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Background: Antimicrobials are medications that inhibit the growth of microbes (bacteria, fungi, protozoans). Antibiotics are grouped within antimicrobial medication since they are used specifically against illnesses caused by bacteria. This type of medication has saved many lives and prevented the spread of disease throughout many years, but the misuse of antibiotics also comes with a lot of problems. Misuse of antibiotics refers to the faulty use, the overuse, and the underuse of the medication. The excessive use and the faulty use of antibiotics leads to failure in disease treatment and will potentially lead to resistance of bacteria to the antibiotics. The underuse of antibiotics can result in a prolonged disease and an increase in morbidity and mortality.The factor that most frequently contributes to the misuse of antibiotics in high-income countries (HICs) is the over prescription and faulty prescription by health care professionals while in low- and middle- income countries (LMICs) it has been found that the leading factor behind the misuse of antibiotics is the self-medication, the use without prescription. A factor that contributes to the underuse of antibiotics in LMICs is the socioeconomic level of the patient/consumer since it relates to the amount of access to health care.Antibiotic consumption has increased worldwide and when comparing the rate of use, LMICs has had the biggest increase. Out of the countries in Latin America, Peru has been one of the countries with the highest rate of use of antibiotics. Among with the increased use of antibiotics, resistance rates of bacteria to certain medications have managed to become very high in Peru.There are laws in Peru that regulate the rational use of antibiotics, allowing the prescription of this medication to be done only by a medical doctor. Although these regulations exist, there is still a high prevalence of misuse of antibiotics which includes over-the-counter sale.The objective of this scoping review was to assess publications made on factors that contribute to the misuse of antibiotics in Peru in order to determine if they are similar to what is stated in the literature about LMICs and to see where there exist research gaps when it comes to the factors behind the misuse of antibiotics in Peru.

Research questions: -What seem to be the main predicting factors behind this misuse of antibiotics in Peru?-Which of these factors seem to contribute the most to the misuse of antibiotics?-Are the trends of antibiotic missuse in Peru similar to those stated in the litterature aboutLMICs?-What gaps can be found in the research regarding the topic of antibiotic misuse in Peru?

Methods: A scoping review was performed to be able to answer the research questions. The two databases that were used for the search were PubMed and Biblioteca Virtual en Salud (BVS). Specific search terms were constructed in accordance to each of database’s specific features. The inclusion criteria focused on articles written in either English or Spanish with empirical data on factors that contribute to the misuse of antibiotics such as individual factors (self-medication, access to health care etc.) and on the accuracy and the way health care professionals prescribe or recommend antibiotic medication. Studies that did not take place in Peru, and articles that did not focus on humans were excluded.After the search for the literature, the titles and abstracts were screened, and articles went to further selection for a full screen. An extraction table and a result table were created containing relevant information of each study.

Results: A total of 178 studies were identified through the selected databases PubMed and Biblioteca Virtual en Salud. After the selection process, nine articles were included in the review. The predictors, which related to the misuse of antibiotics, that were found were individual factors (self-medication and access to health care), and prescription habits by health care professionals. Out of these nine articles, the most publications found on factors that contribute to the misuse of antibiotics in Peru were focused on the accuracy of prescription done by doctors. Hence, the main issues regarding antibiotic medication in Peru laid in the way they are being prescribed.

Discussion: Peru has been and is still a member in various vigilance networks such as “Red Latinoamericano de Vigilancia de la Resistencia a los Antimicrobianos” (Latin American Antimicrobial Resistance Surveillance Network) (ReLAVRA) and “Sistema de Redes de vigilancia de los agentes respsonsables de neumonias y meningitis Bacterianas” (SIREVA II) and has as well been part of other initiatives such as the South American Infectious Disease Initiative (SAIDI). Even though these have been successful in increasing the surveillance in the country, further reinforcement in both the regulation and the use/prescription of antibiotics is needed in order to tackle the misuse of this medication. Previous studies performed in other countries have found similar results as this review when it comes to factors that contribute to the misuse of antibiotics.The strengths of this scoping review were that it covered various different factors that contribute to the misuse of antibiotics and many of the studies that were used were in the native language of Peru, Spanish. The studies covered both the private sector and public sector of health care. Some of the weaknesses of the study were that all of the articles focused on quantitative results and some of the big topics, such as the access to health care, were only covered by one article.