Consumption of antibiotics in a small Pacific island nation: Samoa
High levels of antibiotic use contribute to development of antibiotic resistance. There is little known about levels of antibiotic use in Samoa, although anecdotally, there are high levels of use, and a strain of methicillin-resistant Staphylococcus aureus may have developed there.
The study aimed to gather basic data on levels of antibiotic use in Samoa.
All those who import medicines into Samoa were interviewed; invoices, prescription records in hospitals, pharmacies and health centres were reviewed; and prospective observation was carried out in private pharmacies.
Analysis of orders made in one year provided an estimate of overall antibiotic consumption of 37.3 Defined Daily Doses (DDDs) per 1000 inhabitant days. Penicillins comprised 63% of DDDs used. Antibiotics were around a third of all prescribed drugs in hospitals and pharmacies, and 44% of those dispensed in health centres. Approximately two-thirds of prescriptions dispensed included an antibiotic. A quarter of antibiotic sales in pharmacies were without a prescription.
Samoa has high rates of use of antibiotics and very high reliance on penicillins, compared to other developing countries. Levels of prescribing are high compared with other developing nations. It is feasible to calculate total consumption of medicines in very small developing nations.
2. World Health Organisation. WHO Global Strategy for Containment of Antimicrobial Resistance. Geneve: WHO; 2001.
3. Amyes SG. The rise in bacterial resistance is partly because there have been no new classes of antibiotics since the 1960s. BMJ. 2000 Jan 22;320(7229):199-200.
4. Ellis-Pegler RB. Antimicrobial resistance--can we, should we do anything about it? N Z Med J. 1999;112(1096):349-51.
5. McGregor A, Dovey S, Tilyard M. Antibiotic use in upper respiratory tract infections in New Zealand. Fam Pract. 1995 Jun;12(2):166-70.
6. Kljakovic M. Durham J. Sore throat diagnosis and management in a general practice after-hours service. N Z Fam Physician 1999;26(6):47-50.
7. van Duijn HJ, Kuyvenhoven MM, Schellevis FG, Verheij TJ. Determinants of prescribing of second-choice antibiotics for upper and lower respiratory tract episodes in Dutch general practice. J Antimicrob Chemother. 2005;56(2):420-2.
8. Mazzaglia G, Caputi AP, Rossi A, Bettoncelli G, Stefanini G, Ventriglia G, Nardi R, Brignoli O, Cricelli C. Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care. Eur J Clin Pharmacol. 2003;59(8-9):651-7.
9. Schorling JB, De Souza MA, Guerrant RL. Patterns of antibiotic use among children in an urban Brazilian slum. Int J Epidemiol. 1991;20(1):293-9.
10. Larsson M, Kronvall G, Chuc NT, Karlsson I, Lager F, Hanh HD, Tomson G, Falkenberg T. Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. Trop Med Int Health. 2000;5(10):711-21.
11. Thamlikitkul V. Antibiotic dispensing by drug store personnel in Bangkok, Thailand. J Antimicrob Chemother. 1988 Jan;21(1):125-31.
12. Montefiore D, Rotimi VO, Adeyemi-Doro FA. The problem of bacterial resistance to antibiotics among strains isolated from hospital patients in Lagos and Ibadan, Nigeria. J Antimicrob Chemother. 1989;23(4):641-51
13. Okumura J, Wakai S, Umenai T. Drug utilisation and self-medication in rural communities in Vietnam.. Soc Sci Med. 2002;54(12):1875-86.
14. Smith JM, Cook GM, A decade of community MRSA in New Zealand. Epidemiol Infect. 2005 Oct;133(5):899-904
15. World Health Organisation. Core Health Indicators from the World Health Report: WHOSIS. Geneve: WHO; 2005.
16. Statistics New Zealand, Pacific Profiles - Samoan.
17. Australian Bureau of Statistics, Australian Social Trends: Population - Population characteristics: Ancestry of Australia's Population. 2003, Australian Bureau of Statistics.
18. US Census, Tongan Population: Native Hawaiians and other Pacific Islanders. 2000.
19. Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579-87.
20. World Health Organisation, Department of Essential Drugs and Medicines Policy. How to investigate drug use in health facilities: selected drug use indicators. Geneve: World Health Organisation; 1993. p. 87.
21. Holloway K, Ivanovska V. Measuring use of medicines: progress in the last decade. in ICIUM (International Conference on Improving the Use of Medicines). 2004. Chaing Mai, Thailand.
22. Mitema ES, Kikuvi GM. Surveillance of the overall use of antimicrobial drugs in humans over a 5 year period (1997-2001) in Kenya. J Antimicrob Chemother. 2004 Nov;54(5):966-7.
23. Angunawela II, Diwan VK, Tomson G. Experimental evaluation of the effects of drug information on antibiotic prescribing: a study in outpatient care in an area of Sri lanka. Int J Epidemiol. 1991 Jun;20(2):558-64.
24. Tomson G, Diwan V, Angunawela I. Paediatric prescribing in out-patient care. An example from Sri Lanka. Eur J Clin Pharmacol. 1990;39(5):469-73.
25. Teng CL, Achike FI, Phua KL, Norhayati Y, Nurjahan MI, Nor AH, Koh CN. General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting. Int J Antimicrob Agents. 2004;24(5):496-501.
26. Chalker J, Ratanawijitrasin S, Chuc NT, Petzold M, Tomson G. Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand--a randomized controlled trial.. Soc Sci Med. 2005;60(1):131-41.
27. Wolffers I. Drug information and sale practices in some pharmacies of Colombo, Sri Lanka. Soc Sci Med. 1987;25(3):319-21
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.