Table 2 Current policies related to antibiotic use and problems with their implementation

Antibiotics are prescription only drugs

Discrepancy between number of regulators and retail outlets. No sanctions or penalties for non-compliance.

Allocate more resources to implement the law. Ensure appropriate sanctions and penalties are enforced for non-compliant providers. Public educational initiatives to raise awareness and take advantage of the high literacy rate.

Hospitals need a Drug ad Therapeutics Committee (DTC)

DTCs are not trained in antimicrobial stewardship methodologies and do not have access to current resistance data. Many hospitals do not have DTCs.

Provide tools/guidance on effective hospital antibiotic stewardship. Provide them with reliable and up-to-date resistance data.

Hospitals need an infection control committee

Standardized surveillance structures are not in place. Many hospitals do not have infection control committees.

Provide infection control committees with funding to carry out their activities and improve infrastructure. Train them to use standardized surveillance methodologies and indicators to monitor progress, such as HAI rates by department and hand washing compliance.

Laboratory enhancement program

Inappropriate resistance testing gives erroneous and discrepant results

Ensure quality of laboratory testing by issuing national testing guidelines, including quality control strains. Consider setting up a national reference center (center of excellence) for antibiotic resistance testing and overseeing external quality control. Create an interactive network for sharing information (data, guidelines, expertise).

National antibiotic resistance surveillance

Lack of communication between institutions regarding resistance data

Pool data from all hospitals to create a national resistance database. Release a national annual report that includes both antibiotic use and resistance data in the same document.

Hospital antibiotic use surveillance

No standardized reporting of antibiotic consumption data

Standardize antibiotic usage indicators to international units, like Defined Daily Dosage (DDD) per 100 bed days. Release a national annual report that includes both antibiotic use and resistance data in the same document.

Medical and pharmacy school curriculum

Insufficient emphasis placed on antimicrobial stewardship

Provide sufficient time to teach and train students on appropriate antibiotic use and resistance. Highlight the growing public health problem of drug resistance.

Standard treatment guidelines

Current treatment guidelines are outdated

Ensure timely and evidence based updates of treatment guidelines for infectious diseases, utilizing local resistance data.

Pharmacovigilance

Adequate funding and resources

Engage the center for pharmacovigilance in tackling the issue of inappropriate antibiotic prescribing.

Stop agricultural antibiotic use before harvesting products

Enforcement focuses on farmers producing for export

Enforce the law. Set up a similar national antibiotic use and resistance surveillance system for the agricultural industry. Compile a national annual report that includes both antibiotic use and resistance data in the same document.