Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil

Moura, Maria L.; Boszczowski, Icaro; Blaque, Manuela; Mussarelli, Rafael M.; Fossaluza, Victor; Pierrotti, Ligia C.; Campana, Gustavo; Brandileone, Maria C.; Zanella, Rosemeire; Almeida, Samanta C.G.; Levin, Anna S.

doi:10.3201/eid2801.201928

i

Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil

Supporting Files Public Domain

1 2022
By Moura, Maria L. ; Boszczowski, Icaro ; Blaque, Manuela ; ...

File Language:

English

Details

Alternative Title:

Emerg Infect Dis
Personal Author:

Moura, Maria L. ; Boszczowski, Icaro ; Blaque, Manuela ; Mussarelli, Rafael M. ; Fossaluza, Victor ; Pierrotti, Ligia C. ; Campana, Gustavo ; Brandileone, Maria C. ; Zanella, Rosemeire ; Almeida, Samanta C.G. ; Levin, Anna S.
Description:

Although restricting over-the-counter (OTC) antimicrobial drug sales is recommended globally, no data track its effect on antimicrobial resistance (AMR) in bacteria. We evaluated the effect of a national policy restricting OTC antimicrobial sales, put in place in November 2010, on AMR in a metropolitan region of São Paulo, Brazil. We reviewed associations between antimicrobial sales from private pharmacies and AMR in 404,558 Escherichia coli and 5,797 Streptococcus pneumoniae isolates using a dynamic regression model based on a Bayesian approach. After policy implementation, a substantial drop in AMR in both bacterial species followed decreased amoxicillin and trimethoprim/sulfamethoxazole sales. Conversely, increased ciprofloxacin sales were associated with increased ciprofloxacin resistance, and extended spectrum β-lactamases-positive E. coli isolates and azithromycin sales increases after 2013 were associated with increased erythromycin resistance in S. pneumoniae isolates. These findings suggest that restricting OTC antimicrobial sales may influence patterns of AMR, but multifaceted approaches are needed to avoid unintended consequences.
Subjects:

Anti-Bacterial Agents Anti-Infective Agents Bayes Theorem Drug Resistance, Bacterial Escherichia Coli Microbial Sensitivity Tests Policy
Source:

Emerg Infect Dis. 2022; 28(1):180-187
Pubmed ID:

34932455
Pubmed Central ID:

PMC8714220
Document Type:

Journal Article
Place as Subject:

Brazil
Volume:

28
Issue:

1
Collection(s):

Emerging Infectious Diseases
Main Document Checksum:

urn:sha256:b085eee6049339236854d486c16803a4db488012d589814e48055f1edf105e6e
Download URL:

https://stacks.cdc.gov/view/cdc/113313/cdc_113313_DS1.pdf
File Type:

[PDF - 2.30 MB ]

File Language:

English

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