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Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

Van Katwyk, S. R.; Grimshaw, J. M.; et al (2019) C2

BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc...e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. more

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Climate change and communicable diseases: a manual for health workers

World Health Organization. Regional Office for Europe (2011) C_WHO

There is a broad consensus nowadays that the Earth is warming up as a result of greenhouse gas emissions caused by anthropogenic activities. It is also clear that current trends in the fields of energy, development and population growth will lead to continuous and ever more dramatic climate change. ... more

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Guidance to facilitate monitoring and evaluation for antimicrobial resistance national action plans

Quadripartite: Food and Agriculture Organization of the United Nations FAO; UN Environment Programme UNEP; World Health Organization WHO; World Organisation for Animal Health WAHO (2023) CC

Antimicrobial resistance (AMR) is a global human, animal, plant and environment health threat that needs to be addressed by every country. The impacts of AMR are wide-ranging in terms of human health, animal health, food security and safety, environmental effects on ecosystems and biodiversity, and ...socioeconomic development. Just like the climate crisis, AMR poses a significant threat to the delivery of the 2030 Agenda for Sustainable Development. The response to the AMR crisis has been spearheaded through the global action plan on antimicrobial resistance (GAP-AMR), developed by the World Health Organization (WHO) in 2015, in close collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH), and formally endorsed by the three organizations’ governing bodies and by the Political Declaration of the high-level meeting of the United Nations General Assembly on AMR in 2016. In 2022, the three organizations officially became the Quadripartite by welcoming the United Nations Environment Programme (UNEP) into the alliance “to accelerate coordination strategy on human, animal and ecosystem health”. The aim of the GAP-AMR is to ensure the continuity of successful treatment with effective and safe medicines. Its strategic objectives include: • improving the awareness and understanding of AMR; • strengthening the knowledge and evidence base through surveillance and research; • reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures; optimizing the use of antimicrobial medicines in human and animal health; and • developing the economic case for sustainable investment that takes account of the needs of all countries and increasing investment in new medicines, diagnostic tools, vaccines and other interventions. With the adoption of the GAP-AMR, countries agreed to develop national action plans (NAPs) aligned with the GAP-AMR to mainstream AMR interventions nationally. Individually, the Quadripartite took action to advance AMR interventions in their respective sectors. FAO adopted a resolution on AMR recognizing that it poses an increasingly serious threat to public health and sustainable food production, and developed an AMR action plan to support the resolution’s implementation. For its part, WOAH developed a strategy on AMR aligned with the GAP-AMR, acknowledging the importance of a One Health approach to AMR. Similarly, more recently, UNEP’s governing body, the United Nations Environment Assembly, recognized that AMR is a current and increasing threat and a challenge to global health, food security and the sustainable development of all countries, and welcomed the GAP-AMR and the NAPs developed in accordance with its five overarching strategic objectives more

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Tackling Drug-Resistant Infections Globally: Final Report and Recommendations

The Review on Antimicrobial Resistance (2016) CC

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Antimicrobial resistance

World Health Organization; Food and Agriculture Organization of the United Nations (2016) C_WHO

A manual for developing national action plans.This manual for developing national action plans to address antimicrobial resistance has been developed at the request of the World Health Assembly to assist countries in the initial phase of developing new, or refining existing national action plans in ... more

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Antimicrobial Resistance Global Report on Surveillance
recommended

World Health Organization (WHO) (2014) C_WHO

The report focuses on antibacterial resistance (ABR) in common bacterial pathogens. There is a major gap in knowledge about the magnitude of this problem. Antimicrobial resistance (AMR) threatens the effective revention and treatment of an ever-increasing range of infections caused by bacteria, para... more

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Factsheet for experts - Antimicrobial resistance

European Centers for Disease Control and Prevention ECDC (2019) CC

Nosocomial infections and antimicrobial resistance are two special health issues listed in Annex 1 of Commission Decision 2000/96/EC of 22 December 1999 on the communicable diseases to be progressively covered by the Community network under Decision No 2119/98/EC of the European Parliament and of th... more

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Situational Analysis of Antimicrobial Use and Resistance in Humans and Animals in Zimbabwe

The Center for Disease Dynamics, Economics & Policy CDDEP (2017) C2

This situation analysis has gathered information about the current state of AMR, contributing factors and antimicrobial use in Zimbabwe from the human, animal, agricultural and environmental sectors. Data has been gathered from different sectors such as the general public, academia, the Ministry of ... more

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Iraq Action Plan of Antimicrobial Resistance (2018-2022)

Ministry of Health Environment & Ministry of Agriculture Iraq (2019) C_WHO

Following the high-level meeting of the UN General Assembly on antimicrobial resistance held in September 2016 which called for national, regional and international political commitment to address the issue, member countries agreed on the importance of moving forward to develop national action plans... more

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Take responsibility for your health. Comic strip vol.1

Ecumenical Pharmaceutical Network (2015) C1

Tackling antimicrobial resistance- a story of a community playing its part. This first volume of comic strips is titled "tackling antimicrobial resistance: a story of a community playing its part". It basically contains messages tailored for individuals at the grassroot.

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South African Antimicrobial Resistance National Strategy Framework. A One Health Approach 2018 – 2024

Dept. of Health ; Dept of Agriculture, Forestry & Fisheries, South Africa (2018) C1

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National Action Plan for Containment of Antimicrobial Resistance: Myanmar 2017-2022

World Health Organization WHO (2017) C_WHO

Myanmar, as a country going through rapid socio-political transition and institutional development also suffers with a high burden of infectious disease. An ongoing challenge has been to effectively reach its 51 million population, most of whom battle tuberculosis, acute respiratory infections, diar... more

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Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach & Governance

Ministerial Advisory Committee on Antimicrobial Resistance National Dept. of Health, South Africa (2017) C2

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Analysis of the challenges in implementing guidelines to prevent the spread of multidrug-resistant gram-negativs in Europe

Evelina Tacconelli, Michael Buhl, Hilary Humphreys et al. (2019) C2

The global increase of healthcare-associated infections (HAI) presents a growing concern in healthcare worldwide. According to the European Centre for Disease Prevention and Control (ECDC), the annual number of HAI exceeds 2.6million and produces the highest estimated amou... more

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Resource mobilisation for Antimicrobial Resistance (AMR): Getting AMR into plans and budgets of government and development partners / Nigeria country level report

World Health Organization WHO (2018) C_WHO

The most significant finding of the case study for integrating antimicrobial resistance (AMR)into existing programs and mobilising resources for funding in Nigeria, is that most of the AMR activities within the Nigerian National Action Plan (NAP)canalready be incorporated within exi... more

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Infection prevention, control and surveillance: Limiting the development and spread of drug-resistance

O’Neill, J. Review on Antimicrobial Resistance (2016) C1

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Antimicrobial Resistance in the Western Pacific Region. A Review of Surveillance and Health Systems Response

World Health Organization WHO Western-Pacific Region (2015) C_WHO

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Standing up for patients' health. Comic strip vol.2

Ecumenical Pharmaceutical Network (2015) C1

This volume is specifically meant for health professionals. It is titled "tackling microbial resistance: a story of health professionals playing their part".

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Take responsibility for your health. Comic strip vol.3

Ecumenical Pharmaceutical Network (2015) C1

Like the first volume, this one contains messages for the community but they are presented in a different version.

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The World Medcines situation 2011 Rational use of Medicines

World Health Organization WHO (2011) C_WHO

Millennium Development Goal 8E aims for affordable access to essential medicines. Essential medicines, as defined by WHO, are those that “satisfy the health-care needs of the majority of the population” and that should therefore “be available at all times in adequate amounts”. However, there... more

Antimicrobial Resistance Global Report on Surveillance recommended

Antimicrobial Resistance Global Report on Surveillance
recommended