Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries
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Date
2026-05-20
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JAC-Antimicrobial Resistance
Abstract
Background: There are concerns globally with rising rates of antimicrobial resistance (AMR), particularly in lowand middle-income countries (LMICs). AMR is driven by high rates of inappropriate prescribing and dispensing of
antibiotics, particularly Watch antibiotics. To develop future interventions, it is important to document current knowledge, attitudes and practices (KAP) among key stakeholder groups in LMICs.
Methods: We undertook a narrative review of published papers among four WHO Regions including African and Asian countries. Relevant papers were sourced from 2018 to 2024 and synthesized by key stakeholder group, country, WHO Region, income level and year. The findings were summarized to identify pertinent future activities
for all key stakeholder groups.
Results: We sourced 459 papers, with a large number coming from Africa (42.7%). An appreciable number dealt
with patients’ KAP (33.1%), reflecting their influence on the prescribing and dispensing of antibiotics. There was
marked consistency of findings among key stakeholder groups across the four WHO Regions, all showing concerns with high rates of prescribing of antibiotics for viral infections despite professed knowledge of antibiotics
and AMR. There were similar issues among dispensers. Patients’ beliefs regarding the effectiveness of antibiotics
for self-limiting infectious diseases were a major challenge, although educational programmes did improve
knowledge. The development of the AWaRe (Access, Watch and Reserve) system, including practical prescribing
guidance, provides a future opportunity for the standardization of educational inputs.
Conclusions: Similar KAP regarding the prescribing and dispensing of antibiotics across LMICs and stakeholder
groups presents clear opportunities for standardization of educational input and practical training programmes
based on the AWaRe system.
Description
Keywords
Antibiotic use, Low and middle income countries
Citation
Saleem, Z., Moore, C.E., Kalungia, A.C., Schellack, N., Ogunleye, O., Chigome, A., Chowdhury, K., Kitutu, F.E., Massele, A., Ramdas, N. and Orubu, E.S., 2025. Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low-and middle-income countries. JAC-Antimicrobial Resistance, 7(2), p.dlaf033.