Improper antibiotic management and antimicrobial resistance: an integrative review
DOI:
https://doi.org/10.36557/2009-3578.2025v11n2p8061-8083Keywords:
Antimicrobial Stewardship, Drug Resistence, Inappropriate prescribing, Self Medication, Anti-bacterial AgentsAbstract
Introduction: This study examined the improper management of antimicrobials—including inappropriate prescribing, self-medication, premature treatment interruption, use of leftovers, and non-prescription dispensing—as a major driver of antimicrobial resistance (AMR), a rapidly expanding and globally critical public health threat. Objectives: To evaluate the impact of these practices on AMR, identify factors associated with inappropriate use, analyze barriers to meeting international containment goals, discuss effective strategies for rational antimicrobial use, and synthesize interventions capable of improving prescribing practices among health professionals. Methodology: An integrative review was conducted in the PubMed/MEDLINE, SciELO, and LILACS databases (2020–2025) using descriptors related to improper antimicrobial use and bacterial resistance; of the 121 studies identified, 29 met eligibility criteria and composed the critical thematic analysis. Results: Evidence shows that inappropriate practices intensify selective pressure and favor resistance mechanisms—including β-lactamases, target modifications, efflux pumps, and plasmid-mediated dissemination—contributing to the spread of phenotypes such as MRSA, ESBL-producing organisms, and carbapenemase-producing bacteria. Stewardship interventions, such as audit and feedback, decision-support tools, continuous professional education, and rational use guided by the WHO AWaRe classification, reduced inappropriate prescriptions and excessive treatment durations; in Brazil, regulatory advances such as RDC No. 44/2010, RDC No. 20/2011, and the National Action Plan (PAN-BR) demonstrated positive impact, though limited by structural inequalities and insufficient diagnostic capacity. Final considerations: The study concludes that addressing AMR requires sustained policies, strengthened surveillance, territorial expansion of stewardship programs, robust regulation, public education, and intersectoral integration aligned with the One Health framework, in order to preserve antimicrobial effectiveness for future decades.
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Copyright (c) 2025 Brais Ricardo Barretos Dutra, Carlos Eduardo Chagas da Silva, Felix Barros Silva Filho, Gabriel Fernandes Siqueira, Henrique Almeida Lemes, Iago Paulo Carvalho Barbosa, Iury Daniel Ferraz, José Marcos Machado de Sousa Neto, Leonardo Cardoso Ramos, Márcio Silva da Conceição
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