Coverage of policies to improve antimicrobial stewardship in human medicine in low and middle income countries: results from the Global Survey of Experts on Antimicrobial Resistance.
Antibiotics
Antimicrobial resistance
Legislation
Low and middle income countries
Policies
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
23 Aug 2024
23 Aug 2024
Historique:
received:
17
05
2023
accepted:
19
07
2024
medline:
24
8
2024
pubmed:
24
8
2024
entrez:
23
8
2024
Statut:
epublish
Résumé
Antimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs). To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS). A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR. In many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally.
Sections du résumé
BACKGROUND
BACKGROUND
Antimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs).
METHODS
METHODS
To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS).
RESULTS
RESULTS
A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR.
CONCLUSIONS
CONCLUSIONS
In many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally.
Identifiants
pubmed: 39180027
doi: 10.1186/s12889-024-19542-2
pii: 10.1186/s12889-024-19542-2
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2297Subventions
Organisme : European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie
ID : grant agreement No 801076
Informations de copyright
© 2024. The Author(s).
Références
Toner E, Adalja A, Gronvall GK, Cicero A, Inglesby TV. Antimicrobial resistance is a global health emergency. Health Secur. 2015;13(3):153–5.
pubmed: 26042858
pmcid: 4486712
doi: 10.1089/hs.2014.0088
Jee Y, Carlson J, Rafai E, Musonda K, Huong TTG, Daza P, et al. Antimicrobial resistance: a threat to global health. Lancet Infect Dis. 2018;18(9):939–40.
pubmed: 30152350
doi: 10.1016/S1473-3099(18)30471-7
World Health Organization. Global Action Plan on Antimicrobial Resistance. 2015.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55.
doi: 10.1016/S0140-6736(21)02724-0
Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057–98.
pubmed: 24252483
doi: 10.1016/S1473-3099(13)70318-9
Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176–87.
pubmed: 26603922
doi: 10.1016/S0140-6736(15)00473-0
Hamers RL, van Doorn HR. Antibiotic consumption in low-income and middle-income countries. Lancet Glob Health. 2018;6(7):E732-E.
Fink G, D’Acremont V, Leslie HH, Cohen J. Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys. Lancet Infect Dis. 2020;20(2):179–87.
pubmed: 31843383
doi: 10.1016/S1473-3099(19)30572-9
Sulis G, Sayood S, Gandra S. Antimicrobial resistance in low- and middle-income countries: current status and future directions. Expert Rev Anti-Infe. 2022;20(2):147–60.
doi: 10.1080/14787210.2021.1951705
Pokharel S, Raut S, Adhikari B. Tackling antimicrobial resistance in low-income and middle-income countries. Bmj Glob Health. 2019;4(6):1–3.
Browne AJ, Chipeta MG, Haines-Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S, et al. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study. Lancet Planet Health. 2021;5(12):E893–904.
pubmed: 34774223
pmcid: 8654683
doi: 10.1016/S2542-5196(21)00280-1
A. M. Viens JL. Is Antimicrobial Resistance a Slowly Emerging Disaster? PUBLIC HEALTH ETHICS. 2015;8:255–65.
World Health Organization. Sixty-eighth World Health Assembly (WHA68.7), Agenda Item 15.1, Global action plan on antimicrobial resistance. 2015.
World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. Global Antimicrobial Resistance Surveillance System (GLASS); 2021.
Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, Hoffman SJ. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. PLoS Med. 2019;16(6):e1002819.
Lim JM, Singh SR, Duong MC, Legido-Quigley H, Hsu LY, Tam CC. Impact of national interventions to promote responsible antibiotic use: a systematic review. Journal of Antimicrobial Chemotherapy. 2019;75(1):14–29.
pmcid: 6910191
doi: 10.1093/jac/dkz348
Tejpar S, Van Katwyk SR, Wilson L, Hoffman SJ. Taking stock of global commitments on antimicrobial resistance. Bmj Glob Health. 2022;7(5):2–8.
Cassini A, Tacconelli E. Potential for improvement in governance and national action plans to overcome antimicrobial resistance. Lancet Infect Dis. 2023.
Patel J, Harant A, Fernandes G, Mwamelo AJ, Hein W, Dekker D, Sridhar D. Measuring the global response to antimicrobial resistance, 2020-21: a systematic governance analysis of 114 countries. Lancet Infect Dis. 2023.
Tripartite AMR Country Self-Assessment Survey (TrACSS) 2020-2021. Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS):Global monitoring of country progress on addressing antimicrobial resistance 2020-2021 [Available from: https://amrcountryprogress.org/ .
World Health Organization. Formation of the Quadripartite Technical Group on the Economics of Antimicrobial Resistance. Fields. 2023.
Nwokike J, Clark A, Nguyen PP. Medicines quality assurance to fight antimicrobial resistance. B World Health Organ. 2018;96(2):135-7.
Kelesidis T, Falagas ME. Substandard/Counterfeit Antimicrobial Drugs. Clin Microbiol Rev. 2015;28(2):443–64.
pubmed: 25788516
pmcid: 4402958
doi: 10.1128/CMR.00072-14
Nørstrud KS. Poor Governance and out-of-pocket health expenditure as drivers of antimicrobial resistance: a multivariate analysis. School of Economics, Management and Statistics. 2019.
Holloway KA, Rosella L, Henry D. The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics. PLoS One. 2016;11(3): e0152020.
pubmed: 27002977
pmcid: 4803297
doi: 10.1371/journal.pone.0152020
Holloway KA, Kotwani A, Batmanabane G, Santoso B, Ratanawijitrasin S, Henry D. Promoting quality use of medicines in South-East Asia: reports from country situational analyses. BMC Health Serv Res. 2018;18(1):526.
pubmed: 29976180
pmcid: 6034320
doi: 10.1186/s12913-018-3333-1
Holloway KA, Kotwani A, Batmanabane G, Puri M, Tisocki K. Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses. Bmj. 2017;358: j2291.
pubmed: 28874360
pmcid: 5598252
doi: 10.1136/bmj.j2291
Holloway KA, Ivanovska V, Manikandan S, Jayanthi M, Mohan A, Forte G, Henry D. Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets. PLoS One. 2020;15(2): e0228201.
pubmed: 32027679
pmcid: 7004360
doi: 10.1371/journal.pone.0228201
Tompson AC, Chandler, C.I.R.,. Addressing antibiotic use: insights from social science around the world. A report collated with social scientists of the Antimicrobials in Society Hub. London School of Hygiene and Tropical Medicine,. 2021.
World Bank. New World Bank country classifications by income level: 2019-2020 2021 [Available from: https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2019-2020 .
Hudson NW, Anusic I, Lucas RE, Donnellan MB. Comparing the Reliability and Validity of Global Self-Report Measures of Subjective Well-Being With Experiential Day Reconstruction Measures. Assessment. 2020;27(1):102–16.
pubmed: 29254354
doi: 10.1177/1073191117744660
Tsai FJ, Tipayamongkholgul M. Are countries’ self-reported assessments of their capacity for infectious disease control reliable? Associations among countries’ self-reported international health regulation 2005 capacity assessments and infectious disease control outcomes. BMC Public Health. 2020;20(1):282.
pubmed: 32131785
pmcid: 7057569
doi: 10.1186/s12889-020-8359-8
Walkowiak S, Coutrot A, Hegarty M, Velasco PF, Wiener JM, Dalton RC, et al. Cultural determinants of the gap between self-estimated navigation ability and wayfinding performance: evidence from 46 countries. Scientific Reports. 2023;13(1):10844.
pubmed: 37407585
pmcid: 10322842
doi: 10.1038/s41598-023-30937-w
Lavis JN, Guindon GE, Cameron D, Boupha B, Dejman M, Osei EJ, Sadana R. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of researchers. Cmaj. 2010;182(9):E350-61.
pubmed: 20439449
pmcid: 2882466
doi: 10.1503/cmaj.081164
Silva AC, Nogueira PJ, Paiva JA. Determinants of Antimicrobial Resistance among the Different European Countries: More than Human and Animal Antimicrobial Consumption. Antibiotics-Basel. 2021;10(7).
Aditi Sriram GK, Jessica Craig, Ruchita Balasubramanian, Sehr Brar, Nicola Criscuolo, Alisa Hamilton, Eili Klein, Katie Tseng, Thomas P, Van Boeckel, Ramanan Laxminarayan The State of the World’s Antibiotics Report in 2021:A Global Analysis of Antimicrobial Resistance and Its Drivers. Washington DC: Center For Disease Dynamics, Economics & Policy; 2021
Yao L, Yin J, Huo RT, Yang D, Shen LY, Wen SQ, Sun Q. The effects of the primary health care providers' prescription behavior interventions to improve the rational use of antibiotics: a systematic review. Glob Health Res Pol. 2020;5(1):3–11.
Ashiru-Oredope D, Hopkins S, Vasandani S, Umoh E, Oloyede O, Nilsson A, et al. Healthcare workers’ knowledge, attitudes and behaviours with respect to antibiotics, antibiotic use and antibiotic resistance across 30 EU/EEA countries in 2019. Eurosurveillance. 2021;26(12):13–22.
doi: 10.2807/1560-7917.ES.2021.26.12.1900633
Kirchhelle C, Atkinson P, Broom A, Chuengsatiansup K, Ferreira JP, Fortané N, et al. Setting the standard: multidisciplinary hallmarks for structural, equitable and tracked antibiotic policy. BMJ Glob Health. 2020;5(9).
Ren M, So AD, Chandy SJ, Mpundu M, Peralta AQ, Åkerfeldt K, et al. Equitable Access to Antibiotics: A Core Element and Shared Global Responsibility for Pandemic Preparedness and Response. J Law Med Ethics. 2022;50(S2):34–9.
pubmed: 36889350
pmcid: 10009365
doi: 10.1017/jme.2022.77
Littmann J, Viens AM. The Ethical Significance of Antimicrobial Resistance. Public Health Ethics. 2015;8(3):209–24.
pubmed: 26566395
pmcid: 4638062
Pulcini C, Beovic B, Béraud G, Carlet J, Cars O, Howard P, et al. Ensuring universal access to old antibiotics: a critical but neglected priority. Clinical Microbiology and Infection. 2017;23(9):590–2.1-3.
pubmed: 28522030
doi: 10.1016/j.cmi.2017.04.026
Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PloS one. 2017;12(12): e0189621.
pubmed: 29267306
pmcid: 5739407
doi: 10.1371/journal.pone.0189621
Jacob Piercea AA, Natalie Schellackc, Wanda Cornisteind,Amal Al Maanie, Syamhanin Adnanf, Michael P. Stevensa. Global Antimicrobial Stewardship with a Focus on Low- and Middle-Income Countries: A position statement for the international society for infectious diseases. International Journal of Infectious Diseases. 2020.
Iskandar K, Molinier L, Hallit S, Sartelli M, Hardcastle TC, Haque M, et al. Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture. Antimicrob Resist In. 2021;10(1).
World Health Organization. Antimicrobial resistance: global report on surveillance. 2014.
Shah AS, Karunaratne K, Shakya G, Barreto I, Khare S, Paveenkittiporn W, et al. Strengthening laboratory surveillance of antimicrobial resistance in South East Asia. Bmj. 2017;358: j3474.
pubmed: 28874340
pmcid: 5598293
doi: 10.1136/bmj.j3474
’World Health Organization SEAR. One Health approach to tackle antimicrobial resistance in South East Asia. BMJ (Clinical research ed). 2017;358: j3625.1-2.