Global Antimicrobial Stewardship: A Closer Look at the Formidable Implementation Challenges

Abstract

Antimicrobial stewardship (AMS) has been touted as one of the key strategies required in tackling worldwide escalation of antibiotic resistance. Although AMS has optimized antibiotic usage and reduced the incidence of resistance development in some regions, its full global potential has been curtailed by various AMS-impeding factors. This article seeks to highlight in a detailed perspective, the key challenges that hamper global AMS endeavors, some of which include the paucity of effective implementation strategies that cater for the challenging settings of developing nations, the slow response of governments, uncoordinated AMS activities as well as implementation fragmentation across different sectors and countries. The authors of this article call upon all stakeholders to pay attention to these seemingly obvious but often under-addressed problems. If left unresolved, this may render all current and future AMS initiatives pointless.

The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—A systematic review

“…A study from developed countries also showed similar findings, as health practitioners reported having a limited knowledge of the local resistance patterns and viewed antibiotic resistance to be less of a problem locally than nationally . It is important to note that the use of antibiotics without adequate knowledge on local resistance patterns could contribute to irrational antibiotic use, treatment failure and increased spread of antibiotic resistance . Although infectious diseases are more common in developing countries, thus possibly leading to the more use of antibiotics compared to developed countries, the diagnoses and rationale to use antibiotics are often clinically based, with minimal laboratory investigations .…”

“…Thus, culture‐guided management of infectious diseases, as well as availability of experts in the area of infectious disease, would increase diagnostic certainty, a more rational antibiotic use, and save cost . Such efforts to streamline the use of antibiotics to promote a more rational approach are less common in developing countries when compared to developed countries …”

“…Antibiotic stewardship programmes, which have been proven to encourage rational antibiotic use, are now established in most developing countries . However, the use of such guidelines or establishment of such programmes is more difficult in developing countries due to resource limitations …”

“…7 However, the use of such guidelines or establishment of such programmes is more difficult in developing countries due to resource limitations. 8 In developed countries, inappropriate antimicrobial drug use is well described, but the use of antibiotics in developing countries is less well documented. 9 Data on the perceptions of health practitioners towards antibiotic use and resistance could provide baseline information, such as important target areas, for urgent interventions including the development of antibiotic use policies, as well as setting up and promoting the use of antibiotic stewardship programmes.…”

An Evaluation of Prescriptions Dispensed in Malaysian Community Pharmacies in the Absence of Dispensing Separation

“…It was however noteworthy that the 3 rd highest contribution to medication dispensed was antiinfective for short-term use, comprising 15 % of all medications prescribed. Considering that this study did not capture antiinfective dispensed by the physicians themselves, it is likely this is an underestimation of the true rate of antibiotic prescribing and raises the question regarding the appropriateness of antibiotic prescribing at a time where resistance continues to a major point of concern [14,15] . Indeed, it has been shown that prohibiting physicians from dispensing significantly reduces inappropriate prescriptions of antibiotics [16] .…”