Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries
| Autor: | Chaitanya Pradeep Joshi, Karolin Hijazi, Ian M. Gould |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Decision support system 030106 microbiology Population Psychological intervention Inappropriate Prescribing Microbiology Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Resource (project management) Anti-Infective Agents Virology Humans Antimicrobial stewardship 030212 general & internal medicine Practice Patterns Physicians' Medical prescription education Developing Countries education.field_of_study business.industry Developed Countries Public relations Hospitals Infectious Diseases One Health Business Stewardship |
| Zdroj: | Expert Review of Anti-infective Therapy. 17:621-634 |
| ISSN: | 1744-8336 1478-7210 |
| DOI: | 10.1080/14787210.2019.1640602 |
| Popis: | Introduction: Inappropriate prescription practices, patient and provider knowledge and attitudes, variable availability of diagnostic and surveillance systems, and the unrestricted use of antimicrobials in animals and plants are contributory factors to the global crisis of antimicrobial resistance (AMR). Areas covered: Notwithstanding that interventions to revert AMR should be tailored to the socio-politico-economic landscape, there is a global consensus for the implementation and enhancement of antimicrobial stewardship strategies. Yet the implementation of Antimicrobial Stewardship Programs (ASPs) remains relatively limited within healthcare settings and faces complex challenges in resource-limited countries. The current review summarizes the limitations of current ASPs, translation challenges in resource-limited countries, and potential solutions. Expert opinion: Suboptimal ASP implementation in hospitals is multifactorial. Restriction of antimicrobial use should be informed by risk-benefit analyses, including the potential for substitute prescribing, and displacement of selection pressures. Thresholds in population use of antibiotics above which AMR increases may provide quantitative targets for ASPs. Horizontal and vertical collaborations involving policymakers and the general public are of paramount importance. While impactful prescribing changes require sustained engagement of the public and health-care professionals, we warn against over-estimating the benefits of behavioral interventions. We advocate for population-level stewardship interventions in addition to investment in structural factors that will aid ASP implementation. |
| Databáze: | OpenAIRE |
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