Efecto de la pandemia COVID 19 en la dispensación ambulatoria de algunos antibióticos por parte de un gestor farmacéutico en una ciudad de Colombia
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Introducción: La pandemia de COVID 19 produjo un cambio sin precedentes en los sistemas de salud del mundo, afectando tanto la atención hospitalaria como la ambulatoria, y modificando los patrones de prescripción y dispensación de medicamentos, especialmente de los antibióticos. El objetivo de este estudio fue determinar el efecto de la pandemia COVID 19 en la dispensación ambulatoria de algunos antibióticos en una ciudad de Colombia entre 2018 y 2022. Materiales y métodos: estudio ecológico retrospectivo de series de tiempo interrumpida usando registros mensuales de dispensación de antibióticos amoxicilina, amoxicilina/clavulanato, ampicilina, azitromicina, cefalexina, ciprofloxacina, claritromicina, doxiciclina, norfloxacina, sulfadiazina, trimetoprim/sulfametoxazol y vancomicina. Las dosis diarias definidas por 1000 habitantes por día (DHD) se calcularon según la OMS con población mensual asegurada del gestor y se aplicó regresión segmentada para periodos prepandemia, pandemia y postpandemia. Resultados: Durante la pandemia, la mediana disminuyó 42% de 4,547 a 2,632 DHD. En la postpandemia aumentó a 2,759 DHD, sin alcanzar los niveles prepandemia. Hubo tendencia decreciente prepandemia (–0,122; IC95% – 0,153 a –0,091), cambio de nivel al inicio de la pandemia (–1,268; IC95% – 1,824 a –0,711) y tendencia ascendente (0,149; IC95% 0,107–0,190) durante la pandemia. Doxiciclina (1,114 DHD) y amoxicilina (0,952 DHD) fueron las más dispensadas, y amoxicilina/ clavulanato mostró tendencia ascendente durante y postpandemia. Discusión: Se sugiere reforzar la vigilancia de la resistencia a antimicrobianos en el ámbito comunitario para comprender el efecto de las variaciones de dispensación por principio activo durante y después de la pandemia
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Hsu J. How COVID-19 is accelerating the threat of antimicrobial resistance. BMJ. 2020;369: m1983. https://doi.org/10.1136/bmj.m1983
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622- 9. https://doi.org/10.1016/j.cmi.2020.07.016
Organización Mundial de la Salud. Resistencia a los antimicrobianos [Internet]. Geneva:OMS; [citado 24 de mayo de 2024]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/antimicrobialresistance
Cabrera S. Rational and responsible use of antimicrobials. Arch Med Interna. 2009;31(2-3):74-80.
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2024 [Internet]. Oslo;2024 [citado 6 de julio de 2024]. Disponible en: https://atcddd.fhi.no/atc_ddd_index
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Hogberg LD, Vlahovic-Palcevski V, Pereira C, Weist K, Monnet DL, Strauss R, et al. Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020. Euro Surveill. 2021;26(46):2101020. https://doi.org/10.2807/1560-7917.ES.2021.26.46.2101020
Pereira ML, Mothe DA, Pinheiro KS, Goncalves SS, Santos KV. Antibiotic dispensing during first year of COVID-19 pandemic in brazilian public hospitals. Future Microbiol. 2023;18:639-47. https://doi.org/10.2217/fmb-2022-0255
Al-Nuaimi S, Alkuwari S, Al-Jubouri AM, Hegazi S, Jolo L, Khalid H, et al. Antibiotics prescriptions pattern among patients visiting primary health care centers (PHCC) before and during COVID-19 pandemic: a cross-sectional population-based study from Qatar. Antibiotics (Basel). 2023;12(8):1228. https://doi.org/10.3390/antibiotics12081228
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Melo-Burbano LA, Galindes-Casanova DA, Benitez-Escobar EN, Assis-Reveiz JK, Daza-Arana JE, Oñate-Gutiérrez JM. Frecuencia de prescripción de antibióticos en adultos hospitalizados por SARS-CoV-2 en una institución de alta complejidad en Santiago de Cali, Colombia. Infectio. 2023;27(2):94-101. https://doi.org/10.22354/24223794.1128
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Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J. 2015;15(2):480-500. https://doi.org/10.1177/1536867X1501500208
StataCorp. Stata Statistical Software: Release 19 [Internet]. College Station (TX):StataCorp LLC; 2025 [citado 7 de octubre de 2025]. Disponible en: https://www.stata.com/
Knight BD, Shurgold J, Smith G, MacFadden DR, Schwartz KL, Daneman N, et al. The impact of COVID-19 on community antibiotic use in Canada: an ecological study. Clin Microbiol Infect. 2022;28(3):426-32. https://doi.org/10.1016/j.cmi.2021.10.013
King LM, Lovegrove MC, Shehab N, Tsay S, Budnitz DS, Geller AI, et al. Trends in U.S. outpatient antibiotic prescriptions during the COVID-19 pandemic. Clin Infect Dis. 2020;ciaa1896. https://doi.org/10.1093/cid/ciaa1896
Alzueta N, Echeverria A, García P, Sanz L, Gil-Setas A, Beristain X, et al. Impact of COVID-19 pandemic in antibiotic consumption in Navarre (Spain): an interrupted time series analysis. Antibiotics (Basel). 2023;12(2):318. https://doi.org/10.3390/antibiotics12020318
Armitage R, Nellums LB. Antibiotic prescribing in general practice during COVID-19. Lancet Infect Dis. 2021;21(6):e144. https://doi.org/10.1016/S1473-3099(20)30917-8
Hek K, Ramerman L, Weesie YM, Lambooij AC, Lambert M, Heins MJ, et al. Antibiotic prescribing in dutch daytime and out-of-hours general practice during the COVID-19 pandemic: a retrospective database study. Antibiotics (Basel). 2022;11(3):309. https://doi.org/10.3390/antibiotics11030309
Rachina S, Kozlov R, Kurkova A, Portnyagina U, Palyutin S, Khokhlov A, et al. Antimicrobial dispensing practice in community pharmacies in Russia during the COVID-19 pandemic. Antibiotics (Basel). 2022;11(5):586. https://doi.org/10.3390/antibiotics11050586
Lim AH, Ab Rahman N, Hashim H, Kamal M, Velvanathan T, Chok MCF, et al. Impact of COVID-19 pandemic on antibiotic utilisation in malaysian primary care clinics: an interrupted time series analysis. Antibiotics (Basel). 2023;12(4):659. https://doi.org/10.3390/antibiotics12040659
Rezaei S, Bazyar M, Ahmadi S, Khodamoradi A. From Routine to Crisis: The impact of COVID-19 pandemic on antibiotic consumption in Iran. Health Sci Rep. 2024;7(11):e70161. https://doi.org/10.1002/hsr2.70161
Gacheri J, Hamilton KA, Munywoki P, Wakahiu S, Kiambi K, Fevre EM, et al. Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya. PLOS Glob Public Health. 2024;4(4): e0003046. https://doi.org/10.1371/journal.pgph.0003046
Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, et al. Trends in inpatient antibiotic use among adults hospitalized during the coronavirus disease 2019 pandemic in Argentina, Brasil, and Chile, 2018-2021. Clin Infect Dis. 2023;77(Suppl 1):S4-11. https://doi.org/10.1093/cid/ciad261
Rezel-Potts E, L'Esperance V, Gulliford MC. Antimicrobial stewardship in the UK during the COVID-19 pandemic: a population-based cohort study and interrupted time-series analysis. Br J Gen Pract. 2021;71(706):e331-8. https://doi.org/10.3399/BJGP.2020.1051
Hamilton A, Poleon S, Cherian J, Cosgrove S, Laxminarayan R, Klein E. COVID-19 and outpatient antibiotic prescriptions in the United States: a county- level analysis. Open Forum Infect Dis. 2023;10(3):ofad096. https://doi.org/10.1093/ofid/ofad096
Center for Infectious Disease Research and Policy. US outpatient antibiotic prescribing returning to pre-COVID levels [Internet]. 2024 [citado 10 de octubre de 2025]. Disponible en: https://www.cidrap.umn.edu/antimicrobial- stewardship/us-outpatient-antibiotic-prescribingreturning-pre-covid-levels
Centers for Disease Control and Prevention. COVID-19 impacts on antibiotic use. Atlanta: CDC; 2020.
Bogdanic N, Mocibob L, Vidovic T, Soldo A, Begovac J. Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020. PLoS One. 2022;17(2):e0263437. https://doi.org/10.1371/journal.pone.0263437
Del Fiol F de S, Bergamaschi C de C, De Andrade IP, Lopes LC, Silva MT, Barberato-Filho S. Consumption trends of antibiotics in Brazil during the COVID-19 pandemic. Front Pharmacol. 2022;13:844818. https://doi.org/10.3389/fphar.2022.844818
Ruiz-Garbajosa P, Cantón R. COVID-19: Impact on prescribing and antimicrobial resistance. Rev Esp Quimioter. 2021;34(Suppl 1):63-8. https://doi.org/10.37201/req/s01.19.2021
Wasag DR, Cannings-John R, Hughes K, Ahmed H. Antibiotic dispensing during the COVID-19 pandemic: analysis of Welsh primary care dispensing data. Fam Pract. 2022;39(3):420-5. https://doi.org/10.1093/fampra/cmab141
Clavería A, Delgado-Martín MV, Goicoechea-Castaño A, Iglesias Moreno JM, García-Cendón C, Martín-Miguel MV, et al. Interrupted time series analysis of pediatric infectious diseases and the consumption of antibiotics in an Atlantic european región during the SARS-CoV-2 pandemic. Antibiotics (Basel). 2022;11(2):264. https://doi.org/10.3390/antibiotics11020264
Al Balushi H, Kurdi A, Almutairi N, Baker KI, Amen KM, Karwi H, et al. Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis. Expert Rev Anti Infect Ther. 2024;22(10):895-905. https://doi.org/10.1080/14787210.2024.2363485
Buehrle DJ, Wagener MM, Nguyen MH, Clancy CJ. Trends in outpatient antibiotic prescriptions in the United States during the COVID-19 pandemic in 2020. JAMA Netw Open. 2021;4(9):e2126114. https://doi.org/10.1001/jamanetworkopen.2021.26114
Silva TM, Estrela M, Gomes ER, Piñeiro-Lamas M, Figueiras A, Roque F, et al. The impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care: a nationwide, quasi-experimental approach. Antibiotics (Basel). 2021;10(9):1040. https://doi.org/10.3390/antibiotics10091040
Centers for Disease Control and Prevention. Antibiotic use in the United States, 2021 update: progress and opportunities [Internet]. Atlanta:CDC; 2022 [citado 10 de octubre de 2025]. Disponible en: https://archive.cdc.gov/www_cdc_gov/antibiotic-use/stewardship- report/2021.html
Murray AK. The Novel coronavirus COVID-19 outbreak: global implications for antimicrobial resistance. Front Microbiol. 2020;11:1020. https://doi.org/10.3389/fmicb.2020.01020
Ministerio de Salud y Protección Social. Plan nacional de respuesta a la resistencia a los antimicrobianos [Internet]. Bogotá:Minsalud; 2018 [citado 5 de julio de 2024]. Disponible en: https://www.fao.org/faolex/results/details/en/c/LEX-FAOC197861/
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Rawson TM, Moore LSP, Castro-Sanchez E, Charani E, Davies F, Satta G, et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020;75(7):1681-4. https://doi.org/10.1093/jac/dkaa194
Hsu J. How COVID-19 is accelerating the threat of antimicrobial resistance. BMJ. 2020;369: m1983 https://doi.org/10.1136/bmj.m1983
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622- 9. https://doi.org/10.1016/j.cmi.2020.07.016
Organización Mundial de la Salud. Resistencia a los antimicrobianos [Internet]. Geneva:OMS; [citado 24 de mayo de 2024]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/antimicrobialresistance
Cabrera S. Rational and responsable use of antimicrobials. Arch Med Interna. 2009;31(2-3):74-80.
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2024 [Internet]. Oslo;2024 [citado 6 de julio de 2024]. Disponible en: https://atcddd.fhi.no/atc_ddd_index/
World Health Organization. Country, territory or area profiles [Internet]. Geneva:WHO;[citado 5 de enero de 2026]. Disponible en: https://worldhealthorg.shinyapps.io/glass-dashboard/_w_2adc71e405d247f891587628eb644974/#!/cta-profiles
Ministerio de Salud y Protección Social. Lineamientos técnicos para la implementación de programas de optimización de antimicrobianos en el escenario hospitalario y ambulatorio [Internet]. Bogotá:Minsalud; [citado 29 de septiembre de 2025]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/line amientosoptimizacion-uso-antimicrobianos.pdf
Hogberg LD, Vlahovic-Palcevski V, Pereira C, Weist K, Monnet DL, Strauss R, et al. Decrease in community antibiotic consumption during the COVID-19 pandemic, EU/EEA, 2020. Euro Surveill. 2021;26(46):2101020. https://doi.org/10.2807/1560-7917.ES.2021.26.46.2101020
Pereira ML, Mothe DA, Pinheiro KS, Goncalves SS, Santos KV. Antibiotic dispensing during first year of COVID-19 pandemic in brazilian public hospitals. Future Microbiol. 2023;18:639-47. https://doi.org/10.2217/fmb-2022-0255
Al-Nuaimi S, Alkuwari S, Al-Jubouri AM, Hegazi S, Jolo L, Khalid H, et al. Antibiotics prescriptions pattern among patients visiting primary health care centers (PHCC) before and during COVID-19 pandemic: a cross-sectional population-based study from Qatar. Antibiotics (Basel). 2023;12(8):1228. https://doi.org/10.3390/antibiotics12081228
Gardner TL, Dovey SM, Tilyard MW, Gurr E. Differences between prescribed and dispensed medications. N Z Med J. 1996;109(1017):69-72.
Ministerio de Salud y Protección Social. Presidente Duque declara Emergencia Sanitaria frente a COVID-19 [Internet]. Bogotá: Minsalud; 2020 [citado 8 de septiembre de 2024]. Disponible en: https://www.minsalud.gov.co/Paginas/Presidente-Duque-declara-Emergencia- Sanitaria-frentea-COVID-19.aspx
Presidencia de la República de Colombia. Fin a la emergencia sanitaria por covid-19 en Colombia [Internet]. Bogotá:Presidencia; 2022 [citado 8 de septiembre de 2024]. Disponible en: https://consultorsalud.com/finemergencia-sanitaria-covid-19-colombia/
Colonia DRM, Ramírez Patiño D, Higuita-Gutiérrez LF. Knowledge, attitudes, and practices regarding antibiotic sales in pharmacies in Medellín, Colombia 2023. Antibiotics (Basel). 2023;12(9):1456. https://doi.org/10.3390/antibiotics12091456
Melo-Burbano LA, Galindes-Casanova DA, Benitez-Escobar EN, Assis- Reveiz JK, Daza-Arana JE, Oñate-Gutiérrez JM. Frecuencia de prescripción de antibióticos en adultos hospitalizados por SARS-CoV-2 en una institución de alta complejidad en Santiago de Cali, Colombia. Infectio. 2023;27(2):94-101. https://doi.org/10.22354/24223794.1128
Monroe S, Polk R. Antimicrobial use and bacterial resistance. Curr Opin Microbiol. 2000;3(5):496-501. https://doi.org/10.1016/S1369-5274(00)00129-6
Instituto Nacional de Salud. Consumo de antibióticos en ámbito hospitalario [Internet]. Bogotá:INS; [citado 26 de diciembre de 2024]. Disponible en: https://www.ins.gov.co/buscador- eventos/Informesdeevento/CONSUMO%20DE%20ANTIBI%C3%93TICOS%20EN%20%C3%81MBITO%20HOSPITALARIO_2020.pdf
Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J. 2015;15(2):480-500. https://doi.org/10.1177/1536867X1501500208
StataCorp. Stata Statistical Software: Release 19 [Internet]. College Station (TX):StataCorp LLC; 2025 [citado 7 de octubre de 2025]. Disponible en: https://www.stata.com/
Knight BD, Shurgold J, Smith G, MacFadden DR, Schwartz KL, Daneman N, et al. The impact of COVID-19 on community antibiotic use in Canada: an ecological study. Clin Microbiol Infect. 2022;28(3):426-32. https://doi.org/10.1016/j.cmi.2021.10.013
King LM, Lovegrove MC, Shehab N, Tsay S, Budnitz DS, Geller AI, et al. Trends in U.S. outpatient antibiotic prescriptions during the COVID-19 pandemic. Clin Infect Dis. 2020;ciaa1896.
Alzueta N, Echeverría A, García P, Sanz L, Gil-Setas A, Beristain X, et al. Impact of COVID-19 pandemic in antibiotic consumption in Navarre (Spain): an interrupted time series analysis. Antibiotics (Basel). 2023;12(2):318. https://doi.org/10.3390/antibiotics12020318
Armitage R, Nellums LB. Antibiotic prescribing in general practice during COVID-19. Lancet Infect Dis. 2021;21(6):e144. https://doi.org/10.1016/S1473-3099(20)30917-8
Hek K, Ramerman L, Weesie YM, Lambooij AC, Lambert M, Heins MJ, et al. Antibiotic prescribing in dutch daytime and outof-hours general practice during the COVID-19 pandemic: a retrospective database study. Antibiotics (Basel). 2022;11(3):309. https://doi.org/10.3390/antibiotics11030309
Rachina S, Kozlov R, Kurkova A, Portnyagina U, Palyutin S, Khokhlov A, et al. Antimicrobial dispensing practice in community pharmacies in Russia during the COVID-19 pandemic. Antibiotics (Basel). 2022;11(5):586. https://doi.org/10.3390/antibiotics11050586
Lim AH, Ab Rahman N, Hashim H, Kamal M, Velvanathan T, Chok MCF, et al. Impact of COVID-19 pandemic on antibiotic utilisation in malaysian primary care clinics: an interrupted time series analysis. Antibiotics (Basel). 2023;12(4):659. https://doi.org/10.3390/antibiotics12040659
Rezaei S, Bazyar M, Ahmadi S, Khodamoradi A. From Routine to Crisis: The impact of COVID 19 pandemic on antibiotic consumption in Iran. Health Sci Rep. 2024;7(11):e70161. https://doi.org/10.1002/hsr2.70161
Gacheri J, Hamilton KA, Munywoki P, Wakahiu S, Kiambi K, Fevre EM, et al. Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya. PLOS Glob Public Health. 2024;4(4): e0003046. https://doi.org/10.1371/journal.pgph.0003046
Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, et al. Trends in inpatient antibiotic use among adults hospitalized during the coronavirus disease 2019 pandemic in Argentina, Brasil, and Chile, 2018-2021. Clin Infect Dis. 2023;77(Suppl 1):S4-11. https://doi.org/10.1093/cid/ciad261
Rezel-Potts E, L'Esperance V, Gulliford MC. Antimicrobial stewardship in the UK during the COVID-19 pandemic: a population-based cohort study and interrupted time-series analysis. Br J Gen Pract. 2021;71(706):e331-8. https://doi.org/10.3399/BJGP.2020.1051
Hamilton A, Poleon S, Cherian J, Cosgrove S, Laxminarayan R, Klein E. COVID-19 and outpatient antibiotic prescriptions in the United States: a county- level analysis. Open Forum Infect Dis. 2023;10(3):ofad096. https://doi.org/10.1093/ofid/ofad096
Center for Infectious Disease Research and Policy. US outpatient antibiotic prescribing returning to pre-COVID levels [Internet]. 2024 [citado 10 de octubre de 2025]. Disponible en: https://www.cidrap.umn.edu/antimicrobial- stewardship/us-outpatient-antibiotic-prescribingreturning-pre-covid-levels
Centers for Disease Control and Prevention. COVID 19 impacts on antibiotic use. Atlanta: CDC; 2020.
Bogdanic N, Mocibob L, Vidovic T, Soldo A, Begovac J. Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020. PLoS One. 2022;17(2):e0263437. https://doi.org/10.1371/journal.pone.0263437
Del Fiol F de S, Bergamaschi C de C, De Andrade IP, Lopes LC, Silva MT, Barberato-Filho S. Consumption trends of antibiotics in Brazil during the COVID-19 pandemic. Front Pharmacol. 2022;13:844818. https://doi.org/10.3389/fphar.2022.844818
Ruiz-Garbajosa P, Cantón R. COVID 19: Impact on prescribing and antimicrobial resistance. Rev Esp Quimioter. 2021;34(Suppl 1):63-8. https://doi.org/10.37201/req/s01.19.2021
Wasag DR, Cannings-John R, Hughes K, Ahmed H. Antibiotic dispensing during the COVID 19 pandemic: analysis of Welsh primary care dispensing data. Fam Pract. 2022;39(3):420-5. https://doi.org/10.1093/fampra/cmab141
Clavería A, Delgado-Martín MV, Goicoechea-Castaño A, IglesiasMoreno JM, García-Cendón C, Martín-Miguel MV, et al. Interrupted time series analysis of pediatric infectious diseases and the consumption of antibiotics in an Atlantic european región during the SARS-CoV-2 pandemic. Antibiotics (Basel). 2022;11(2):264. https://doi.org/10.3390/antibiotics11020264
Al Balushi H, Kurdi A, Almutairi N, Baker KI, Amen KM, Karwi H, et al. Impact of the COVID 19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis. Expert Rev Anti Infect Ther. 2024;22(10):895-905. https://doi.org/10.1080/14787210.2024.2363485
Buehrle DJ, Wagener MM, Nguyen MH, Clancy CJ. Trends in outpatient antibiotic prescriptions in the United States during the COVID 19 pandemic in 2020. JAMA Netw Open. 2021;4(9):e2126114. https://doi.org/10.1001/jamanetworkopen.2021.26114
Silva TM, Estrela M, Gomes ER, Piñeiro-Lamas M, Figueiras A, Roque F, et al. The impact of the COVID 19 pandemic on antibiotic prescribing trends in outpatient care: a nationwide, quasi-experimental approach. Antibiotics (Basel). 2021;10(9):1040. https://doi.org/10.3390/antibiotics10091040
Centers for Disease Control and Prevention. Antibiotic use in the United States, 2021 update: progress and opportunities [Internet]. Atlanta:CDC; 2022 [citado 10 de octubre de 2025]. Disponible en: https://archive.cdc.gov/www_cdc_gov/antibiotic-use/stewardship- report/2021.html
Murray AK. The Novel coronavirus COVID 19 outbreak: global implications for antimicrobial resistance. Front Microbiol. 2020;11:1020 https://doi.org/10.3389/fmicb.2020.01020
Ministerio de Salud y Protección Social. Plan nacional de respuesta a la resistencia a los antimicrobianos [Internet]. Bogotá:Minsalud; 2018 [citado 5 de julio de 2024]. Disponible en: https://www.fao.org/faolex/results/details/en/c/LEX-FAOC197861/
World Health Organization. Global AMU data [Internet]. Geneva:WHO; 2025 [citado 1 de octubre de 2025]. Disponible en: https://worldhealthorg.shinyapps.io/glass-dashboard/_w_c19bcec939df430d90dbef9ce2de33ec/#!/amu
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