A Comprehensive Systematic Review of Antimicrobial Resistance in Community - Acquired Infections Managed in Primary Health Care
Keywords:
Antimicrobial Resistance, Primary Health Care, Community-Acquired Infections, Systematic Review, Antimicrobial Stewardship, Antibiotic Prescribing, Urinary Tract Infection, Respiratory Tract InfectionAbstract
Introduction: Antimicrobial resistance (AMR) in community-acquired infections presents a critical global health threat, disproportionately affecting primary healthcare settings where most antibiotics are prescribed. Despite two decades of stewardship efforts, antibiotic prescribing rates remain persistently high, and resistance patterns show alarming geographic and temporal trends. This systematic review synthesizes the current evidence on the prevalence, clinical impact, drivers, and management of AMR in community-acquired infections within primary care.
Methods: We conducted a comprehensive systematic review following established guidelines. We screened studies based on predefined criteria focusing on community-acquired bacterial infections, primary healthcare settings, and AMR data. Data from 80 included studies were extracted across domains including study setting, pathogens, resistance methodologies, findings, associated factors, and intervention outcomes. Studies encompassed systematic reviews, randomized trials, observational studies, and quasi-experimental designs from diverse global regions.
Results: AMR prevalence varies significantly by infection type and geography. In urinary tract infections (UTIs), E. coli resistance to ampicillin was 53.4% in OECD countries versus 79.8% in non-OECD countries. Ciprofloxacin resistance is rising in community-acquired UTIs (P=0.003). For respiratory tract infections, pneumococcal penicillin non-susceptibility reached 58% in some regions, though amoxicillin susceptibility remains preserved in many areas. Antibiotic-resistant infections lead to worse clinical outcomes, particularly in UTIs (OR 4.19 for clinical failure), increased healthcare utilization, and higher economic costs. Antibiotic exposure directly increases individual patient resistance, with effects persisting for up to 12 months. Inappropriate prescribing is pervasive (global pooled estimate 57.6%). Multifaceted antimicrobial stewardship (AMS) interventions, especially those incorporating education, audit/feedback, and decision support, are effective and cost-effective, reducing inappropriate prescribing by 4.2% to 63.69% without compromising patient safety.
Discussion: The observed heterogeneity in resistance rates stems from differential antibiotic access policies, healthcare utilization patterns, and dynamic temporal evolution. The discrepancy in clinical impact between UTIs and respiratory tract infections is explained by the differing self-limiting nature of these illnesses and variations in empiric therapy efficacy. The persistence of resistance post-exposure varies by antibiotic class, influenced by the fitness costs of resistance mechanisms. Successful interventions must be context-specific, targeting high-prescribing settings with intensive, multifaceted programs.
Conclusion: AMR in primary care is a complex, evolving challenge marked by stark global disparities. The direct link between antibiotic prescribing and individual-level resistance underscores the urgency of optimizing prescribing. Evidence-based, context-adapted AMS interventions are effective and should be widely implemented. Future efforts must prioritize equitable diagnostic access, shorter antibiotic courses, and ongoing surveillance to guide empiric therapy and steward our remaining antimicrobial arsenal.
References
A. Bryce, A. Hay, I. Lane, H. Thornton, M. Wootton, and C. Costelloe. “Global Prevalence of Antibiotic Resistance in Paediatric Urinary Tract Infections Caused by Escherichia Coli and Association with Routine Use of Antibiotics in Primary Care: Systematic Review and Meta-Analysis.” British Medical Journal, 2016.
A. Bryce, C. Costelloe, Claire Hawcroft, M. Wootton, and A. Hay. “Faecal Carriage of Antibiotic Resistant Escherichia Coli in Asymptomatic Children and Associations with Primary Care Antibiotic Prescribing: A Systematic Review and Meta-Analysis.” BMC Infectious Diseases, 2016.
A. Figueiras, P. López-Vázquez, Cristian González-González, J. Vázquez-Lago, M. Piñeiro-Lamas, A. López‐Durán, Coro Sánchez, et al. “Impact of a Multifaceted Intervention to Improve Antibiotic Prescribing: A Pragmatic Cluster-Randomised Controlled Trial.” Antimicrobial Resistance and Infection Control, 2020.
A. Ginsburg, Laura Tinkham, K. Riley, N. Kay, K. Klugman, and C. Gill. “Antibiotic Non-Susceptibility Among Streptococcus Pneumoniae and Haemophilus Influenzae Isolates Identified in African Cohorts: A Meta-Analysis of Three Decades of Published Studies.” International Journal of Antimicrobial Agents, 2013.
A. Harris, L. Hicks, and A. Qaseem. “Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention.” Annals of Internal Medicine, 2016.
A. Holm, G. Cordoba, T. M. Sørensen, L. R. Jessen, V. Siersma, and L. Bjerrum. “Point of Care Susceptibility Testing in Primary Care - Does It Lead to a More Appropriate Prescription of Antibiotics in Patients with Uncomplicated Urinary Tract Infections? Protocol for a Randomized Controlled Trial.” BMC Family Practice, 2015.
A. Sugianli, Franciscus Ginting, I. Parwati, M. D. de Jong, F. van Leth, and C. Schultsz. “Antimicrobial Resistance Among Uropathogens in the Asia-Pacific Region: A Systematic Review.” JAC-Antimicrobial Resistance, 2021.
A. Teixeira Rodrigues, F. Roque, M. Piñeiro-Lamas, A. Falcão, A. Figueiras, and M. T. Herdeiro. “Effectiveness of an Intervention to Improve Antibiotic-Prescribing Behaviour in Primary Care: A Controlled, Interrupted Time-Series Study.” Journal of Antimicrobial Chemotherapy, 2019.
A. Tolley, Akhil Bansal, Rebecca Murerwa, and James Howard Dicks. “Cost-Effectiveness of Point-of-Care Diagnostics for AMR: A Systematic Review.” Journal of Antimicrobial Chemotherapy, 2024.
A. W. van der Velden, E. Pijpers, M. Kuyvenhoven, S. Tonkin-Crine, P. Little, and T. Verheij. “Effectiveness of Physician-Targeted Interventions to Improve Antibiotic Use for Respiratory Tract Infections.” The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 2012.
“Antibiotikaresistenzen Beim Einzelnen Patienten,” 2011.
Arinze Nkemdirim Okere, Miquetta L. Trimble, Vassiki Sanogo, Ukamaka Smith, C. Brown, and Sarah G Buxbaum. “The Potential Effects of Implementing an Antibiotic Stewardship Program by Integrating It with Medication Therapy Service in a Low-Income Serving Clinic - A Single-Center Experience.” INNOVATIONS in Pharmacy, 2022.
B. Langford, M. So, M. Simeonova, V. Leung, Jennifer Lo, Tiffany Kan, S. Raybardhan, et al. “Antimicrobial Resistance in Patients with COVID-19: A Systematic Review and Meta-Analysis.” The Lancet Microbe, 2023.
B. Wubishet, G. Merlo, N. Ghahreman-Falconer, L. Hall, and T. Comans. “Economic Evaluation of Antimicrobial Stewardship in Primary Care: A Systematic Review and Quality Assessment.” Journal of Antimicrobial Chemotherapy, 2022.
C. Costelloe, C. Metcalfe, A. Lovering, D. Mant, and A. Hay. “Effect of Antibiotic Prescribing in Primary Care on Antimicrobial Resistance in Individual Patients: Systematic Review and Meta-Analysis.” British Medical Journal, 2010.
C. McNulty, J. Richards, D. Livermore, Paul Little, André Charlett, E. Freeman, Ian Harvey, and Mike Thomas. “Clinical Relevance of Laboratory-Reported Antibiotic Resistance in Acute Uncomplicated Urinary Tract Infection in Primary Care.” Journal of Antimicrobial Chemotherapy, 2006.
C. McNulty, Meredith K. D. Hawking, D. Lecky, L. Jones, Rebecca Owens, A. Charlett, C. Butler, Philippa Moore, and N. Francis. “Effects of Primary Care Antimicrobial Stewardship Outreach on Antibiotic Use by General Practice Staff: Pragmatic Randomized Controlled Trial of the TARGET Antibiotics Workshop.” Journal of Antimicrobial Chemotherapy, 2018.
C. Zhuo, Xiaolin Wei, Zhitong Zhang, J. Hicks, Jinkun Zheng, Zhixu Chen, V. Haldane, et al. “An Antibiotic Stewardship Programme to Reduce Inappropriate Antibiotic Prescribing for Acute Respiratory Infections in Rural Chinese Primary Care Facilities: Study Protocol for a Clustered Randomised Controlled Trial.” Trials, 2020.
Chris Del Mar. “Antibiotic Use Results in Resistance Even for Individual Children.” Jornal de Pediatria, 2008.
D. Drekonja, G. Filice, N. Greer, A. Olson, R. MacDonald, I. Rutks, and T. Wilt. “Antimicrobial Stewardship in Outpatient Settings: A Systematic Review.” Infection Control & Hospital Epidemiology, 2014.
D. Gornyk, M. Scharlach, B. Buhr-Riehm, C. Klett-Tammen, S. Eberhard, J. Stahmeyer, A. Grosshennig, et al. “Effectiveness of Trainings of General Practitioners on Antibiotic Stewardship: Methods of a Pragmatic Quasi-Experimental Study in a Controlled Before-After Design in South-East-Lower Saxony, Germany (WASA).” Frontiers in Pharmacology, 2021.
E. de Vries, Y. Johnson, B. Willems, W. Bedeker, T. Ras, R. Coetzee, Y. Tembo, and A. Brink. “Improving Primary Care Antimicrobial Stewardship by Implementing a Peer Audit and Feedback Intervention in Cape Town Community Healthcare Centres.” South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde, 2022.
Emma J Baillie, Gregory Merlo, M. V. van Driel, Parker J Magin, and Lisa Hall. “Early-Career General Practitioners’ Antibiotic Prescribing for Acute Infections: A Systematic Review.” Journal of Antimicrobial Chemotherapy, 2024.
Eskild Johansen, Henrik Nielsen, David Gillespie, R. Aabenhus, and M. Hansen. “The Optimal Antibiotic Treatment Duration for Community-Acquired Pneumonia in Adults Diagnosed in General Practice in Denmark (CAP-D): An Open-Label, Pragmatic, Randomised Controlled Trial.” Trials, 2024.
F. Kong, J. Hocking, and C. Fairley. “Is There a Future for the Ongoing Use of Azithromycin for the Treatment of Neisseria Gonorrhoeae?” Clinical Microbiology and Infection, 2020.
Grace C Mortrude, M. Rehs, K. Sherman, N. Gundacker, and C. Dysart. “141. Implementation of Veterans Affairs Outpatient Antimicrobial Stewardship Interventions for Asymptomatic Bacteriuria and Acute Respiratory Infections, a Stepped Wedge Randomized Study.” Open Forum Infectious Diseases, 2020.
———. “Implementation of Veterans Affairs Primary Care Antimicrobial Stewardship Interventions For Asymptomatic Bacteriuria And Acute Respiratory Infections.” Open Forum Infectious Diseases, 2021.
I. Dwiprahasto, and E. Kristin. “Improving the Use of Antibiotics in Primary Health Centres Through a Problem-Based Pharmacotherapy Training Approach,” 2015.
I. Gágyor, Alexandra Greser, P. Heuschmann, Viktoria Rücker, A. Maun, J. Bleidorn, C. Heintze, et al. “REDuction of Antibiotic RESistance (REDARES) in Urinary Tract Infections Using Treatments According to National Clinical Guidelines: Study Protocol for a Pragmatic Randomized Controlled Trial with a Multimodal Intervention in Primary Care.” BMC Infectious Diseases, 2021.
I. Olaru, M. Chisenga, S. Yeung, P. Chonzi, Kudzai Masunda, R. Ferrand, and K. Kranzer. “Clinical and Bacteriological Outcomes in Patients with Urinary Tract Infections Presenting to Primary Care in Harare, Zimbabwe: A Cohort Study.” Wellcome Open Research, 2021.
Inés Urbiztondo, L. Bjerrum, Lidia Caballero, M. A. Suarez, Monica Olinisky, and G. Cordoba. “Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America—Cluster Randomized Controlled Trial.” Antibiotics, 2017.
J. Beam, and Bernadette D. Buckley. “Community-Acquired Methicillin-Resistant Staphylococcus Aureus: Prevalence and Risk Factors.” Journal of Athletic Training, 2006.
J. H. Wu, F. Khalid, B. Langford, Nathan P. Beahm, Mark T Mcintyre, K. Schwartz, G. Garber, and V. Leung. “Community Pharmacist Prescribing of Antimicrobials: A Systematic Review from an Antimicrobial Stewardship Perspective.” Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 2021.
J. Teepe, B. Broekhuizen, H. Goossens, P. Hordijk, K. Loens, C. Lammens, M. Ieven, et al. “Clinical Relevance of Bacterial Resistance in Lower Respiratory Tract Infection in Primary Care: Secondary Analysis of a Multicentre European Trial.” The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 2018.
K. Bhate, Liang-Yu Lin, J. Barbieri, C. Leyrat, S. Hopkins, R. Stabler, L. Shallcross, et al. “Is There an Association Between Long-Term Antibiotics for Acne and Subsequent Infection Sequelae and Antimicrobial Resistance? A Systematic Review.” The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 2021.
K. Hoffmann, G. Wagner, P. Apfalter, and M. Maier. “Antibiotic Resistance in Primary Care in Austria - a Systematic Review of Scientific and Grey Literature.” BMC Infectious Diseases, 2011.
L. Westerhof, Lisa E. Dumkow, Tarajo L Hanrahan, Samantha V McPharlin, and N. Egwuatu. “Outcomes of an Ambulatory Care Pharmacist-Led Antimicrobial Stewardship Program Within a Family Medicine Resident Clinic.” Infection Control and Hospital Epidemiology, 2020.
L. Yao, Jia Yin, Qiang Sun, Ruiting Huo, Ding Yang, Liyan Shen, and Shuqin Wen. “The Effects of the Primary Health Care Providers’ Prescription Behavior Interventions to Improve the Rational Use of Antibiotics: A Systematic Review.” Global Health Research and Policy, 2020.
Leesa Lin, Ruyu Sun, Tingting Yao, Xudong Zhou, and S. Harbarth. “Factors Influencing Inappropriate Use of Antibiotics in Outpatient and Community Settings in China: A Mixed-Methods Systematic Review.” BMJ Global Health, 2020.
Lilian Downie, Raffaela Armiento, Rami Subhi, J. Kelly, V. Clifford, and T. Duke. “Community-Acquired Neonatal and Infant Sepsis in Developing Countries: Efficacy of WHO's Currently Recommended Antibiotics—Systematic Review and Meta-Analysis.” Archives of Disease in Childhood, 2012.
M. Bakhit, Emma J Baillie, N. Krzyżaniak, M. V. van Driel, J. Clark, P. Glasziou, and C. Del Mar. “Antibiotic Prescribing for Acute Infections in Synchronous Telehealth Consultations: A Systematic Review and Meta-Analysis.” BJGP Open, 2021.
M. Bakhit, T. Hoffmann, A. Scott, E. Beller, J. Rathbone, and C. Del Mar. “Resistance Decay in Individuals After Antibiotic Exposure in Primary Care: A Systematic Review and Meta-Analysis.” BMC Medicine, 2018.
M. Kamradt, P. Kaufmann-Kolle, Edith Andres, Tonia Brand, A. Klingenberg, K. Glassen, Regina Poss-Doering, et al. “Sustainable Reduction of Antibiotic-Induced Antimicrobial Resistance (ARena) in German Ambulatory Care: Study Protocol of a Cluster Randomised Trial.” Implementation Science, 2018.
M. Larsson. “ANTIBIOTIC USE AND RESISTANCE,” 2003.
M. Pfaller, and Ronald N. Jones. “Gatifloxacin Phase IV Surveillance Trial (TeqCES Study) Utilizing 5000 Primary Care Physician Practices: Report of Pathogens Isolated and Susceptibility Patterns in Community-Acquired Respiratory Tract Infections.” Diagnostic Microbiology and Infectious Disease, 2002.
M. Samore, K. Bateman, S. Alder, E. Hannah, Sharon Donnelly, G. Stoddard, Bassam Haddadin, et al. “Clinical Decision Support and Appropriateness of Antimicrobial Prescribing: A Randomized Trial.” Journal of the American Medical Association (JAMA), 2005.
M. Takenoshita, D. Hettle, and Graziella Quattrocchi. “O02 Antibiotic Prescribing Practices in Primary Healthcare in Sub-Saharan Africa: A Systematic Review and Our Experience on the Use of Telemedicine in Zambia.” JAC-Antimicrobial Resistance, 2022.
M. Vervloet, M. Meulepas, J. Cals, M. Eimers, L. S. van der Hoek, and L. van Dijk. “Reducing Antibiotic Prescriptions for Respiratory Tract Infections in Family Practice: Results of a Cluster Randomized Controlled Trial Evaluating a Multifaceted Peer-Group-Based Intervention.” Npj Primary Care Respiratory Medicine, 2016.
María Verónica Cuevas-González, Gabriela Anaid Mungarro-Cornejo, L. F. Espinosa-Cristóbal, Alejandro Donohue-Cornejo, Karla Lizette Tovar Carrillo, R. A. Saucedo Acuña, Alma Graciela García Calderón, Dalia Abril Guzmán Gastelum, Graciela Zambrano-Galván, and J. Cuevas-González. “Antimicrobial Resistance in Odontogenic Infections: A Protocol for Systematic Review.” Medicine, 2022.
Martijn Sijbom, F. Büchner, N. Saadah, M. Numans, and M. D. de Boer. “Determinants of Inappropriate Antibiotic Prescription in Primary Care in Developed Countries with General Practitioners as Gatekeepers: A Systematic Review and Construction of a Framework.” BMJ Open, 2023.
Milena Aparecida del Masso Pereira, and C. M. Fortaleza. “Factors Associated with Community-Onset Multidrug-Resistant Organisms in Inner Brazil.” American Journal of Infection Control, 2018.
“More on Communiy Acquired Pneumonia: Antibiotic Resistance.” Archives of Disease in Childhood, 2022.
N. A. Martínez-González, S. Coenen, A. Plate, Annelies Colliers, T. Rosemann, O. Senn, and S. Neuner-Jehle. “The Impact of Interventions to Improve the Quality of Prescribing and Use of Antibiotics in Primary Care Patients with Respiratory Tract Infections: A Systematic Review Protocol.” BMJ Open, 2017.
N. J. Zhu, M. Weldegiorgis, Emma Carter, Colin S. Brown, Alison Holmes, and Paul Aylin. “Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis.” JMIR Public Health and Surveillance, 2023.
Nathan P. Beahm, D. Smyth, and R. Tsuyuki. “Antimicrobial Utilization and Stewardship in Patients with Uncomplicated Urinary Tract Infections Managed by Pharmacists in the Community: A Sub-Study of the RxOUTMAP Trial.” Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal Officiel de l'Association Pour La Microbiologie Medicale Et l'infectiologie Canada, 2021.
Noah O. Okumu, D. Muloi, Arshnee Moodley, Julie Watson, A. Kiarie, Linnet Ochieng, J. Wasonga, et al. “Antimicrobial Resistance in Community-Acquired Enteric Pathogens Among Children Aged ≤ 10-Years in Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis.” Frontiers in Microbiology, 2025.
O. Fasugba, A. Gardner, B. Mitchell, and G. Mnatzaganian. “Ciprofloxacin Resistance in Community- and Hospital-Acquired Escherichia Coli Urinary Tract Infections: A Systematic Review and Meta-Analysis of Observational Studies.” BMC Infectious Diseases, 2015.
O. van Hecke, Kay Wang, J. Lee, N. Roberts, and C. Butler. “Implications of Antibiotic Resistance for Patients’ Recovery From Common Infections in the Community: A Systematic Review and Meta-Analysis.” Clinical Infectious Diseases, 2017.
Olawale Salami, P. Horgan, C. Moore, A. Giri, Asadu Sserwanga, A. Pathak, B. Basnyat, et al. “Impact of a Package of Diagnostic Tools, Clinical Algorithm, and Training and Communication on Outpatient Acute Fever Case Management in Low- and Middle-Income Countries: Protocol for a Randomized Controlled Trial.” Trials, 2020.
P. Gillespie, A. Callan, E. O'Shea, Sinead Duane, A. Murphy, C. Domegan, S. Galvin, and Akke Vellinga. “The Cost Effectiveness of the SIMPle Intervention to Improve Antimicrobial Prescribing for Urinary Tract Infection in Primary Care.” Journal of Public Health, 2016.
Pablo March-López, R. Madridejos, R. Tomás, Lucía Boix, P. Arcenillas, L. Gómez, E. Padilla, et al. “Impact of a Multifaceted Antimicrobial Stewardship Intervention in a Primary Health Care Area: A Quasi-Experimental Study.” Frontiers in Pharmacology, 2020.
Prajwol Nepal, A. Subedee, H. Shakya, Sanjaya Poudel, Supriya Joshi, K. Karki, D. Bajracharya, T. Prentiss, L. Kaljee, and Yubraj Acharya. “Protocol for a Randomized Controlled Trial on Community Education and Surveillance on Antibiotics Use Among Young Children in Nepal.” Contemporary Clinical Trials Communications, 2023.
Qihua Song, Jinxi Li, Pengfei Zhou, Rui Chen, Zhen Liu, Hui Li, and Xiaoxv Yin. “Worldwide Antibiotic Prescription Practices in Primary Care and Associated Factors: A Systematic Review and Meta-Analysis.” American Journal of Infection Control, 2025.
R. Shields, Wendy Y Cheng, Kalé Kponee-Shovein, Fernando Kuwer, Chi Gao, Ashish V Joshi, Fanny S. Mitrani-Gold, et al. “2838. Clinical Application and Validation of a Predictive Antimicrobial Resistance Risk Categorization Framework for Patients with Uncomplicated Urinary Tract Infection.” Open Forum Infectious Diseases, 2023.
Rainer Tan, Godfrey Kavishe, L. Luwanda, A. Kulinkina, Sabine Renggli, C. Mangu, Geofrey Ashery, et al. “A Digital Health Algorithm to Guide Antibiotic Prescription in Pediatric Outpatient Care: A Cluster Randomized Controlled Trial.” Nature Network Boston, 2023.
Raymond Oppong, Richard D Smith, Paul Little, T. Verheij, Chris C Butler, Herman Goossens, S. Coenen, et al. “Cost-Effectiveness of Internet-Based Training for Primary Care Clinicians on Antibiotic Prescribing for Acute Respiratory Tract Infections in Europe.” Journal of Antimicrobial Chemotherapy, 2018.
Regina Poss-Doering, D. Kronsteiner, M. Kamradt, P. Kaufmann-Kolle, Edith Andres, V. Wambach, Julian Bleek, M. Wensing, ARena-Study Group, and J. Szecsenyi. “Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena.” Antibiotics, 2021.
Regina Poss-Doering, D. Weber, M. Kamradt, Edith Andres, P. Kaufmann-Kolle, and J. Szecsenyi. “Baseline Assessment of Antibiotics Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany in the Cluster Randomized Trial ARena,” 2020.
Ron Cheah, Caroline Chen, Daniel Capurro, J. Manski-Nankervis, V. Rozova, and K. Thursky. “A Systematic Review on How Primary Care Electronic Medical Record Data Have Been Used for Antimicrobial Stewardship.” Antimicrobial Stewardship and Healthcare Epidemiology, 2025.
Ron Dagan, E. Leibovitz, A. Leiberman, and P. Yagupsky. “Clinical Significance of Antibiotic Resistance in Acute Otitis Media and Implication of Antibiotic Treatment on Carriage and Spread of Resistant Organisms.” The Pediatric Infectious Disease Journal, 2000.
Ruyu Sun, Tingting Yao, Xudong Zhou, S. Harbarth, and Leesa Lin. “Non-Biomedical Factors Affecting Antibiotic Use in the Community: A Mixed-Methods Systematic Review and Meta-Analysis.” Clinical Microbiology and Infection, 2021.
S. Goyet, E. Vlieghe, Varun Kumar, Steven W Newell, C. Moore, R. Bousfield, Heng C. Leang, et al. “Etiologies and Resistance Profiles of Bacterial Community-Acquired Pneumonia in Cambodian and Neighboring Countries’ Health Care Settings: A Systematic Review (1995 to 2012).” PLoS ONE, 2014.
S. Hillier, J. Magee, A. Howard, and S. Palmer. “How Strong Is the Evidence That Antibiotic Use Is a Risk Factor for Antibiotic-Resistant, Community-Acquired Urinary Tract Infection?” Journal of Antimicrobial Chemotherapy, 2002.
S. Malhotra-Kumar, L. van Heirstraeten, S. Coenen, C. Lammens, N. Adriaenssens, A. Kowalczyk, M. Godycki-Cwirko, et al. “Impact of Amoxicillin Therapy on Resistance Selection in Patients with Community-Acquired Lower Respiratory Tract Infections: A Randomized, Placebo-Controlled Study.” Journal of Antimicrobial Chemotherapy, 2016.
S. Yakobi, Yolisa B Magibile, and O. Pooe. “A Systematic Review of Neisseria Gonorrhoeae Drug Resistance Development in South Africa.” Brazilian Journal of Microbiology, 2024.
Sharon A Simpson, C. Butler, Kerry Hood, David Cohen, Frank Dunstan, Meirion R Evans, Stephen Rollnick, et al. “Stemming the Tide of Antibiotic Resistance (STAR): A Protocol for a Trial of a Complex Intervention Addressing the 'Why' and 'How' of Appropriate Antibiotic Prescribing in General Practice.” BMC Family Practice, 2009.
T. Alam, D. Ahmed, T. Ahmed, M. Chisti, Mw Rahman, A. Chauhan, S. Deb, et al. “Extended Effect of Short-Course Azithromycin for the Treatment of Diarrhoea in Children on Antimicrobial Resistance in Nasopharyngeal and Intestinal Bacteria: Study Protocol for the Antimicrobial Resistance Sub-Study of the Multicountry AntiBiotics for Children with Diarrhea (ABCD) Trial.” medRxiv, 2020.
Taissa A. Bej, Brigid M Wilson, Ukwen C. Akpoji, Nicole Mongilardi, T. Chengsupanimit, Sunah Song, Corinne Kowal, et al. “Feasibility of a Low-Intensity Intervention to Influence Antibiotic Prescribing Rates Use in Outpatient Settings: A Cluster Randomized Controlled Clinical Trial.” Open Forum Infectious Diseases, 2024.
W. McIsaac, Sahana Kukan, E. Huszti, L. Szadkowski, B. O’Neill, S. Virani, N. Ivers, et al. “A Pragmatic Randomized Trial of a Primary Care Antimicrobial Stewardship Intervention in Ontario, Canada.” BMC Family Practice, 2021.
Y. Kuo, Jyh-Ming Liou, E. El-Omar, Jeng‐Yih Wu, A. Leow, K. Goh, Rajashree Das, et al. “Primary Antibiotic Resistance in Helicobacter Pylori in the Asia-Pacific Region: A Systematic Review and Meta-Analysis.” The Lancet Gastroenterology and Hepatology, 2017.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Agsion Marce Kombongan (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
