Managing Sustainable Use of Antibiotics—The Role of Trust

From ignorance to awareness: Quality of collaborative governance enhances public awareness of AMR

In representative democracies, the public administration plays a pivotal role in managing a myriad of public policies. While considerable knowledge exists regarding how public issue awareness influences political competition before policy enactment, its persistence in the administrative aftermath is characterized by much more uncertainty. This study addresses this puzzle within the challenging context of antimicrobial resistance (AMR) governance in Europe, posing the question: How does administrative governance shape public AMR awareness? Drawing on newly collected expert survey data from all EU member states and a recent Eurobarometer survey measuring behavioral aspects related to AMR (N = 26.502), the findings show that different aspects of administrative governance yield mixed results. Notably, there is a strong and positive relationship between the quality of collaborative governance and public awareness. These results underscore the critical role of administrative governance quality in understanding public behavior, particularly in the context of combating AMR.

Growth suppression of bacteria by biofilm deterioration using silver nanoparticles with magnetic doping

Decades of antibiotic use and misuse have generated selective pressure toward the rise of antibiotic-resistant bacteria, which now contaminate our environment and pose a major threat to humanity. According to the evolutionary "Red queen theory", developing new antimicrobial technologies is both urgent and mandatory. While new antibiotics and antibacterial technologies have been developed, most fail to penetrate the biofilm that protects bacteria against external antimicrobial attacks. Hence, new antimicrobial formulations should combine toxicity for bacteria, biofilm permeation ability, biofilm deterioration capability, and tolerability by the organism without renouncing compatibility with a sustainable, low-cost, and scalable production route as well as an acceptable ecological impact after the ineluctable release of the antibacterial compound in the environment. Here, we report on the use of silver nanoparticles (NPs) doped with magnetic elements (Co and Fe) that allow standard silver antibacterial agents to perforate bacterial biofilms through magnetophoretic migration upon the application of an external magnetic field. The method has been proved to be effective in opening micrometric channels and reducing the thicknesses of models of biofilms containing bacteria such as Enterococcus faecalis, Enterobacter cloacae, and Bacillus subtilis. Besides, the NPs increase the membrane lipid peroxidation biomarkers through the formation of reactive oxygen species in E. faecalis, E. cloacae, B. subtilis, and Pseudomonas putida colonies. The NPs are produced using a one-step, scalable, and environmentally low-cost procedure based on laser ablation in a liquid, allowing easy transfer to real-world applications. The antibacterial effectiveness of these magnetic silver NPs may be further optimized by engineering the external magnetic fields and surface conjugation with specific functionalities for biofilm disruption or bactericidal effectiveness.

Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population

Prior studies indicate prevalence of unregulated non-prescription use of antibiotics also in the northern European countries. The aim of this study is to investigate the extent to which antibiotics are acquired without prescription in Sweden, and people's attitudes and motives linked to this practice. We use data from an online survey of a representative sample of the Swedish general population which included questions about respondents' antibiotic use, attitudes towards antibiotics, health care contacts, self-rated health and trust in health care. We also asked about their reason for obtaining/not obtaining antibiotics without a prescription. The results show that, in the last five years, 2,3% of the respondents had acquired antibiotics in other ways than from a Swedish physician having issued a prescription, and 4,3% reported that they are likely to do so in the future. We also show that the two most important reasons for non-prescription acquisition were physicians' refusal to prescribe antibiotics followed by travel abroad. The most important reason for not obtaining antibiotics without a prescription was to not contribute to antibiotic resistance. Using logistic regression, we show that non-prescription acquisition of antibiotics, and the intention to engage in this practice in the future, are strongly associated with low trust in health care.

Comparing public attitudes, knowledge, beliefs and behaviours towards antibiotics and antimicrobial resistance in Australia, United Kingdom, and Sweden (2010-2021): A systematic review, meta-analysis, and comparative policy analysis

BACKGROUND

Social and behavioural drivers of inappropriate antibiotic use contribute to antimicrobial resistance (AMR). Recent reports indicate the Australian community consumes more than twice the defined daily doses (DDD) of antibiotics per 1000 population than in Sweden, and about 20% more than in the United Kingdom (UK). We compare measures of public knowledge, attitudes and practices (KAP) surrounding AMR in Australia, the UK and Sweden against the policy approaches taken in these settings to address inappropriate antibiotic use.

METHODS

National antimicrobial stewardship policies in Australia, Sweden, and the UK were reviewed, supplemented by empirical studies of their effectiveness. We searched PubMed, EMBASE, PsycINFO, Web of Science and CINAHL databases for primary studies of the general public's KAP around antibiotic use and AMR in each setting (January 1 2011 until July 30 2021). Where feasible, we meta-analysed data on the proportion of participants agreeing with identical or very similar survey questions, using a random effects model.

RESULTS

Policies in Sweden enact tighter control of community antibiotic use; reducing antibiotic use through public awareness raising is not a priority. Policies in the UK and Australia are more reliant on practitioner and public education to encourage appropriate antibiotic use. 26 KAP were included in the review and 16 were meta-analysable. KAP respondents in Australia and the UK are consistently more likely to report beliefs and behaviours that are not aligned with appropriate antibiotic use, compared to participants in similar studies conducted in Sweden.

CONCLUSIONS

Interactions between public knowledge, attitudes and their impacts on behaviours surrounding community use of antibiotics are complex and contingent. Despite a greater focus on raising public awareness in Australia and the UK, neither antibiotic consumption nor community knowledge and attitudes are changing significantly. Clearly public education campaigns can contribute to mitigating AMR. However, the relative success of policy approaches taken in Sweden suggests that practice level interventions may also be required to activate prescribers and the communities they serve to make substantive reductions in inappropriate antibiotic use.

Accounting for variation in and overuse of antibiotics among humans

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

Who is willing to stay sick for the collective? - Individual characteristics, experience, and trust

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We study attitudes towards antibiotics and antibiotic resistance.

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We analyze results from a novel web-survey of Swedish citizens (n = 1906).

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Acceptability of doctor's decision not to prescribe antibiotics was found to be large.

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Trust in the healthcare sector is linked to acceptability of doctor's decision.

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Concern about antibiotic resistance is linked to willingness to limit antibiotic use.

Forming a successful public health collaborative: A qualitative study

BACKGROUND

Coordinated approaches are needed to optimally control the spread of resistant organisms across facilities that share patients. Our goal was to understand social tensions that may inhibit public health-led community partnerships and to identify factors for success.

METHODS

A collaborative to control transmission of multidrug-resistant organisms (MDROs) was formed in Utah following a regional outbreak, with members from public health, hospitals, laboratories, and transport services. We conducted and qualitatively analyzed 3 focus groups among collaborative stakeholders to discuss their experiences.

RESULTS

Via 3 focus groups and additional interviews, we found the collaborative made institutional tensions between stakeholders explicit. We identified 4 factors that facilitated the ability to overcome institutional tensions: public health leadership to establish a safe space, creation of cross-institutional group identity with mutual respect and support, standardized communication, and group cohesiveness through shared mental models of interdependencies.

DISCUSSION

Stakeholders' concerns regarding being blamed for MDRO transmission versus contributing to shared health care community MDRO control efforts resembled a "prisoner's dilemma." Four social components mitigated tensions and facilitated cooperation in this public health-led collaborative.

CONCLUSIONS

This study identified strategies that public health-led coordinated approaches can use to facilitate cooperation.