Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses

• Country situational analyses provide rapid assessment of antibiotic use and policies, particularly where infrastructure for routine monitoring is lacking, so help to build political will and government capacity to take action to improve the appropriate use of antibiotics • South East Asian countries have high antibiotic use, and poor implementation of policies to encourage appropriate use • Measures such as a dedicated government unit for antimicrobial stewardship, a national strategy to contain antimicrobial resistance, updated standard treatment guidelines, hospital drug and therapeutic committees, public education, and restriction of newer antibiotics being available without prescription must be implemented I nappropriate use of antibiotics is rampant in South East Asia and is a major contributor to antimicrobial resistance. However, data on antibiotic use are scant, few effective interventions to improve appropriate antibiotic use have been implemented, and implementation of policies for appropriate use of antibiotics is also poor. An analysis of secondary data on antibiotic use from 56 low and middle income countries found that countries reporting implementation of more policies also had more appropriate antibiotic use. Effective policies included having a government health department to promote rational use of medicines, a national strategy to contain antimicrobial resistance, a national drug information centre, drug and therapeutic committees in more than half of all general hospitals and provinces, and undergraduate education on standard treatment guidelines. An updated essential medicines list and national formularies were also associated with lower antibiotic use. Many h igh l eve l f o rums have recommended that countries undertake routine monitoring of antibiotic use and use an integrated health systems approach to improve access to and use of medicines, including antibiotics. Most South East Asian countries lack the infrastructure for this, and the responsibility for medicines management is often divided between different government units with no clear accountability. Since 2010, South East Asian countries have been conducting national situational analyses on medicines management every four years, supported by the World Health Organization. This process involves rapid systematic data collection on use and availability of medicines, including antibiotics, and implementation of policies to ensure appropriate use. A multidisciplinary government team of four to eight people conducts this analysis over two weeks using a predesigned workbook tool. The process ends with a national workshop to identify priorities for action. We present key findings from published reports of the situational analyses done during 2010-15 and propose next steps to improve antibiotic management.