The facilitators of and barriers to antimicrobial use and misuse in Lalitpur, Nepal: a qualitative study

Background: Antimicrobial resistance (AMR) is a pressing global health concern driven by inappropriate antibiotic use, which is in turn influenced by various social, systemic, and individual factors. This study, nested within FIND’s AMR Diagnostic Use Accelerator clinical trial in Nepal, aimed to (i) explore the perspectives of patients, caregivers, and healthcare workers (HCWs) on antibiotic prescription adherence and (ii) assess the impact of a training and communication (T&C) intervention on adherence to antibiotic prescriptions. Methods: Using qualitative, semi-structured interviews, pre-intervention and Day 7 follow-up components, and the Behaviour Change Wheel process, we investigated the facilitators of and barriers to the use and misuse of antibiotic prescriptions. Results: Results of the study revealed that adherence to antibiotic prescriptions is influenced by a complex interplay of factors, including knowledge and understanding, forgetfulness, effective communication, expectations, beliefs and habits, attitudes and behaviours, convenience of purchasing, trust in medical effectiveness, and issues of child preferences. The T&C package was also shown to play a role in addressing specific barriers to treatment adherence. Conclusions: Overall, the results of this study provide a nuanced understanding of the challenges associated with antibiotic use and suggest that tailored interventions, informed by behaviour frameworks, can enhance prescription adherence, may be applicable in diverse settings and can contribute to the global effort to mitigate the rising threat of AMR

Successful management of delayed presentation of massive paracetamol overdose in a resource‐limited setting: A case report from Nepal

Abstract We present a case of self‐poisoning with a massive dose of paracetamol by a young Nepalese female patient who presented late to our emergency department. This report highlights the successful management of the patient with the extended use of N‐acetylcysteine over 4 days and continuous supportive therapy as required. The case is an example of the management of delayed presentation of a massive paracetamol poisoning in a resource‐limited setting, where intensive care units and hemodialysis facilities are not easily available. However, when available, massive poisoning should always be managed in continuous monitoring units under the expertise of a toxicologist

Fever clearance time – subgroup analyses.

<p>Heterogeneity was tested with a Cox regression model that included an interaction between treatment effect and subgroup.</p><p>MIC's and age were missing for some patients. N number, pts patients, MIC minimum inhibitory concentration.</p

Baseline characteristics of patients according to treatment group (intention to treat population).

<p>AST = serum aspartate aminotransferase (normal range 12–30 U/L), ALT = serum alanine aminotransferase (normal range 13–40 U/L).</p

Scatter plots of drugs MIC versus fever clearance time.

<p>Gatifloxacin and ofloxacin MICs versus fever clearance time by treatment group for patients with blood culture confirmed enteric fever. Blue lines correspond to LOESS scatter plot smoothers.</p

Treatment failure – subgroup analyses.

<p>Heterogeneity was tested with a Cox regression model that included an interaction between treatment effect and subgroup.</p>#<p>Based on Cox regression with Firth's penalized likelihood to cope with separation.</p><p>MIC's and age were missing for some patients. N number, pts patients, MIC minimum inhibitory concentration.</p

Minimum inhibitory concentration MIC of <i>Salmonella</i> Typhi and paratyphi A.

<p>132 <i>S</i>.Typhi and 86 <i>S</i>.Paratyphi A were available for MIC testing. MIC 50/90 = concentration at which 50% and 90% of the organisms, respectively, are inhibited. Comparison based on Fisher's exact test for categorical data and Wilcoxon test for continuous data.</p

Trial profile.

<p>Numbers in blue font represent numbers of patients infected with nalidixic acid resistant isolates.</p

Kaplan-Meier estimates for patients infected with nalidixic acid resistant isolates.

<p>Kaplan- Meier estimates of the probability of treatment failure, fever clearance time, and the probability of relapse for patients infected with nalidixic acid resistant isolates.</p