A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

Abstract

Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

Reducing the Risk of Transmission of Critical Antimicrobial Resistance Determinants From Contaminated Pork Products to Humans in South-East Asia

“…Antimicrobial resistance (AMR) in bacterial species and strains is a critical global threat, and has been monitored in animals, humans and the environment through international collaborations aimed at AMR reduction (Gerbin, 2014;Lechner et al, 2020;Singh et al, 2021). The main factors contributing to the emergence of AMR are overuse and misuse of antimicrobials, and the lack of quality control of antimicrobials and active pharmaceutical ingredients in the market (Simba et al, 2016;Tangcharoensathien et al, 2018;Barroga et al, 2020).…”

Educational Activities for Students and Citizens Supporting the One-Health Approach on Antimicrobial Resistance

“…Informal and formal strategies for antimicrobial stewardship are diverse and have great content; however, they are limited to the awareness and attitudes of the clinical professionals that implement them. Citizen education on resistances to antibiotics is, therefore, vital to achieve a community impact, but the provisions are quite diffuse all over the world [ 39 , 40 ]; we recommend a central or regional repository to share best practice. Educators also need better resources to communicate effectively.…”

Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

“…The goals of antimicrobial stewardship programs include improving prescription patterns for physicians and ensuring antimicrobial resistance surveillance. ASPs are currently sparse and unstructured in India, but they are gaining momentum with the support of the government [3,22]. Hospital policies on polymyxin dosing are vital in ensuring that patients are not subject to either underdosing or overdosing, which can lead to the emergence of resistance or drug toxicities, respectively.…”