This study provides the first systematic assessment of antibiotic use trends in Kazakhstan's primary healthcare over eight years, revealing the potential antimicrobial resistance risks associated with the continuous increase in the proportion of Watch and Reserve antibiotics. It also analyzes the impact of different healthcare providers on antibiotic prescriptions, offering critical data support for adjusting antimicrobial resistance policies.
Literature Overview
This article, 'Trends in ‘Watch’ and ‘Reserve’ Antibiotic Use in Primary Care in Kazakhstan: The Imperative for Enhancing Stewardship Strategies', published in the journal Antibiotics, reviews and summarizes antibiotic usage patterns in Kazakhstan's primary care sector from 2017 to 2024. Using the AWaRe classification, it predicts trends in the usage of different antibiotics and highlights the urgent need for improved stewardship strategies.
Background Knowledge
Antimicrobial resistance (AMR) has become a significant global public health challenge. The WHO's AWaRe classification divides antibiotics into three categories—Access, Watch, and Reserve—to optimize antimicrobial use. This study focuses on Kazakhstan, a low- to middle-income country in Central Asia, where the primary healthcare system follows the Soviet model and faces challenges in implementing effective antibiotic policies. The findings indicate that although over-the-counter sales of antibiotics have been banned, the proportion of Watch antibiotics reached 54.4% in 2024, and the use of Reserve antibiotics is increasing, suggesting that prescription practices still need standardization. Moreover, specific primary care providers, such as general practitioners and community internists, show significant associations with particular antibiotic prescriptions, indicating that policy interventions should consider differences in healthcare provider structures. These findings hold important implications for global antimicrobial stewardship.
Research Methods and Experimental Design
The study employed the WHO GLASS-AMC methodology to calculate antibiotic use in primary care based on Defined Daily Doses (DID). Data were sourced from the Vi-ORTIS database, covering antibiotic sales in Kazakhstan from 2017 to 2024. Correlation analyses were conducted using healthcare workforce data from the Ministry of Health. Trend forecasting was performed using ARIMA and simple exponential smoothing models, while Pearson correlation analyses explored the relationship between antibiotic use and healthcare provider density.
Key Findings and Perspectives
Research Significance and Future Directions
The findings underscore the high usage of Watch and Reserve antibiotics in Kazakhstan’s primary healthcare, closely linked to the structure of the healthcare workforce. Future efforts should focus on strengthening prescription monitoring, promoting oral formulations, and revising national clinical guidelines to align with WHO recommendations. This study provides empirical evidence for policy adjustments and offers a Central Asian perspective on global AMR control.
Conclusion
This study systematically analyzed antibiotic use trends in Kazakhstan's primary healthcare, identifying a continuous rise in Watch antibiotic prescriptions and an increasing trend in Reserve antibiotic use. Despite national antibiotic management policies, implementation remains weak. Notably, after 2020, during the pandemic, relaxed oversight may have contributed to a rebound in antibiotic prescriptions. The research also found that different primary healthcare providers significantly influence prescription patterns, suggesting that policy interventions must consider workforce composition. Future initiatives should focus on revising clinical guidelines, promoting Access antibiotics, reducing broad-spectrum antibiotic prescriptions, and enhancing electronic prescribing systems to improve antibiotic stewardship. These insights offer both national guidance for Kazakhstan and empirical reference for AMR management in emerging economies.
