm.2015.76 26769226

31. Abdulah R, Insani WN, Putri NE, Purba HP, Destiani DP, Barliana MI. Pattern of medication use in geriatric patients at primary health care facilities in Karawang, Indonesia. Drug Healthc Patient Saf. 2019;11:1–5. doi: 10.2147/DHPS.S187829 30799958

32. Adisa R, Fakeye TO, Aindero VO. Evaluation of prescription pattern and patients’ opinion on healthcare practices in selected primary healthcare facilities in Ibadan, South-Western Nigeria. Afr Health Sci. 2015;15(4):1318–29. doi: 10.4314/ahs.v15i4.35 26958037

33. Ahiabu MA, Tersbol BP, Biritwum R, Bygbjerg IC, Magnussen P. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana. Health Policy Plan. 2016;31(2):250–8. doi: 10.1093/heapol/czv048 26045328

34. Akl OA, El Mahalli AA, Elkahky AA, Salem AM. WHO/INRUD drug use indicators at primary healthcare centers in Alexandria, Egypt. J Taibah Univ Med Sci. 2014;9(1):54–64. doi: 10.1016/j.jtumed.2013.06.002

35. Atif M, Sarwar MR, Azeem M, Naz M, Amir S, Nazir K. Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan. BMC Health Serv Res. 2016;16(1):684. doi: 10.1186/s12913-016-1932-2 27931213

36. Beri SG, Pandit VA, Khade KS, Sarda KD. The pattern of drug use in acute fever by general practitioners (GPs) in Pune City, India. J Clin Diagn Res. 2013;7(3):467–72. doi: 10.7860/JCDR/2013/4719.2800 23634398

37. Chem ED, Anong DN, Akoachere JKT. Prescribing patterns and associated factors of antibiotic prescription in primary health care facilities of Kumbo East and Kumbo West Health Districts, North West Cameroon. PLoS ONE. 2018;13(3):e0193353. doi: 10.1371/journal.pone.0193353 29505584

38. El Mahalli AA, Akl OA. Effect of adopting integrated management of childhood illness guidelines on drug use at a primary health care center: a case study from Egypt. J Family Community Med. 2011;18(3):118–23. doi: 10.4103/2230-8229.90010 22175038

39. Graham K, Sinyangwe C, Nicholas S, King R, Mukupa S, Kallander K, et al. Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: a cross-sectional mixed methods study. BMC Public Health. 2016;16:897. doi: 10.1186/s12889-016-3541-8 27567604

40. Jose J, Devassykutty D. Paediatric prescription analysis in a primary health care institution. J Clin Diagn Res. 2016;10(11):FC05–8. doi: 10.7860/JCDR/2016/22350.8797 28050392

41. Kasabi GS, Thilakavathi S, Allam RR, Grace CA, Shivanna R, Murhekar MV. Prescription practices & use of essential medicines in the primary health care system, Shimoga district, Karnataka, India. Indian J Med Res. 2015;142(2):216–9. doi: 10.4103/0971-5916.164261 26354220

42. Ndhlovu M, Nkhama E, Miller JM, Hamer DH. Antibiotic prescribing practices for patients with fever in the transition from presumptive treatment of malaria to ‘confirm and treat’ in Zambia: a cross-sectional study. Trop Med Int Health. 2015;20(12):1696–706. doi: 10.1111/tmi.12591 26311240

43. Omole VN, Joshua IA, Muhammad-Idris ZK, Usman NO, Ahmad IA. Use of injections and antibiotics and profile of health workers in rural primary health care facilities in north-western Nigeria. Int J Med Health Dev. 2018;23(1):183–8. doi: 10.4314/jcm.v23i1.3

44. Oyeyemi AS, Ogunleye OA. Rational use of medicines: assessing progress using primary health centres in Shomolu local government area of Lagos, Nigeria. West Afr J Med. 2013;32(2):121–5. 23913500

45. Raza UA, Khursheed T, Irfan M, Abbas M, Irfan UM. Prescription patterns of general practitioners in Peshawar, Pakistan. Pak J Med Sci. 2014;30(3):462–5. doi: 10.12669/pjms.303.4931 24948959

46. Sarwar MR, Saqib A, Iftikhar S, Sadiq T. Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan. BMC Infect Dis. 2018;18(1):492. doi: 10.1186/s12879-018-3407-z 30268106

47. Saurabh MK, Biswas NK, Yadav AK, Singhai A, Saurabh A. Study of prescribing habits and assessment of rational use of drugs among doctors of primary health care facilities. Asian J Pharm Clin Res. 2011;4(4):102–5.

48. Saweri OPM, Hetzel MW, Mueller I, Siba PM, Pulford J. The treatment of non-malarial febrile illness in Papua New Guinea: findings from cross sectional and longitudinal studies of health worker practice. BMC Health Serv Res. 2017;17(1):10. doi: 10.1186/s12913-016-1965-6 28056949

49. Sudarsan M, Sitikantha B, Aparajita D. Audit and quality assessment of prescriptions in an urban health centre of Kolkata. Int J Med Public Health. 2016;6(3):136–9. doi: 10.5530/ijmedph.2016.3.8

50. Yousif BM, Supakankunti S. General practitioners’ prescribing patterns at primary healthcare centers in national health insurance, Gezira, Sudan. Drugs Real World Outcomes. 2016;3(3):327–32. doi: 10.1007/s40801-016-0087-0 27747832

51. Yuniar CT, Anggadiredja K, Islamiyah AN. Evaluation of rational drug use for acute pharyngitis associated with the incidence and prevalence of the disease at two community health centers in Indonesia. Sci Pharm. 2017;85(2):22. doi: 10.3390/scipharm85020022 28452967

52. Ahmadi F, Zarei E. Prescribing patterns of rural family physicians: a study in Kermanshah Province, Iran. BMC Public Health. 2017;17(1):908. doi: 10.1186/s12889-017-4932-1 29183293

53. Alabid AH, Ibrahim MI, Hassali MA. Antibiotics dispensing for urtis by community pharmacists (CPs) and general medical practitioners in Penang, Malaysia: a comparative study using simulated patients (SPs). J Clin Diagn Res. 2014;8(1):119–23. doi: 10.7860/JCDR/2014/6199.3923 24596741

54. Bielsa-Fernandez MV, Frati-Munari AC, Ariza-Andraca R. Treatment to patients with acute diarrhea: survey to a group of general practitioners from Mexico. Atencion Familiar. 2016;23(4):119–24. doi: 10.1016/

55. Gasson J, Blockman M, Willems B. Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa. S Afr Med J. 2018;108(4):304–10. doi: 10.7196/SAMJ.2017.v108i4.12564 29629681

56. Greer RC, Intralawan D, Mukaka M, Wannapinij P, Day NPJ, Nedsuwan S, et al. Retrospective review of the management of acute infections and the indications for antibiotic prescription in primary care in northern Thailand. BMJ Open. 2018;8(7):e022250. doi: 10.1136/bmjopen-2018-022250 30061442

57. Lima MG, Dutra KR, Martins UCM. Prescribing indicators in primary health care in Belo Horizonte, Brazil: associated factors. Int J Clin Pharm. 2017;39(4):913–8. doi: 10.1007/s11096-017-0501-z 28626850

58. Mashalla Y, Setlhare V, Massele A, Sepako E, Tiroyakgosi C, Kgatlwane J, et al. Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: findings and implications. Int J Clin Pract. 2017;71(12). doi: 10.1111/ijcp.13042 29178350

59. Ab Rahman N, Teng CL, Sivasampu S. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis. 2016;16:208. doi: 10.1186/s12879-016-1530-2 27188538

60. Sadeghian GH, Safaeian L, Mahdanian AR, Salami S, Kebriaee-Zadeh J. Prescribing quality in medical specialists in Isfahan, Iran. Iran J Pharm Res. 2013;12(1):235–41. 24250595

61. Safaeian L, Mahdanian AR, Salami S, Pakmehr F, Mansourian M. Seasonality and physician-related factors associated with antibiotic prescribing: a cross-sectional study in Isfahan, Iran. Int J Prev Med. 2015;6:1. doi: 10.4103/2008-7802.151431 25789136

62. Sánchez Choez X, Armijos Acurio ML, Jimbo Sotomayor RE. Appropriateness and adequacy of antibiotic prescription for upper respiratory tract infections in ambulatory health care centers in Ecuador. BMC Pharmacol Toxicol. 2018;19(1):46. doi: 10.1186/s40360-018-0237-y 30049281

63. Sun Q, Dyar OJ, Zhao L, Tomson G, Nilsson LE, Grape M, et al. Overuse of antibiotics for the common cold—attitudes and behaviors among doctors in rural areas of Shandong Province, China. BMC Pharmacol Toxicol. 2015;16:6. doi: 10.1186/s40360-015-0009-x 25884702

64. Wang J, Wang P, Wang X, Zheng Y, Xiao Y. Use and prescription of antibiotics in primary health care settings in China. JAMA Intern Med. 2014;174(12):1914–20. doi: 10.1001/jamainternmed.2014.5214 25285394

65. Xue H, Shi Y, Huang L, Yi H, Zhou H, Zhou C, et al. Diagnostic ability and inappropriate antibiotic prescriptions: a quasi-experimental study of primary care providers in rural China. J Antimicrob Chemother. 2019;74(1):256–63. doi: 10.1093/jac/dky390 30285113

66. Yin X, Gong Y, Yang C, Tu X, Liu W, Cao S, et al. A comparison of quality of community health services between public and private community health centers in urban China. Med Care. 2015;53(10):888–93. doi: 10.1097/MLR.0000000000000414 26366520

67. Zhang Z, Hu Y, Zou G, Lin M, Zeng J, Deng S, et al. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions. Glob Health Action. 2017;10(1):1287334. doi: 10.1080/16549716.2017.1287334 28462635

68. Baltzell K, Kortz TB, Scarr E, Blair A, Mguntha A, Bandawe G, et al. ‘Not all fevers are malaria’: a mixed methods study of non-malarial fever management in rural southern Malawi. Rural Remote Health. 2019;19(2):4818. doi: 10.22605/RRH4818 31200600

69. Zhan Q, Wang YL, Chen X. Evaluation of antibacterial use in outpatients of township and community primary medical institutions in a district of Sichuan Province, China. J Glob Antimicrob Resist. 2019;19:201–6. doi: 10.1016/j.jgar.2019.04.021 31077858

70. Kjærgaard J, Anastasaki M, Stubbe Østergaard M, Isaeva E, Akylbekov A, Nguyen NQ, et al. Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: a descriptive FRESH AIR study. PLoS ONE. 2019;14(11):e0221389. doi: 10.1371/journal.pone.0221389 31693667

71. Liu C, Wang D, Zhang X. Intrinsic and external determinants of antibiotic prescribing: a multi-level path analysis of primary care prescriptions in Hubei, China. Antimicrob Resist Infect Control. 2019;8:132. doi: 10.1186/s13756-019-0592-5 31406571

72. Mekuria LA, de Wit TF, Spieker N, Koech R, Nyarango R, Ndwiga S, et al. Analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: a mixed-methods study. PLoS ONE. 2019;14(9):e0222651. doi: 10.1371/journal.pone.0222651 31557170

73. Nepal A, Hendrie D, Robinson S, Selvey LA. Analysis of patterns of antibiotic prescribing in public health facilities in Nepal. J Infect Dev Ctries. 2020;14(1):18–27. doi: 10.3855/jidc.11817 32088680

74. Yin J, Dyar OJ, Yang P, Yang D, Marrone G, Sun M, et al. Pattern of antibiotic prescribing and factors associated with it in eight village clinics in rural Shandong Province, China: a descriptive study. Trans R Soc Trop Med Hyg. 2019;113(11):714–21. doi: 10.1093/trstmh/trz058 31294806

75. Kwan A, Daniels B, Saria V, Satyanarayana S, Subbaraman R, McDowell A, et al. Variations in the quality of tuberculosis care in urban India: a cross-sectional, standardized patient study in two cities. PLoS Med. 2018;15(9):e1002653. doi: 10.1371/journal.pmed.1002653 30252849

76. Leonard K, Masatu MC. Outpatient process quality evaluation and the Hawthorne effect. Soc Sci Med. 2006;63(9):2330–40. doi: 10.1016/j.socscimed.2006.06.003 16887245

77. Leonard KL, Masatu MC. The use of direct clinician observation and vignettes for health services quality evaluation in developing countries. Soc Sci Med. 2005;61(9):1944–51. doi: 10.1016/j.socscimed.2005.03.043 15936863

78. Using indicators to measure country pharmaceutical situations. Fact book on WHO Level I and Level II monitoring indicators. Geneva: World Health Organization; 2006 [cited 2020 May 13]. Available from:

79. Hsia Y, Sharland M, Jackson C, Wong ICK, Magrini N, Bielicki JA. Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries. Lancet Infect Dis. 2019;19(1):67–75. doi: 10.1016/S1473-3099(18)30547-4 30522834

80. Thompson W, Tonkin-Crine S, Pavitt SH, McEachan RRC, Douglas GVA, Aggarwal VR, et al. Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. J Antimicrob Chemother. 2019;74(8):2139–52. doi: 10.1093/jac/dkz152 31002336

81. Dolk FCK, Pouwels KB, Smith DRM, Robotham JV, Smieszek T. Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? J Antimicrob Chemother. 2018;73(Suppl. 2):ii2–10. doi: 10.1093/jac/dkx504 29490062

82. Kohli M, Sen P, Pai M. Improving access to essential tests for infectious diseases. Microbes Infect. 2019;21(1):1–3. doi: 10.1016/j.micinf.2018.08.003 30217736

83. Pulcini C ESGAP AMOXDOSE working group. Amoxicillin dosing recommendations are very different in European countries: a cross-sectional survey. Clin Microbiol Infect. 2017;23(6):414–5. doi: 10.1016/j.cmi.2016.11.013 27890458

84. World Health Organization. Executive summary: the selection and use of essential medicines 2019. Report of the 22nd WHO Expert Committee on the Selection and Use of Essential Medicines. Geneva: World Health Organization; 2019 [cited 2020 May 13]. Available from:

85. Spivak ES, Cosgrove SE, Srinivasan A. Measuring appropriate antimicrobial use: attempts at opening the black box. Clin Infect Dis. 2016;63(12):1639–44. doi: 10.1093/cid/ciw658 27682070

86. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858. doi: 10.1016/S0140-6736(18)32279-7 30496104

87. World Health Organization. Global Antimicrobial Resistance Surveillance System (GLASS) report: early implementation 2016–2017. Geneva: World Health Organization; 2017 [cited 2020 May 13]. Available from:

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