In 2010 the National Health Surveillance Agency in Brazil introduced a new regulation to prevent the sale of antibiotics to patients that lack a prescription. Since this change there has been some data to indicate a decrease in antibiotic use by as much as 70%, however Prof Pignatari emphasized the need for better data in order to draw firm conclusions.
Currently the majority of official government programmes in Brazil are focused on preventing hospital-acquired infections rather than providing advice on the use of antibiotics in the community setting. This is to tackle the relatively high levels of nosocomial infections by resistant bacteria in Latin American countries compared to Europe and the US. Consequently, stewardship programmes exist predominantly for hospitals rather than the community. In Brazil it is common for the patient to go the emergency room (ER) rather than the GP for an initial consultation. Therefore there is particular effort to educate ER doctors and hospital pharmacists to lower the rate of antibiotic prescriptions.
Most of the effort from the official government programs is for hospitals, not for the community - specifically to tackle nosocomial infections
Prof Antonio Carlos Pignatari
The data on antibiotic use in Brazil is also affected by the current economic climate. The use of antibiotics in the community may well decrease due to lack of affordability rather an increase in education. As a consequence of the economic crisis, some patients are switching from a private healthcare provider to use the public system. The situation is further compounded by a lack of availability for some of the cheaper antibiotics due to some pharmaceutical companies preferring to produce only the very expensive antibiotics.
Prof Pignatari concluded that there needs to be further emphasis on education primarily through hospital pharmacists, as this is the main source of antibiotic prescriptions.