Promoting rational use of antibiotics in the Kyrgyz Republic

Abstract

Antimicrobial resistance (AMR)-the resistance of disease-causing microbes to treatment with antibiotics and other antimicrobial drugs-is a growing global health threat worldwide, making it more difficult and more expensive to treat common infections such as pneumonia, bladder infections, and skin infections. The World Health Organization’s global strategy for containment of AMR calls for provision of evidence-based clinical guidelines on diagnostic and treatment strategies for common infections; the education of providers on AMR and prescribing guidelines; and institutionalization of regular audits of prescribing practices, providing feedback to clinicians using comparison with peer groups or external standards. AMR is a serious problem in the Kyrgyz Republic, which has one of the highest rates of multidrug-resistant tuberculosis (TB) in the world (25% among new cases of TB; 56% among previously treated cases). In 2012, a United States Agency for International Development (USAID) project for improving health-care quality in the Central Asian Republics began working with partners in the Kyrgyz Republic to promote the rational use of antibiotics among prescribers by using principles of quality improvement. This case describes how these actors conducted baseline audits of use of antibiotics and then developed clinical protocols, training, and job aids to change prescribing practices of providers in pilot districts and how they introduced a database to track audit indicators and feed back the results to providers.