Scoping Review of National Antimicrobial Stewardship Activities in Eight African Countries and Adaptable Recommendations.

Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists' and other healthcare professionals' curricula for pre-service and in-service training.

Evaluation of the antidiarrheal activity of the leaf extract of Parquetina nigrescens and formulation into oral suspensions.

PURPOSE: Parquetina nigrescens (Pn) extract was evaluated for safety and antidiarrheal activity, formulated into stable suspensions, and characterized. METHODS: Acute toxicity of the extract based on Organization for Economic Cooperation and Development-423 guidelines was performed. The antidiarrheal effects of the extract on castor oil-induced diarrhea in four groups of Wistar rats were determined. The first and second groups received 5 and 200 mg/kg body weight (bw) of the extract, while the third and fourth groups received normal saline (5 mg/kg bw) and loperamide (5 mg/kg bw) as negative and positive controls, respectively. Pn extract was used at 1.25% w/v to formulate structured vehicle (carboxylmethylcellulose, polyvinylpyrrolidone and tragacanth) suspensions. The suspensions were tested for pharmacological activity and characterized. RESULTS: Acute toxicity gave a lethal dose 50 (LD50) that is greater than 300 and less than 2,000 mg/kg bw. A reduction in intestinal transit by 0.14 and 0.15% at 5 and 200 mg/kg of the extract was achieved as compared to an inhibition of 0.12% by 5 mg/kg loperamide. There was a dose-dependent decrease in the frequency of watery stool passed in castor oil-induced rats by 35.29% and 64.70% at 5 and 200 mg/kg, respectively. All the suspensions inhibited diarrhea, exhibiting a dose-dependent pattern and remained stable after 4 weeks. Their pH values ranged from 4.60±2.73 to 4.73±1.91, while viscosity ranged from 3.50±1.23 to 6.75±1.24 Pas at 60 rpm. CONCLUSION: The results suggest that Pn possesses significant antidiarrheal activity. Suspensions of Pn were successfully formulated in structured vehicles and were effective in the control of diarrhea in Wistar rats.