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Volume 28, Number 1—January 2022
Research

Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil

Maria L. Moura, Icaro Boszczowski, Manuela Blaque, Rafael M. Mussarelli, Victor Fossaluza, Ligia C. Pierrotti, Gustavo Campana, Maria C. Brandileone, Rosemeire Zanella, Samanta C.G. Almeida, and Anna S. LevinComments to Author 
Author affiliations: Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil (M.L. Moura, I. Boszczowski); Universidade de São Paulo Instituto de Matemática e Estatística, São Paulo (M. Blaque, R.M. Mussarelli, V. Fossaluza); Diagnósticos da América Laboratory, São Paulo (L.C. Pierrotti, G. Campana); National Laboratory for Meningitis and Pneumococcal Infections, São Paulo (M.C. Brandileone, R. Zanella, S.C.G. Almeida); Universidade de São Paulo Faculdade de Medicina, São Paulo (A.S. Levin)

Main Article

Figure 2

Descriptive analysis of ciprofloxacin sales and Escherichia coli resistance in the São Paulo metropolitan area, Brazil, before and after a national policy restricting over-the-counter antimicrobial sales began. A, B) Ciprofloxacin sales and resistance in E. coli; C, D) Ciprofloxacin sales and proportion of ESBL-positive isolates. Panels C and D show distribution of estimated β-values obtained from dynamic regression model, representing the association between ciprofloxacin sales and resistance for E. coli and proportion of ESBL-positive isolates. A β-value and 95% CrI >0 indicate a direct association between sales and resistance, except for the period between 2011 and 2013. Estimated β values >0 before and after the policy began indicate no influence of the regulation on ciprofloxacin resistance. Light blue shaded areas represent period after the restriction policy began. CrI, credible interval; DID, defined daily dose/1,000 inhabitant-days; ESBL, extended spectrum β-lactamases.

Figure 2. Descriptive analysis of ciprofloxacin sales and Escherichia coli resistance in the São Paulo metropolitan area, Brazil, before and after a national policy restricting over-the-counter antimicrobial sales began. A, B) Ciprofloxacin sales and resistance in E. coli; C, D) Ciprofloxacin sales and proportion of ESBL-positive isolates. Panels C and D show distribution of estimated β-values obtained from dynamic regression model, representing the association between ciprofloxacin sales and resistance for E. coli and proportion of ESBL-positive isolates. A β-value and 95% CrI >0 indicate a direct association between sales and resistance, except for the period between 2011 and 2013. Estimated β values >0 before and after the policy began indicate no influence of the regulation on ciprofloxacin resistance. Light blue shaded areas represent period after the restriction policy began. CrI, credible interval; DID, defined daily dose/1,000 inhabitant-days; ESBL, extended spectrum β-lactamases.

Main Article

Page created: December 01, 2021
Page updated: December 20, 2021
Page reviewed: December 20, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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