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Rogers Van Katwyk S, Poirier MJP, Chandy SJ, Faure K, Fisher C, Lhermie G, Moodley A, Sarkar S, Sophie M, Strong K, Weldon I, Hoffman SJ. 1-10-100: Unifying goals to mobilize global action on antimicrobial resistance. Global Health 2024; 20:66. [PMID: 39187834 PMCID: PMC11348599 DOI: 10.1186/s12992-024-01070-8] [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: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024] Open
Abstract
The Bellagio Group for Accelerating AMR Action met in April 2024 to develop the ambitious but achievable 1-10-100 unifying goals to galvanize global policy change and investments for antimicrobial resistance mitigation: 1 Health; 10 million lives saved; and 100% sustainable access to effective antimicrobials. High profile political goals such as the Paris Agreement's objective to keep global warming well below 2° Celsius compared to pre-industrial levels, UNAIDS' 90-90-90 goal, and the Sustainable Development Goals challenge global norms, direct attention towards relevant activities, and serve an energizing function to motivate action over an extended period of time. The 1-10-100 unifying goals propose to unite the world through a One Health approach to safeguard human health, animal welfare, agrifood systems, and the environment from the emergence and spread of drug-resistant microbes and infections; save over 10 million lives by 2040 through concerted efforts to prevent and appropriately treat infections while preserving the vital systems and services that depend on sustained antimicrobial effectiveness; and commit to ensuring that antimicrobials are available and affordable for all, used prudently, and secured for the future through innovation. Compared to existing technical targets, these unifying goals offer advantages of focusing on prevention, encouraging multisectoral action and collaboration, promoting health equity, recognizing the need for innovation, and integrating with Sustainable Development Goals. By committing to 1 Health, 10 million lives saved, and 100% sustainable access to effective antimicrobials, we can protect lives and livelihoods today and safeguard options for tomorrow.
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Affiliation(s)
- Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, M3J 2S5, Canada
| | - Mathieu J P Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, M3J 2S5, Canada.
- School of Global Health, Faculty of Health, York University, Toronto, M3J 2S5, Canada.
| | - Sujith J Chandy
- International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark
| | - Kim Faure
- Global Antibiotic R&D Partnership, 1202, Geneva, Switzerland
| | - Caitlin Fisher
- School of the Arts, Media, Performance, and Design, York University, Toronto, M3J 2S5, Canada
| | - Guillaume Lhermie
- School of Public Policy, University of Calgary, Calgary, T2P 1H9, Canada
- Faculty of Veterinary Medicine, University of Calgary, Calgary, T2N 4Z6, Canada
- One Health at UCalgary, University of Calgary, Calgary, T2N 1N4, Canada
| | - Arshnee Moodley
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870, Frederiksberg, Denmark
- Animal and Human Health Programme, International Livestock Research Institute, Nairobi, Kenya
| | - Satyajit Sarkar
- Department of Policy & Economic Research, International Vaccine Institute, Seoul, 08826, Korea
| | | | - Kayla Strong
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, M3J 2S5, Canada
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, M3J 2S5, Canada
- Centre for Law, Medicine, and Life Sciences, Faculty of Law, University of Cambridge, Cambridge, CB3 9DZ, UK
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, M3J 2S5, Canada
- School of Global Health, Faculty of Health, York University, Toronto, M3J 2S5, Canada
- Osgoode Hall Law School, York University, Toronto, M3J 1P3, Canada
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2
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Zay Ya K, Lambiris MJ, Levine GA, Tediosi F, Fink G. 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. BMC Public Health 2024; 24:2297. [PMID: 39180027 PMCID: PMC11342495 DOI: 10.1186/s12889-024-19542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
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 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 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 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.
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Affiliation(s)
- Kyaw Zay Ya
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark J Lambiris
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Gillian A Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland.
- University of Basel, Basel, Switzerland.
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3
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Bhuller Y, Deonandan R, Krewski D. Relevance and feasibility of principles for health and environmental risk decision-making. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2024; 27:189-211. [PMID: 38743482 DOI: 10.1080/10937404.2024.2338078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Globally, national regulatory authorities are both responsible and accountable for health and environmental decisions related to diverse products and risk decision contexts. These authorities provided regulatory oversight and expedited market authorizations of vaccines and other therapeutic products during the COVID-19 pandemic. Regulatory decisions regarding such products and situations depend upon well-established risk assessment and management steps. The underlying processes supporting such decisions were outlined in frameworks describing the complex interactions between factors including risk assessment and management steps as well as principles which help guide risk decision-making. In 2022, experts in risk science proposed a set of 10 guiding principles, further examining the intersection and utility of these principles using 10 diverse risk contexts, and inviting a broader discourse on the application of these principles in risk decision-making. To add to this information, Canadian regulatory practitioners responsible for evaluating health and environmental risks and establishing policies convened at a Health Canada workshop on Principles for Risk Decision-Making. This review reports the results derived from this interactive engagement and provides a first pragmatic analysis of the relevance, importance, and feasibility of such principles for health and environmental risk decision-making within the Canadian regulatory context.
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Affiliation(s)
- Yadvinder Bhuller
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Bajwa M, Afzal S, Sheikh SA, Saleem Z. Drug Inspector as an antibiotic Steward: challenges and recommendations to implement national action plan of Pakistan on antimicrobial resistance. Expert Rev Anti Infect Ther 2024. [PMID: 38872588 DOI: 10.1080/14787210.2024.2368825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Despite significant measures, low- and middle-income countries (LMICs), including Pakistan, struggle to curtail non-prescription antibiotic sales, enforce regulations, and implement National Action Plan (NAP) against antimicrobial resistance (AMR). NAP Pakistan entails drug inspectors (DIs) to ensure prescription-based sales of antibiotics. This study seeks to understand the perspective of DIs regarding antimicrobial sales without prescription, underlying factors, and policy implementation status. METHODS A qualitative study employing a semi-structured interview guide using in-depth interviews with purposively selected 17 DIs was conducted. Interviews were transcribed verbatim, and data were analyzed following a thematic analysis framework utilizing MAXQDA 2022 software. RESULTS Five main themes emerged after data analysis: (1) drug inspector - the regulator of the antimicrobial armamentarium, (2) the policy context, (3) awareness regarding AMR, (4) barriers to combatting AMR, and (5) the way forward: strategies and recommendations. CONCLUSION A weak regulatory framework, low level of awareness, quackery, vested interests, and socio-economic factors augment inappropriate antibiotic utilization. Opting for better policies and strengthening the DI fraternity as outlined in NAP Pakistan is recommended. Recognizing drug inspectors as effective surveilling units and mobilizing field force against irrational antibiotic utilization is the need of the hour and requires policy reformation.
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Affiliation(s)
- Mishal Bajwa
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shairyar Afzal
- Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University, Pakistan
- Department of Pharmacy, DHQ Hospital Jhelum, Jhelum, Pakistan
| | - Sadaf Areej Sheikh
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| | - Zikria Saleem
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Punjab, Pakistan
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5
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Knowles R, Chandler C, O’Neill S, Sharland M, Mays N. A systematic review of national interventions and policies to optimize antibiotic use in healthcare settings in England. J Antimicrob Chemother 2024; 79:1234-1247. [PMID: 38507232 PMCID: PMC11144483 DOI: 10.1093/jac/dkae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES To identify and assess the effectiveness of national antibiotic optimization interventions in primary and secondary care in England (2013-2022). METHODS A systematic scoping review was conducted. Literature databases (Embase and Medline) were used to identify interventions and evaluations. Reports included the UK AMR Strategy (2013-2018), National Action Plan (2019-2024) and English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports (2014-2022). The design, focus and quality of evaluations and the interventions' effectiveness were extracted. FINDINGS Four hundred and seventy-seven peer-reviewed studies and 13 reports were screened. One hundred and three studies were included for review, identifying 109 interventions in eight categories: policy and commissioning (n = 9); classifications (n = 1); guidance and toolkits (n = 22); monitoring and feedback (n = 17); professional engagement and training (n = 19); prescriber tools (n = 12); public awareness (n = 17); workforce and governance (n = 12).Most interventions lack high-quality effectiveness evidence. Evaluations mainly focused on clinical, microbiological or antibiotic use outcomes, or intervention implementation, often assessing how interventions were perceived to affect behaviour. Only 16 interventions had studies that quantified effects on prescribing, of which six reported reductions. The largest reduction was reported with structural-level interventions and attributed to a policy and commissioning intervention (primary care financial incentives). Behavioural interventions (guidance and toolkits) reported the greatest impact in hospitals. CONCLUSIONS Many interventions have targeted antibiotic use, each pulling different levers across the health system simultaneously. On the basis of these studies, structural-level interventions may have the greatest impact. Collectively, the combination of interventions may explain England's decline in prescribing but direct evidence of causality is unavailable.
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Affiliation(s)
- Rebecca Knowles
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen O’Neill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Mays
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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6
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Kerek Á, Szabó Á, Jerzsele Á. Antimicrobial Susceptibility Profiles of Pasteurella multocida Isolates from Clinical Cases of Waterfowl in Hungary between 2022 and 2023. Vet Sci 2024; 11:194. [PMID: 38787166 PMCID: PMC11125817 DOI: 10.3390/vetsci11050194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
The waterfowl industry represents a narrow, yet economically significant, sector within the poultry industry. Although less prominent, the waterfowl sector is nonetheless of equal importance to any other livestock sector in terms of antimicrobial resistance and animal health issues. This study assesses the antimicrobial resistance profile of Pasteurella multocida bacterial strains isolated from clinical cases in Hungary's duck and goose populations, determining the minimal inhibitory concentration (MIC) of 27 samples collected from 15 different locations. The results indicate that the isolated strains were susceptible to most antibiotics, except for notable resistance to enrofloxacin. These findings support that Pasteurella multocida largely retained its susceptibility. However, the observed resistance to enrofloxacin suggests overuse of fluoroquinolones, which indicates the potential need for stricter regulation of their use in the poultry industry.
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Affiliation(s)
- Ádám Kerek
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, István utca 2, 1078 Budapest, Hungary; (Á.S.); (Á.J.)
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Ábel Szabó
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, István utca 2, 1078 Budapest, Hungary; (Á.S.); (Á.J.)
| | - Ákos Jerzsele
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, István utca 2, 1078 Budapest, Hungary; (Á.S.); (Á.J.)
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, 1078 Budapest, Hungary
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7
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Canto ESM, Bentes VS, Silva MJA, Lima ES, Silva DR, Nunez CV, Cortez ACA, Souza ES, Souza JVB. Tapping into Tapajos: antibacterial potential of fungal strains isolated from decaying wood in the Brazilian Amazon. BRAZ J BIOL 2023; 83:e275573. [PMID: 38126585 DOI: 10.1590/1519-6984.275573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The emergence of bacterial resistance to antimicrobials poses a significant health threat. To address this issue, exploring the fungal diversity in freshwater environments in the Amazon Forest has potential in the search for new antimicrobials. This study aimed to investigate the production of antibacterial metabolites by aquatic fungi from Amazon lakes, specifically Lake Juá and Lake Maicá (Brazil-PA). The fungal isolates were obtained from wood fragments submerged in these lakes, and the ethyl acetate extracts were evaluated for antibacterial activity against Staphylococcus aureus ATCC 25923, S. aureus (MRSA), ATCC 43300, Escherichia coli ATCC 25922, and E. coli (ESBL) NCTC 13353. Additionally, toxicity of the extracts (EtOAc with antimicrobial activity) against human fibroblasts MRC-5 was investigated. The study identified 40 fungal strains with antimicrobial screening, and the ethyl acetate extracts of Fluviatispora C34, Helicascus C18, Monodictys C15, and Fusarium solani LM6281 exhibited antibacterial activity. F. solani LM6281 showed the lowest minimum inhibitory concentration (MIC) of 50 µg/mL against S. aureus strains and MIC of 100 µg/mL against E. coli strains including ESBL. The cytotoxicity (IC50) of the extract (EtOAc) of F. solani LM6281 was 34.5 µg/mL. Preliminary studies of the TLC culture and RNM-H from the extract (EtOAc) of F. solani suggested the presence of substances from the class of terpenes, quinones, phenolics, and flavonoids. This study highlights the potential of submerged wood fungi in the Amazon region to produce antibacterial substances, thus identifying them as sources of novel bioactive compounds with potential use in the pharmaceutical industry and regional bioeconomy.
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Affiliation(s)
- E S M Canto
- Universidade Federal do Oeste do Pará - UFOPA, Instituto de Ciências e Tecnologia das Águas - ICTA, Santarém, PA, Brasil
| | - V S Bentes
- Universidade Federal do Oeste do Pará - UFOPA, Instituto de Ciências e Tecnologia das Águas - ICTA, Santarém, PA, Brasil
| | - M J A Silva
- Universidade Federal do Amazonas - UFAM, Laboratório de Atividade Biológica, Manaus, AM, Brasil
| | - E S Lima
- Universidade Federal do Amazonas - UFAM, Laboratório de Atividade Biológica, Manaus, AM, Brasil
| | - D R Silva
- Instituto Nacional de Pesquisas da Amazônia - INPA, Laboratório de Bioprospecção e Biotecnologia, Manaus, AM, Brasil
| | - C V Nunez
- Instituto Nacional de Pesquisas da Amazônia - INPA, Laboratório de Bioprospecção e Biotecnologia, Manaus, AM, Brasil
| | - A C A Cortez
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
| | - E S Souza
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
| | - J V B Souza
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
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8
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Abdelsalam Elshenawy R, Umaru N, Aslanpour Z. WHO AWaRe classification for antibiotic stewardship: tackling antimicrobial resistance - a descriptive study from an English NHS Foundation Trust prior to and during the COVID-19 pandemic. Front Microbiol 2023; 14:1298858. [PMID: 38146447 PMCID: PMC10749484 DOI: 10.3389/fmicb.2023.1298858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO's AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of "Watch" category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.
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Affiliation(s)
- Rasha Abdelsalam Elshenawy
- Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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9
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Thornber K, Bashar A, Ahmed MS, Bell A, Trew J, Hasan M, Hasan NA, Alam MM, Chaput DL, Haque MM, Tyler CR. Antimicrobial Resistance in Aquaculture Environments: Unravelling the Complexity and Connectivity of the Underlying Societal Drivers. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14891-14903. [PMID: 36102785 PMCID: PMC9631993 DOI: 10.1021/acs.est.2c00799] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 05/26/2023]
Abstract
Food production environments in low- and middle-income countries (LMICs) are recognized as posing significant and increasing risks to antimicrobial resistance (AMR), one of the greatest threats to global public health and food security systems. In order to maximize and expedite action in mitigating AMR, the World Bank and AMR Global Leaders Group have recommended that AMR is integrated into wider sustainable development strategies. Thus, there is an urgent need for tools to support decision makers in unravelling the complex social and environmental factors driving AMR in LMIC food-producing environments and in demonstrating meaningful connectivity with other sustainable development issues. Here, we applied the Driver-Pressure-State-Impact-Response (DPSIR) conceptual framework to an aquaculture case study site in rural Bangladesh, through the analysis of distinct social, microbiological, and metagenomic data sets. We show how the DPSIR framework supports the integration of these diverse data sets, first to systematically characterize the complex network of societal drivers of AMR in these environments and second to delineate the connectivity between AMR and wider sustainable development issues. Our study illustrates the complexity and challenges of addressing AMR in rural aquaculture environments and supports efforts to implement global policy aimed at mitigating AMR in aquaculture and other rural LMIC food-producing environments.
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Affiliation(s)
- Kelly Thornber
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
| | - Abul Bashar
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | | | - Ashley Bell
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Jahcub Trew
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Mahmudul Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Neaz A. Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Md. Mehedi Alam
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Dominique L. Chaput
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | | | - Charles R. Tyler
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
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10
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Bandara S, Baral P, Joshi A, Muhia J, Rahman-Shepherd A, Adhikari P, Bayingana A, Bookholane H, Changyit-Levin Y, Dada S, Dutta R, Essar MY, Evaborhene NA, Krugman D, Kumar R, Manoj M, Mathewos K, Olson N, Osborne R, Romero-Alvarez D, Tun ZM, Wong BLH. Open Letter to G7 and G20 leaders: resolve global crises to secure our future. Nat Med 2022; 28:1974-1975. [PMID: 35970922 DOI: 10.1038/s41591-022-01944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shashika Bandara
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Prativa Baral
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anshumi Joshi
- Trent/Fleming School of Nursing, Trent University, Ontario, Canada
| | - Joy Muhia
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Afifah Rahman-Shepherd
- Faculty of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Praju Adhikari
- Public and Global Health Program, Tampere University, Tampere, Finland
| | | | - Hloni Bookholane
- Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Yara Changyit-Levin
- Global Health Direct Matriculation Program, Johns Hopkins University, Baltimore, MD, USA
| | - Sara Dada
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rohini Dutta
- Programme for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | | | - Daniel Krugman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ramya Kumar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Malvikha Manoj
- International Working Group for Health Systems Strengthening, New York, NY, USA
| | | | - Nehemiah Olson
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rhiannon Osborne
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Daniel Romero-Alvarez
- One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador
| | - Zaw Myo Tun
- Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Brian Li Han Wong
- The International Digital Health & AI Research Collaborative (I-DAIR), Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland
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11
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Van Katwyk SR, Wilson L, Weldon I, Hoffman SJ, Poirier MJP. Adopting a Global AMR Target within the Pandemic Instrument Will Act as a Catalyst for Action. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:64-70. [PMID: 36889348 PMCID: PMC10009368 DOI: 10.1017/jme.2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Ensuring that life-saving antimicrobials remain available as effective treatment options in the face of rapidly rising levels of antimicrobial resistance will require a massive and coordinated global effort. Setting a collective direction for progress is the first step towards aligning global efforts on AMR. This process would be greatly accelerated by adopting a unifying global target - a well-defined global target that unites all countries and sectors. The proposed pandemic instrument - with its focus on prevention, preparedness and response - represents an ideal opportunity to develop and adopt a unifying global target that catalyzes global action on AMR. We propose three key characteristics of a unifying global target for AMR that - if embedded within the pandemic preparedness instrument - could rally public support, funding, and political commitment commensurate with the scale of the AMR challenge.
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