A kaleidoscope of antibiotic use in Sri Lanka: are we doing it right?

Effective antibiotics are essential for both prevention and treatment of infections, and to reduce mortality associated with severe infections. The association between antibiotic use and the development of antibacterial resistance (ABR) is well documented and results in longer illnesses, prolonged hospital stay, increased overall costs and higher mortality. Alert to this crisis, the World Health Assembly adopted a global action plan to combat anti-microbial resistance.The development of ABR is dependent on prescribing and dispensing practices, the use and misuse of antibiotics by patients, and issues related to the availability and quality of medicines which may drive the use of broad-spectrum antibiotics.The factors affecting the correct use of antibiotics by different stakeholders are the focus of this oration. The research spans a decade of work in this area and explores the perceptions of the public regarding antibiotics and their use to identify the gaps in perceptions and practices and analyses prescriber practices when treating common infections in patients with and without cancers and the appropriateness of prescribed antibiotics to these patients, especially when prescribed in accordance with National Guidelines. The findings of the first national survey on antibiotic consumption (ABC) are also presented and the work highlights the issues that affect the correct estimation of antibiotic consumption. A low-cost method that can be applied to compare the quality of parenteral antibiotics in vivo is also described.This information will help identify the areas that need to be addressed to combat the ever increasing threat of antibiotic resistance.