Antibiotics: achieving the balance between access and excess

Hardly a week goes by without antimicrobial resistance being in the news. Increasing recognition that the problem has become a serious public health threat has prompted Presidents and Prime Ministers, together with global health leaders, to prioritise antibiotic resistance in their speeches and communiqués. 1 G7Declaration of G7 Health Ministers, G7 Germany 2015. http://www.ip-watch.org/weblog/wp-content/uploads/2015/10/G7-Health-Ministers-Declaration-AMR-and-EBOLA-final-Scan-mit-Unterschriften.pdfDate: 2015 Google Scholar The consequence has been a welcome surge of declarations, announcements, and campaigns. There is, for example, now a Global Action Plan on Antimicrobial Resistance. 2 WHOGlobal action plan on antimicrobial resistance. http://www.who.int/drugresistance/global_action_plan/en/Date: 2015 Google Scholar Antimicrobial resistance is at last fashionable. The subject has come of age. The issue of resistance, and the threat of resurgence of previously controlled infectious diseases, has the political visibility that it so desperately needed. However, this Lancet Series, Antimicrobials: access and sustainable effectiveness, 3 Laxminarayan R Matsoso P Pant S et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00474-2 Google Scholar , 4 Holmes AH Moore LSP Sundsfjord A et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00473-0 Google Scholar , 5 Mendelson M Røttingen J-A Gopinathan U et al. Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00547-4 Google Scholar , 6 Dar OA Hasan R Schlundt J et al. Exploring the evidence base for national and regional policy interventions to combat resistance. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00520-6 Google Scholar , 7 Årdal C Outterson K Hoffman SJ et al. International cooperation to improve access to and sustain effectiveness of antimicrobials. Lancet. 2015; (published online Nov 18.)http://dx.doi.org/10.1016/S0140-6736(15)00470-5 PubMed Google Scholar seeks to add an important and missing dimension to the prevailing debate about antibiotic resistance. Access to effective antimicrobials: a worldwide challengeRecent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. Full-Text PDF Understanding the mechanisms and drivers of antimicrobial resistanceTo combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is affected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Full-Text PDF Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countriesAccess to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. Full-Text PDF Exploring the evidence base for national and regional policy interventions to combat resistanceThe effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Full-Text PDF International cooperation to improve access to and sustain effectiveness of antimicrobialsSecuring access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. Full-Text PDF