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Yang D, Dyar OJ, Yin J, Ma W, Sun Q, Lundborg CS. Antimicrobial resistance in China across human, animal, and environment sectors - a review of policy documents using a governance framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101111. [PMID: 38948912 PMCID: PMC11214315 DOI: 10.1016/j.lanwpc.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024]
Abstract
Antimicrobial resistance (AMR) poses a multifaceted threat to the human, animal, and environment sectors. In response, China has formulated a series of policies since the 2000s. Thus far, there has been no comprehensive assessment of these policy documents. This study aims to review the content of AMR policy documents at the national level using a governance framework covering three areas: Policy Design; Implementation Tools; and Monitoring and Evaluation. We identified 44 AMR documents from 2003 to 2022 sourced from government agency websites. Our findings have revealed noticeable discrepancies across the three governance areas. The Policy Design and Monitoring and Evaluation areas should be strengthened, particularly in the domains of 'Coordination', 'Accountability', 'Sustainability', and 'Effectiveness'. From a 'One Health' perspective, the environment sector has received less attention compared to the human and animal sectors. Effectively addressing these challenges requires a stronger commitment and widespread support from diverse stakeholders.
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Affiliation(s)
- Ding Yang
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Oliver James Dyar
- Department of Public Health and Caring Sciences, Uppsala University, 75122, Uppsala, Sweden
| | - Jia Yin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenwen Ma
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
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Allel K, Fernandez-Miyakawa M, Gaze W, Petroni A, Corso A, Luna F, Barcelona L, Boden L, Pitchforth E. Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis. BMJ Open 2024; 14:e082156. [PMID: 38889938 PMCID: PMC11191766 DOI: 10.1136/bmjopen-2023-082156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Gaps in antimicrobial resistance (AMR) surveillance and control, including implementation of national action plans (NAPs), are evident internationally. Countries' capacity to translate political commitment into action is crucial to cope with AMR at the human-animal-environment interface. METHODS We employed a two-stage process to understand opportunities and challenges related to AMR surveillance and control at the human-animal interface in Argentina. First, we compiled the central AMR policies locally and mapped vital stakeholders around the NAP and the national commission against bacterial resistance. Second, we conducted qualitative interviews using a semistructured questionnaire covering stakeholders' understanding and progress towards AMR and NAP. We employed a mixed deductive-inductive approach and used the constant comparative analysis method. We created categories and themes to cluster subthemes and determined crucial relationships among thematic groups. RESULTS Crucial AMR policy developments have been made since 1969, including gradually banning colistin in food-producing animals. In 2023, a new government decree prioritised AMR following the 2015 NAP launch. Our qualitative analyses identified seven major themes for tackling AMR: (I) Cultural factors and sociopolitical country context hampering AMR progress, (II) Fragmented governance, (III) Antibiotic access and use, (IV) AMR knowledge and awareness throughout stakeholders, (V) AMR surveillance, (VI) NAP efforts and (VII) External drivers. We identified a fragmented structure of the food production chain, poor cross-coordination between stakeholders, limited surveillance and regulation among food-producing animals and geographical disparities over access, diagnosis and treatment. The country is moving to integrate animal and food production into its surveillance system, with most hospitals experienced in monitoring AMR through antimicrobial stewardship programmes. CONCLUSION AMR accountability should involve underpinning collaboration at different NAP implementation levels and providing adequate resources to safeguard long-term sustainability. Incorporating a multisectoral context-specific approach relying on different One Health domains is crucial to strengthening local AMR surveillance.
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Affiliation(s)
- Kasim Allel
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Heatlh Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxfordshire, UK
| | | | - William Gaze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alejandro Petroni
- Instituto Nacional de Enfermedades Infecciosas, Buenos Aires, Argentina
| | - Alejandra Corso
- Instituto Nacional de Enfermedades Infecciosas, Buenos Aires, Argentina
| | | | - Laura Barcelona
- Comisión Nacional de Control de la Resistencia Antimicrobiana, Buenos Aires, Argentina
| | - Lisa Boden
- University of Edinburgh Royal Dick School of Veterinary Studies, Easter Bush Campus, Midlothian, UK
| | - Emma Pitchforth
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Tyagi P, Tyagi S, Stewart L, Glickman S. SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis. Antibiotics (Basel) 2024; 13:328. [PMID: 38667004 PMCID: PMC11047466 DOI: 10.3390/antibiotics13040328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds-drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shachi Tyagi
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
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Nie X, Lin M, Xu S, Zhang L, Lin X, Huang W. Strategically reducing carbapenem-resistant Acinetobacter baumannii through PDCA cycle-driven antibiotic management. Indian J Med Microbiol 2024; 48:100527. [PMID: 38185209 DOI: 10.1016/j.ijmmb.2024.100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE With the escalating global challenge of antibiotic resistance, particularly the resistance rate of Acinetobacter baumannii, the need to rationalize carbapenem antibiotic use in clinical settings has become paramount. Our study tapped into a fishbone diagram to uncover the irrationalities in applying these antibiotics and highlight potential influencing factors. METHODS Based on these analyses, we initiated targeted intervention strategies. A PDCA cycle-based scientific management approach was implemented through the combined efforts of our antimicrobial stewardship team and relevant departments. RESULTS Our study showed a significant post-intervention increase in the rational use of carbapenem antibiotics (P < 0.01) and a concurrent decrease in the detection of carbapenem-resistant Acinetobacter baumannii. CONCLUSION Our findings underscore that carbapenem usage can be effectively minimized with the continuous refinements offered by the PDCA cycle, leading to a reduction in multidrug-resistant bacteria, thus fostering rational drug use in healthcare.
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Affiliation(s)
- Xuekun Nie
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
| | - Minhua Lin
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
| | - Shuanglin Xu
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
| | - Lingling Zhang
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
| | - Xiaohui Lin
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
| | - Weiying Huang
- Department of Clinical Pharmacy, Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, 352100, China; Collaborative Innovation Center of Active Ingredient Research of She Medicine (2020Z03), Innovation Center of Clinical Pharmacy Service (2023T06), Ningde Normal University, Ningde, Fujian, 352100, China.
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Zhao R, Han B, Yang F, Zhang Z, Sun Y, Li X, Liu Y, Ding Y. Analysis of extracellular and intracellular antibiotic resistance genes in commercial organic fertilizers reveals a non-negligible risk posed by extracellular genes. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 354:120359. [PMID: 38359629 DOI: 10.1016/j.jenvman.2024.120359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Livestock manure is known to be a significant reservoir of antibiotic resistance genes (ARGs), posing a major threat to human health and animal safety. ARGs are found in both intracellular and extracellular DNA fractions. However, there has been no comprehensive analysis of these fractions in commercial organic fertilizers (COFs). The present study conducted a systematic survey of the profiles of intracellular ARGs (iARGs) and extracellular ARGs (eARGs) and their contributing factor in COFs in Northern China. Results showed that the ARG diversity in COFs (i.e., 57 iARGs and 53 eARGs) was significantly lower than that in cow dung (i.e., 68 iARGs and 69 eARGs). The total abundance of iARGs and eARGs decreased by 85.7% and 75.8%, respectively, after compost processing, and there were no significant differences between iARGs and eARGs in COFs (P > 0.05). Notably, the relative abundance of Campilobacterota decreased significantly (99.1-100.0%) after composting, while that of Actinobacteriota and Firmicutes increased by 21.1% and 29.7%, respectively, becoming the dominant bacteria in COFs. Co-occurrence analysis showed that microorganisms and mobile genetic elements (MGEs) were more closely related to eARGs than iARGs in COFs. And structural equation models (SEMs) further verified that microbial community was an essential factor regulating iARGs and eARGs variation in COFs, with a direct influence (λ = 0.74 and 0.62, P < 0.01), following by similar effects of MGEs (λ = 0.59 and 0.43, P < 0.05). These findings indicate the need to separate eARGs and iARGs when assessing the risk of dissemination and during removal management in the environment.
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Affiliation(s)
- Ran Zhao
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China
| | - Bingjun Han
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China
| | - Fengxia Yang
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China.
| | - Zulin Zhang
- The James Hutton Institute, Aberdeen AB15 8QH, UK
| | - Yutao Sun
- Tianjin Zhongtao Earthworm Breeding Professional Cooperative, Tianjin 300191, China
| | - Xue Li
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China
| | - Yiming Liu
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China
| | - Yongzhen Ding
- China-UK Agro-Environmental Pollution Prevention and Control Joint Research Centre, Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin 300191, China.
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Wasan H, Reeta KH, Gupta YK. Strategies to improve antibiotic access and a way forward for lower middle-income countries. J Antimicrob Chemother 2024; 79:1-10. [PMID: 38008421 DOI: 10.1093/jac/dkad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Antibiotics have substantially improved life expectancy in past decades through direct control or prevention of infections. However, emerging antibiotic resistance and lack of access to effective antibiotics have significantly increased the death toll from infectious diseases, making it one of the biggest threats to global health. Addressing the antibiotic crisis to meet future needs require considerable investment in both research and development along with ensuring a viable marketplace to encourage innovation. Fortunately, there has been some improvement in the number of antibiotics approved or in different phases of development through collective global efforts. However, the universal access to these essential novel and generic antibiotics, especially in low- and middle-income countries (LMICs), is challenged by poor economic incentives, regulatory hurdles and poor health infrastructure. Recently, the agenda of securing and expanding access has gained global attention. Several mechanisms are now being proposed and implemented to improve access to essential antibiotics. This review provides an insight into the major barriers to antibiotic access as well as the models proposed and implemented to mitigate accessibility issues. These models include but are not limited to market entry rewards, subscription models and transferable exclusivity vouchers. Further, global access programmes including, Global Antibiotic Research and Development Partnership, Antimicrobial Resistance Action Fund and SECURE Platform are discussed. We also propose the way forward for improving access in LMICs with suggested measures to improve access to generic and novel antibiotics.
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Affiliation(s)
- Himika Wasan
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - K H Reeta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- All India Institute of Medical Sciences, Jammu, India
- India Strategy Development, Global Antibiotics Research & Development Partnership (GARDP), New Delhi, India
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Dorta HG, Nandi A. Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: A cross-sectional study. J Glob Health 2023; 13:04159. [PMID: 38131631 PMCID: PMC10740384 DOI: 10.7189/jogh.13.04159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Methods Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17 472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. Results We estimated that 18.7% (95% CI = 17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi, no religion and other) (PD = 11.7 (95% CI = 6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD = 5.8 (95% CI = 1.7-9.9)) compared to mothers lacking formal education. Conclusions Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India.
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Rocke T, Udofia AA, El Omeiri N, Ramon-Pardo P. READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review. Rev Panam Salud Publica 2023; 47:e106. [PMID: 37489236 PMCID: PMC10361420 DOI: 10.26633/rpsp.2023.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/03/2023] [Indexed: 07/26/2023] Open
Abstract
Objective To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network.
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Affiliation(s)
- Tamarie Rocke
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Aniebiot-abasi Udofia
- University of South WalesCardiffUnited KingdomUniversity of South Wales, Cardiff, United Kingdom
| | - Nathalie El Omeiri
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Pilar Ramon-Pardo
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
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Vijay D, Bedi JS, Dhaka P, Singh R, Singh J, Arora AK, Gill JPS. Monitoring of antimicrobial usage among adult bovines in dairy herds of Punjab, India: A quantitative analysis of pattern and frequency. Front Vet Sci 2023; 10:1089307. [PMID: 37065232 PMCID: PMC10098197 DOI: 10.3389/fvets.2023.1089307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
The present study aimed to evaluate the antimicrobial usage (AMU) pattern in dairy herds of Punjab, India. The on-farm quantification of AMU in adult bovine animals by the manual collection of empty drug containers ("bin method") along with the records of the treatment was carried out in 38 dairy farms involving 1010 adult bovines for 1 year from July 2020 to June 2021. The farm owners were asked to record the antibiotic treatments as well as to deposit empty antibiotic packaging/vials into the provided bins placed at the farms. A total of 14 different antibiotic agents in 265 commercial antibiotic products were administered to the dairy herds during the study. A total of 179 (67.55%) administered products contained antimicrobials of "critical importance" as per the World Health Organization (WHO). Mastitis (54.72%), followed by the treatment of fever (19.62%), reproductive problems (15.47%), and diarrhea (3.40%) accounted for the majority of drugs administered in the herds during the study period. The most commonly used antibiotics were enrofloxacin (89.47% herds; 21.51% products), followed by ceftriaxone (50% herds; 12.83% products), amoxicillin (50% herds; 12.83% products), oxytetracycline (55.26% herds; 11.70% products), and procaine penicillin (47.37% herds; 12.83% products). The highest quantity of AMU [in terms of antimicrobial drug use rate (ADUR)] was observed for ceftiofur, followed by ceftriaxone, procaine benzyl penicillin ceftizoxime, enrofloxacin, cefoperazone, amoxicillin and ampicillin. A total of 125 (47.17%) products contained "highest priority critically important antimicrobials" (HPCIA) and 54 (20.37%) products contained "high priority critically important antimicrobials". In terms of overall number of animal daily doses (nADD), the highest priority critically important antimicrobials (HPCIA) of the WHO such as third-generation cephalosporins and quinolones, respectively accounted for 44.64 and 22.35% of the total antibiotic use in the herds. The bin method offers an alternative to monitoring AMU as a more accessible approach for recording the actual consumption of antimicrobials. The present study, to the best of our knowledge, is the first of its kind to provide an overview of the qualitative and quantitative estimate of AMU among adult bovines from India.
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Affiliation(s)
- Deepthi Vijay
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Jasbir Singh Bedi
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
- *Correspondence: Jasbir Singh Bedi
| | - Pankaj Dhaka
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Randhir Singh
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Jaswinder Singh
- Department of Veterinary and Animal Husbandry Extension Education, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Anil Kumar Arora
- Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
| | - Jatinder Paul Singh Gill
- Centre for One Health, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, India
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Pyörälä E, Sepponen K, Lauhio A, Saastamoinen L. Outpatient Antibiotic Use and Costs in Adults: A Nationwide Register-Based Study in Finland 2008-2019. Antibiotics (Basel) 2022; 11:1453. [PMID: 36358108 PMCID: PMC9686641 DOI: 10.3390/antibiotics11111453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 12/27/2023] Open
Abstract
The objective of this study was to describe the prevalence of outpatient use and costs for systemic antibacterials by age and sex among adults in Finland from 2008-2019. Data from the Finnish statistical database Kelasto, containing information concerning all reimbursed medicines for 18+-year-olds during 2008-2019, were analyzed. In addition to the decreased (26%) use of systemic antibiotics, decreased use was observed in all antibiotic categories, notably including several wide-spectrum antibiotics. The use of quinolones decreased by 49% and of tetracyclines by 39%. The 10 most frequently used antibiotics covered 89% of all adult antibiotic prescriptions. Antibiotic use also decreased in every age group during the study period. Although the overall yearly costs of outpatient antibiotics during the 10-year study period decreased from EUR 36.4 million to EUR 30.7 million, the cost per prescription increased slightly. In conclusion, according to the findings of this study, concerning adults and the results of our previous study concerning children and adolescents (2008-2016), there has been a decreasing trend of outpatient antibacterial use among the whole Finnish outpatient population over the duration of nearly one decade. However, during the same time period, there has been a specific increasing trend for the Gram-negative AMR threat regarding E. coli resistance. Therefore, based on our important findings in Finland, methods other than the restriction of antibiotic use, such as new anti-infective innovations, including antibacterials, are needed as soon as possible to tackle this major global health threat-a silent pandemic.
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Affiliation(s)
- Elisa Pyörälä
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Kati Sepponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland
| | - Anneli Lauhio
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Finnish Medicines Agency Fimea, 00300 Helsinki, Finland
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Sulis G, Pradhan R, Kotwani A, Gandra S. India's ban on antimicrobial fixed-dose combinations: winning the battle, losing the war? J Pharm Policy Pract 2022; 15:33. [PMID: 35484606 PMCID: PMC9047325 DOI: 10.1186/s40545-022-00428-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background and objectives India, the country with the largest market availability of antimicrobial fixed-dose combinations (FDCs), banned certain antimicrobial FDCs in September 2018. Our objective was to examine the impact of Government ban on the sales of antimicrobial FDCs. Methods The sales patterns of 14 of the 26 banned antimicrobial FDCs were analyzed using monthly private sector drug sales data from IQVIA (a comprehensive and nationally representative drug sales database) between January 2018 and December 2019. We carried out descriptive analyses to evaluate the trend in sales over time for banned and non-banned antimicrobial FDCs using cumulative sales volumes. Results Overall, the cumulative sales volume of banned antimicrobial FDCs declined by 75% between January and September 2018 and the same months of 2019, although some banned FDCs continued to be available in significant volumes. The effectiveness of the ban was offset by several pathways. First, the sales of combinations containing moieties belonging to the same drug-classes as the antimicrobials in the banned FDCs increased after the ban. Second, while certain formulations of particular combinations were banned, the sales of other non-banned formulation of these combinations increased. Third, in some cases, products containing new non-antimicrobial components added to the banned combinations remained available. Interpretation and conclusions While sales of the banned antimicrobial FDCs decreased in 2019, we identified several mechanisms that counterbalanced the ban, including implementation failure, rising sales of congeners, and products with additional non-antimicrobial components. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00428-w.
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Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Richeek Pradhan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Anita Kotwani
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, India
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO, USA.
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Górski A, Borysowski J, Międzybrodzki R. The contribution of phage therapy to medical knowledge. J Glob Antimicrob Resist 2022; 28:238-240. [DOI: 10.1016/j.jgar.2022.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/23/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022] Open
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