Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

Abstract

Background: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.

Objectives: To review the situation with respect to AMR in Brazil and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Brazil and to improve patient outcomes.

Methods: National initiatives to address AMR, antibiotic use and prescribing in Brazil, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infections (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, along with local antibiotic availability.

Conclusions: In Brazil there have been some initiatives addressing AMR such as the National Action Plan for AMR, established in 2018. Antibiotic consumption in Brazil is high but a ban on over-the-counter sales of antibiotics has led to a decrease in consumption. Local antibiotic susceptibility testing needs to be increased and the Survey of Antibiotic Resistance (SOAR) study in Brazil will provide useful data for pathogens causing CA-RTIs. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Brazil, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.

Figure 1.

Percentage susceptibility rates based on CLSI breakpoints for antibiotics against S. pneumoniae isolates from the ATLAS surveillance programme in Brazil 2015–16. Data access date 21 November 2021.

Figure 2.

Percentage susceptibility rates based on CLSI breakpoints for antibiotics against H. influenzae isolates from the ATLAS surveillance programme in Brazil 2016–19. Data access date 21 November 2021.

Figure 3.

Percentage susceptibility rates based on CLSI breakpoints for antibiotics against S. pneumoniae isolates from the SENTRY surveillance programme in Brazil 2014–19. Data access date 21 November 2021.

Figure 4.

Percentage susceptibility rates based on CLSI breakpoints for antibiotics against H. influenzae isolates from the SENTRY surveillance programme in Brazil 2014–18. Data access date 21 November 2021.