Antimicrobial resistance (AMR) is a major public health challenge, which is recognized as high priority area by the Government of India. The increasing consumption of antibiotics is one of the key drivers of antimicrobial resistance seen in bugs of public health importance. Irrational prescription o...f broad-spectrum antibiotics, poor regulations around sale of antibiotics, self-medication, lack of education and awareness regarding responsible use of antibiotics have been identified as some of the key factors driving antimicrobial resistance in our country. The ‘National Health Policy’ (2017), addresses antimicrobial resistance as one of the key issues and prioritises development of guidelines regarding antibiotic use, limiting the over-the-counter use of antibiotics, restricting the use of antibiotics as growth promoters in livestock, and pharmaco-vigilance including prescription audit inclusive of antibiotic usage in the hospital and community.
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Treatment Recommendations for Adult Inpatients
S Afr Med J 2018;108(7):546-550. DOI:10.7196/SAMJ.2018.v108i7.13149
Antimicrobial stewardship programmes have been introduced worldwide in response to the rise in antimicrobial resistance. The World Health Organization has mandated each Member State to produce a plan to address this problem. We rep...ort on the organic development of an antibiotic stewardship programme in a rural regional hospital in a resource-limited setting in South Africa. This has resulted in organisational change with increased awareness, participation, monitoring and education in antibiotic stewardship throughout the hospital
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This book provides a perfect companion to BSAC’s FREE Massive Open Online Course on Antimicrobial Stewardship, which is available in English, Mandarin, Spanish, and Russian. Visit www.futurelearn.com/courses/antimicrobial-stewardship for details.
Please download the complete e-book form the websi...te (Large File 41 MB!)
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CDC’s Core Elements of Hospital Antibiotic Stewardship Programs suggests that pharmacists review antibiotic therapy that is unnecessarily duplicative, including the use of agents with overlapping spectra. The combination of two agents with anaerobic activity is unnecessary in most cases. Exception...s may include Clostridioides difficile infection, necrotizing fasciitis, and certain biliary infections.
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Scientists have known for more than half a century that patients could develop resistance to the drugs used to treat them. Alexander Fleming, who is credited with creating the first antibiotic, penicillin, in 1928, cautioned of the impending crisis while accepting his Nobel prize in 1945: “There ...is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Since then antibiotics have proved one of the most effective interventions in human medicine. Sadly, the overuse and misuse of this precious resource have brought us to a global crisis of antimicrobial resistance (AMR). To address this crisis nearly seven decades after Fleming’s lecture the first UN general assembly meeting on drug resistance bacteria was convened in September 2017.
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This guideline covers making people aware of how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse. It also includesmeasures to prevent and control infection that can stop people needing antimicrobials or spreadinginfection to o...thers. It aims to change people's behaviour to reduce antimicrobial resistance and thespread of resistant microbes.
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User GuideThe toolkit is composed of three sections: Hospital and Health System Resources - includes a readiness assessment tool, the starting point in developing or enhancing a successful Antimicrobial Stewardship Program (ASP). The tool, a checklist developed by the CDC, should be shared with se...nior management, a senior leader for quality, purchasing directors, clinic managers, nurse managers, key physician leaders, risk managers, pharmacy leaders, infection preventionists and hospital epidemiologists, laboratory staff and information technology staff. For ease of use, it is divided into two sections, one for those just beginning a program, the other for those who wish to enhance an existing program. Clinician Resources - includes webinars, clinical evidence supporting appropriate use of antibiotics, implementation guides and related articles.Patient Resources - includes frequently asked questions, pamphlets and handouts on how patients can best engage in their care and resources on appropriate use of antibiotics.
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As a public good, antimicrobial medicines require rational use if their effectiveness is to be preserved. However, up to 50% of antibiotic use is inappropriate, adding considerable costs to patient care, and increasing morbidity and mortality. In addition, there is compelling evidence that antimicro...bial resistance is driven by the volume of antimicrobial agents used. High rates of antimicrobial resistance to common treatments are currently reported all over the world, both in health care settings and in the community. For over two decades, the Region of the Americas has been a pioneer in confronting antimicrobial resistance from a public health perspective. However, those efforts need to be stepped up if we are to have an impact on antimicrobial resistance and want to quantify said impact.
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The international community sits at the tipping pointof a post-‐antibiotic era, where common bacterial infections are no longer treatable with the antibiotic armamentarium that exists. In South Africa, t...he identification of the first case of pan-‐resistant Klebsiella pneumoniae(Brink et al, J Clin Microbiol. 2013;51(1):369-‐72) marks a watershed moment and highlights ourtip of the antibiotic resistance ‘iceberg’ in this country. Multi-‐drug resistant (MDR)-‐bacterial infections, predominantly in Gram-‐negative bacteria such as Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosaand Acinetobacter baumanniiare now commonplace in South African hospitals. Whilst a number of expensive new antibiotics for Gram-‐positive bacterial infections have been manufactured recently (some of which are licenced for usein South Africa), no new antibiotics active against Gram-‐negative infections are expected in the next 10-‐15years. Hence what we have now, needs conserving
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An essential participant in antimicrobial stewardship who has been unrecognized and underutilized is the“staff nurse.”Although the role of staff nurses has not formally been recognized in guidelines for implementing and operating antimicrobial stewardship programs (ASPs) or defined in the medica...l literature, they have always performed numerous functions that are integral to successful antimicrobial stewardship. Nurses are antibiotic first responders, central communicators, coordinators of care, as well as 24-hour monitors of patient status, safety, and response to antibiotic therapy. An operational analysis of inpatient admissions evaluates these nursing stewardship activities and analyzes the potential benefits of nurses’formal education about, and inclusion into, ASPs.
Clinical Infectious Diseases - CID 2016:62 (1 January)•CLINICAL PRACTICE
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Improving the quality of hospital antibiotic use is a major goal of WHO’s global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally.... We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.
www.thelancet.com/lancetgh Vol 7 July 2019
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Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure optimal use of antimicrobials to improve patient outcomes, while limiting the risk of adverse events (including antimicrobial resistance (AMR)). Introduction of AMS programmes in hospitals is part of most national action... plans to mitigate AMR, yet the optimal components and actions of such a programme remain undetermined.
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Barbados currently has a rudimentary framework and capacity to address the issue of antimicrobial resistance. There however needs to be coordination of efforts and improvement in areas where gaps have been identified.Actions required include improved antibiotic stewardship in healthcare settings, pr...evention of the spread of drug-resistant organisms//bacteria, elimination of the use of medically-important antibiotics for growth promotion in food animals, and expanded surveillance for drug-resistant bacteria in humans and animals.
The National Action Plan will provide the roadmap to guide Barbados in the effort to address the urgent and serious threat of AMR and will be organized around three goals for collaborative action.
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Antimicrobial resistance (AMR) surveillance plays an important role in the early detection of resistant strains of public health importance and prompt response to outbreaks in hospitals and the community. Surveillance findings are needed to inform medical practice, antibiotic stewardship, and policy... and interventions to combat AMR. Appropriate use of antimicrobials, informed by surveillance, improves patients’ treatment outcomes and reduces the emergence and spread of AMR. This protocol describes the steps and procedures to establish/enhance AMR surveillance in Latin America and the Caribbean.
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The toolkit provides guidance on where to get started, including the structures and resources that should be put in place at the national and health-care facility level, through a stepwise approach in low-resource settings. As the ultimate goal of an AMS programme is sustainable behaviour change in ...physicians’ antibiotic prescribing practices, the toolkit also provides detailed guidance on how to plan, perform and assess AMS interventions – including feedback on antibiotic use over time. Finally, the toolkit provides an overview of the competencies an AMS team needs to guide health-care professionals in changing their antibiotic prescribing behaviours.
Please note that this course is part of a training package, so please register for the complementary course WHO Policy Guidance on Integrated Antimicrobial Stewardship Activities so that you can complete your learning journey.
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The publication of the of the Antimicrobial Treatment Guidelines represents the
culmination of the efforts of the Antimicrobial Stewardship Program of ICMR to publish treatment guidelines for common syndromes in India. These guidelines are targeted for the health care settings. It aims to rationali...ze the usage of antibiotics on our Essential Medicines Formulary (EMF) and to establish consistency in the treatment of various infectious conditions.
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Antimicrobial resistance (AMR) as a serious public health threat was globally acknowledged by WHO in 2015, through the launch of the Global Action Plan (GAP). With a limited number of new antibiotics in the developmental pipeline, many countries are in the process of establishing strategies for anti...microbial stewardship (AMS). Within each country, different healthcare challenges have
contributed to AMR. This has also shaped individual AMS strategies and policies. In South Africa (SA), there is a high burden of infectious diseases, mainly of bacterial origin. In addition, SA also has the highest number of people living with
human immunodeficiency virus (HIV) globally. According to the 2019 statistics, there are approximately 7.97 million people living with HIV in SA. Together with this, SA has the fourth largest tuberculosis population globally.
Other important challenges include poverty, malnutrition, a high burden of non-communicable diseases, and a dire shortage of trained healthcare professionals (e.g. clinicians, pharmacists, and nurses).
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Antimicrobial resistance (AMR) is one of the world’s top 10 public health threats. The World Health Organization (WHO) in the African Region, using the Antimicrobial Stewardship assessment tool, has assessed Member States progress on strengthening national capacity need for effective implementatio...n of antimicrobial stewardship interventions to mitigate the threat posed by AMR. The African Region bears the bulk of the global burden of AMR, which drives up health care costs and the increases the economic burden on families and societies. Ultimately, this puts the achievements of modern medicine at risk when infections can no longer be treated with first-line antibiotics. In 2019, the deaths associated with and those directly attributable to bacterial resistance were estimated around 4.95 million and 1.27 million respectively. Left unchecked, deaths from drug resistant infections will surpass the predicted annual death toll of 10 million by 2050.
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Most of the global burden of sepsis occurs in low- and middle-income countries (LMICs), but the prevalence and etiology of sepsis in LMICs are not well understood. In particular, the lack of laboratory infrastructure in many LMICs has historically precluded an assessment of the pathogens leading to ...sepsis. A recent systematic review found that data describing antimicrobial resistance were absent for 43% of countries in Africa, and only two countries have national antimicrobial resistance plans. In addition, small studies have identified indiscriminate antibiotic use both in and out of hospital settings in sub-Saharan Africa. The absence of microbiological data and lack of antibiotic stewardship complicate sepsis management and almost certainly worsens outcomes, particularly in low-resource systems. The purpose of this study was to examine the prevalence, etiology, and outcomes of sepsis among a cohort of critically ill patients in a referral hospital of Malawi, with a focus on the prevalence of culture-confirmed bacteremia and urinary tract infections.
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