Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR
Issued Date
2024-02-01
Resource Type
eISSN
26321823
Scopus ID
2-s2.0-85183187554
Journal Title
JAC-Antimicrobial Resistance
Volume
6
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAC-Antimicrobial Resistance Vol.6 No.1 (2024)
Suggested Citation
Chansamouth V., Inlorkham P., Keohavong B., Bellingham K., van Doorn H.R., Mayxay M., Newton P.N., Turner P., Day N.P.J., Ashley E.A. Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR. JAC-Antimicrobial Resistance Vol.6 No.1 (2024). doi:10.1093/jacamr/dlae004 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/95741
Title
Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR
Corresponding Author(s)
Other Contributor(s)
Abstract
In 2022, WHO released the WHO AWaRe (Access, Watch, Reserve) antibiotic book to promote the rational use of antibiotics. Here, we review the AWaRe antibiotic book from the perspective of implementation in low-resource settings, using the Lao PDR (Laos) as a case study. Not all recommendations in the AWaRe antibiotic book match the epidemiology of infectious diseases and antimicrobial susceptibility patterns in Laos and other low- and middle-income countries (LMICs), e.g. melioidosis, rickettsial disease and leptospirosis are common causes of sepsis and febrile illness in Laos but do not feature in the AWaRe book. Conversely, some infectious diseases like Clostridioides difficile-associated diarrhoea are in the AWaRe antibiotic book but rarely considered in Laos with no diagnostic tests available. Only 29/39 antibiotics in the AWaRe book are available in Laos, with no Reserve group antimicrobials available. The AWaRe book stimulates countries such as Laos to consider alternative diagnoses and include additional antimicrobials in the national essential medicines list (NEML). However, it should be updated to include regional important pathogens that are not included. Comprehensive antibiotic use guidelines alone might not assure appropriate use or control overuse of antibiotics. Access to antibiotics is challenging in low-resource settings in terms of unavailability in the country (low demand or small market size), patchy access, especially for those living in remote areas, and unaffordability. All these systemic factors can contribute to inappropriate use of antibiotics. Improved access to antibiotics, strengthening diagnostic capacity and promoting antibiotic stewardship should be combined.