What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review

Abstract Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least de...

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Veröffentlicht in:Journal of antimicrobial chemotherapy 2021-04, Vol.76 (5), p.1117-1129
Hauptverfasser: Lam, Thanh Tuan, Dang, Duc Anh, Tran, Huy Hoang, Do, Dung Van, Le, Hien, Negin, Joel, Jan, Stephen, Marks, Guy B, Nguyen, Thu Anh, Fox, Greg J, Beardsley, Justin
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Sprache:eng
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Zusammenfassung:Abstract Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkaa556