ReviewAntimicrobial resistance and infection control2021
Antimicrobial stewardship in rural and remote primary health care: a narrative review.
Review in Antimicrobial resistance and infection control, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 2 syntheses or guidelines pooled it, 65 citations in OpenAlex.
- Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Economic evaluation of antimicrobial stewardship in primary care: a systematic review and quality assessment.The Journal of antimicrobial chemotherapy · 2022Pooled it
- Trial
- Educational Intervention Improves Antimicrobial Stewardship Knowledge but Reveals Persistent Barriers in Rural Hospitals.Antibiotics (Basel, Switzerland) · 2026Article
- Ceftazidime-avibactam for multidrug-resistant gram-negative infections: outcomes and timing of initiation across 22 U.S. medical centers.Antimicrobial agents and chemotherapy · 2026Article
- Morbidity patterns, mortality, and antimicrobial resistance among children hospitalized in neonatal and pediatric intensive care units in a rural area of Vietnam.IJID regions · 2026Article
- Applying a gender and equity matrix for a contextualized antimicrobial stewardship intervention in Pakistan.Health policy and planning · 2026Article
- Antimicrobial Consumption and Resistance Dynamics Across Healthcare Level: Global Evidence and Stewardship Implications.Pathogens (Basel, Switzerland) · 2026Review
- Strengthening healthcare systems to prevent antimicrobial resistance in LMICs: it is time to act.Journal of global health · 2026Article
- Antimicrobial stewardship from a One Health perspective.Nature reviews. Microbiology · 2026Review
- Barriers and facilitators for the implementation of Antimicrobial Stewardship Programs in Dar es Salaam Regional Referral Hospitals (RRHs).PLOS global public health · 2026Article
- The changing landscape of outpatient antibiotic prescriptions among advanced practice clinicians in the United States, 2011 and 2022.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Susceptibility Patterns and Factors Associated with Multidrug Antibiotic Resistance Among Patients with Productive Cough in Southwestern Uganda.Infection and drug resistance · 2026Article
- Burnout, depression, and medication errors among family physicians.Scientific reports · 2025Article
- Third-generation Cephalosporin resistance in Sub-Saharan Africa: a systematic review and meta-analysis.Communications medicine · 2025Article
- The Road Less Traveled: Exploring the Genomic Characteristics and Antimicrobial Resistance Potential of Acinetobacter baumannii From the Indigenous Orang Asli Community in Peninsular Malaysia.MicrobiologyOpen · 2025Article
- Nationwide surveillance of carbapenem-resistant Gram-negative pathogens in the Lebanese environment.Applied and environmental microbiology · 2025Article
- Influence of Access to Care on Decision-making About Antibiotic Duration at Discharge.Open forum infectious diseases · 2025Article
- Article
- A Pilot Study on Understanding the Contextual Factors Impacting the Implementation of an Antibiotic Stewardship Program in a Single Health Center Serving Rural and Underserved Communities in the United States-A Mixed-Methods Approach.Antibiotics (Basel, Switzerland) · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies.
methodsThe international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools.
resultsFifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing.
conclusionsInappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.