Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC)

Abstract

Antimicrobial stewardship (AMS) is a set of coordinated strategies to improve the use of antimicrobials, to enhance patient outcomes, reduce antimicrobial resistance, and decrease unnecessary costs. The pioneer years of AMS were restricted to high-income countries (HIC), where overconsumption of antibiotics was associated with emergence of multidrug-resistant (MDR) bacteria. AMS in low-and middle-income countries (LMIC) is also necessary. However, programs effective in HIC may not perform as well in LMIC, because (i) While decreased consumption of antibiotics may be an appropriate target in overconsuming HIC, this may be dangerous in LMIC, where many patients die from the lack of access to antibiotics; (ii) although AMS programs in HIC can be designed and monitored through laboratory surveillance of resistance, surveillance programs are not available in many LMIC; (iii) the heterogeneity of health care systems implies that AMS programs must be carefully contextualized. Despite the need to individually tailor AMS programs in LMIC, international collaborations remain highly valuable, through the dissemination of high-quality documents and educational material, that may be shared, adapted where needed, and adopted worldwide. This process, facilitated by modern communication tools, combines many benefits, including: (i) saving time, a precious Tattevin et al. Antimicrobial Stewardship in LMIC dimension for health care workers, by avoiding the duplication of similar works in different settings; (ii) taking advantage of colleagues skills, and initiatives, through open access to the work performed in other parts of the world; (iii) sharing experiences, so that we all learn from each others' successes and failures.

Assessing the impact of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) on hospital antimicrobial stewardship programmes: results of a worldwide survey

“…Hospitals in LMIC were more often confronted with unavailability of prescribing guidelines, insufficient laboratory capacity and suboptimal use of the available laboratory services. Indeed, in addition to strengthening the microbiological laboratory capacity in LMIC, efforts should be directed at promoting diagnostic stewardship and improving the communication interface between clinicians and laboratory services [ 48 , 49 ]. Many hospitals also reported a lack of knowledge on good prescribing practices and a lack of cooperation from prescribers as key barriers to a successful AMS programme.…”

Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study

“…AMS programmes in LMICs generally encounter challenges of limited financial and physical resources available for implementation including substandard lab practices, lack of well-trained staff, insufficient opportunities for continuing professional development and difficulties in deploying prescription-based stewardship strategies. 26 27 Despite numerous challenges and limited, poor-quality evidence available, 30 effective AMS programmes can be feasible in these settings although contextualisation is essential in this implementation. 7 The need for contextualisation in LMICs was also highlighted in several qualitative and mixed-methods AMS studies.…”

“…The current status of microbiology in LMICs would not allow for a desirable level of support to AMS programmes. 26 However, improvements can be made even within resource-constrained conditions. Our study showed that simply compiling the current data and presenting the summary data in the AMS meetings has stimulated the discussions on the immediate and long-term actions to improve the problem.…”

The Need for Ongoing Antimicrobial Stewardship during the COVID-19 Pandemic and Actionable Recommendations

“…National and international advocacy as well as advocacy through civil societies is particularly important in resource-limited areas [ 60 ]. Through the effort of governmental and international collaborations to share established strategies, policies and skills; resource-limited countries may benefit from the experience of countries with existing AMS programmes.…”

“…Through the effort of governmental and international collaborations to share established strategies, policies and skills; resource-limited countries may benefit from the experience of countries with existing AMS programmes. This can provide a framework to kickstart and expand AMS programmes without unnecessary delays [ 60 ].…”