AWaRe – a new WHO tool to help countries improve antibiotic treatment, increase access and reduce resistance. We can reduce or even reverse antibiotic resistance by using antibiotics more responsi...bly. But how do we do that and still ensure that patients are treated effectively?WHO has developed a tool to help global, regional and national decision-making on which antibiotics to use when. The tool indexes the most effective antibiotics into three groups – ACCESS, WATCH, RESERVE (AWaRe for short). Evidence shows that to optimize use of antibiotics and reduce resistance, countries should increase the proportion of ACCESS antibiotics to correspond to at least 60% of total national consumption.
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Antibiotic Stewardship (AS) is a coordinated program that promotes the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance, and decrease the spread of multi-drug resistant organisms. In clinical settings, stewa...rdship activities focus on measuring and improving how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management.
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This policy brief identifies and explains the main reasons behind the rise of antimicrobial resistance (AMR) associated with improper use of antibiotics in the livestock sector. Focusing on the low- and middle- income country setting, this brief pro...vides recommendations for a deliberated policy strategy aimed to prevent healthcare crisis that could happen as a result of AMR.
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In 1998 the Swedish Veterinary Association decided to adopt a general policy for the use of antibiotics in animals. Since then specifi c policies for the use of antibiotics in dogs and cats have been adopted and in 2011 Guidelines for the use of Antibiotics in Production animals – Cattle and Pigs,... were accepted. By decision of the board of the Swedish Veterinary Society (SVS) these guidelines have been updated. Th e over-arching goal of SVS is to achieve a low and controlled use of antibiotics in Swedish animal production so that the fi rst-hand choices of treatment remain effi cient and that the spread of antimicrobial resistance – among animals and herds as well as in the food chain – is kept at a minimum. Keeping antimicrobial resistance in animals low is important also for human health, since we are all part of the same ecosystem. Th e authors of these guidelines hope that they may be useful for veteri-narians in clinical practice when deciding on treatments for common diseases and ailments caused by bacteria. Sometimes the decision may even be to refrain from use of antibiotics and chose other ways of improving herd health.
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The era of effective antibiotics is coming to a close. In just a few generations, many “miracle medicines”have been beaten into ineffectiveness by the bacteria they were intended to eradicate. Bacteria quickly adapt to the presence of antibacterial agents in order ...to survive. The misuse of antibiotics,which is an international problem, only exacerbates the steady evolution of resistance. In August 2010, the journal Lancet Infectious Diseases posed the question "Is this the end of antibiotics?" documentingthe rapid spread of multidrug-resistant bacteriaand predicting that 10 years remain in the useful life of many agents.
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As a public good, antimicrobial medicines require rational use if their effectiveness is to be preserved. However, up to 50% of antibiotic use is inappropriate, adding considerable costs to patient care, and increasing morbidity and mortality. In addition, there is compelling evidence that antimicro...bial resistance is driven by the volume of antimicrobial agents used. High rates of antimicrobial resistance to common treatments are currently reported all over the world, both in health care settings and in the community. For over two decades, the Region of the Americas has been a pioneer in confronting antimicrobial resistance from a public health perspective. However, those efforts need to be stepped up if we are to have an impact on antimicrobial resistance and want to quantify said impact.
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Nepal has only recently started its journey on the path to an integrated response to the challenge of antimicrobial resistance (AMR). Despite this, it is notable that the Nepal Health Sector Strategy Plan (HSSP)-2 mentions growing antibiotic ...lass="attribute-to-highlight medbox">resistanceas a public health challenge.
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The WHO CIA List should be used as a reference to help formulate and prioritize risk assessment and risk management strategies for containing antimicrobial resistance. The WHO CIA List supports strategies to mitigate the human... health risks associated with antimicrobial use in food-producing animals and has been used by both public and private sector organizations. The list helps regulators and stakeholders know which types of antimicrobials used in animals present potentially higher risks to human populations and how use of antimicrobials might be managed to minimize antimicrobial resistance of medical importance. The use of the WHO CIA List, in conjunction with the OIE list of antimicrobials of veterinary importance (1) and the WHO Model Lists of Essential Medicines (2) , will allow for prioritization of risk management strategies in the human sector, the food animal sector, inagriculture (crops) and horticulture, through a coordinated multisectoral One Health approach.
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WHO CIA list categorizes all antimicrobials used in human medicine into 3 groups based on their importance to human medicine. The current scope is limited to antibacterial drugs of which most are also used in veterinary medicine. The list assists in man...aging antimicrobial resistance, ensuring that all, especially critically important antimicrobials, are used prudently both in human and veterinary medicine
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La liste CIA de l’OMS catégorise tous les antimicrobiens utilisés en médecine humaine en 3 groupes, selon leur importance pour la médecine humaine. Elle se limite actuellement aux médicaments antibactériens, dont la plupart sont également employés en médecine vété...rinaire.Cette liste est destinée à aider à la gestion de la résistance bactérienne, en veillant à ce que l’ensemble des antimicrobiens, surtout ceux d’importance critique, sont utilisés prudemment aussi bien en médecine humaine qu’en médecine vétérinaire.
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Written by international experts in the fields of infection control and hospital epidemiology, the ISID’s Guide to Infection Control in the Healthcare Setting brings together the most up-to-date principles and interventions that can reduce the rate of infection and the impact of associated consequ...ences for patients, their families, and healthcare systems including: lengthier hospital stays; long-term disability; increased anti-microbial resistance; higher financial costs; and unnecessary deaths.
As the field of infection prevention grows in importance and the science supporting it continues to evolve, the Guide’s objectives are to facilitate the implementation of effective prevention and control measures across different resource levels to improve quality of care; minimize risk; save lives; reduce costs; and limit the use of antibiotics to fight these often preventable infections around the world.
The chapters herein are intended to facilitate the implementation of effective infection prevention and control measures across different resource levels, improve quality of care, minimize risk, save lives, and reduce costs.
To explore the Guide click on the sections below to view the chapters. Chapters have been divided into four parts
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The international community sits at the tipping pointof a post-‐antibiotic era, where common bacterial infections are no longer treatable with the antibiotic armamentarium that exists. In South Africa, t...he identification of the first case of pan-‐resistant Klebsiella pneumoniae(Brink et al, J Clin Microbiol. 2013;51(1):369-‐72) marks a watershed moment and highlights ourtip of the antibiotic resistance ‘iceberg’ in this country. Multi-‐drug resistant (MDR)-‐bacterial infections, predominantly in Gram-‐negative bacteria such as Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosaand Acinetobacter baumanniiare now commonplace in South African hospitals. Whilst a number of expensive new antibiotics for Gram-‐positive bacterial infections have been manufactured recently (some of which are licenced for usein South Africa), no new antibiotics active against Gram-‐negative infections are expected in the next 10-‐15years. Hence what we have now, needs conserving
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Overuse of antimicrobial agents occurs globally in both community and hospital settings. Misuse of antibiotics can lead to a variety of adverse outcomes, including the development of antimicrobial resistanceand increased cost of hospitalization.... This issuehas been particularly problematic in developing countries, where antibiotic-management programs rarely exist and where antibiotics can be purchased without aprescription. In Thailand, the rate of antibiotic resistance among gram-positive and gram-negative or-ganisms has increased significantly over the past decade. These findings provide compelling evidence ofthe need for more-rational use of antimicrobial agents in Thailand.
Clinical Infectious Diseases2006; 42:768–752006 by the Infectious Diseases Society of America.
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Improving the quality of hospital antibiotic use is a major goal of WHO’s global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship... interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.
www.thelancet.com/lancetgh Vol 7 July 2019
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In May 2015, the Sixty-eighth World Health Assembly recognized the importance of the public health problem posed by antimicrobial resistance by adopting the global action plan on antimicrobial ...medbox">resistance (“global action plan”). The global action plan proposes interventions to control antimicrobial resistance, including reducing the unnecessary use of antimicrobials in humans and in animals. The global action plan also emphasizes the need to take a cross-sectoral, “One Health” approach for controlling antimicrobial resistance, involving efforts by actors from many disciplines including human and veterinary medicine.
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Overuse and misuse of antibiotics in animals and humans is contributing to the rising threat of antibiotic resistance. Some types of bacteria that cause serious infections in humans have already developed ...ghlight medbox">resistance to most or all of the available treatments, and there are very few promising options in the research pipeline
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L’utilisation excessive ou inadaptée des antibiotiques chez l’homme et chez l’animal contribue à amplifier la menace provenant de la résistance à ces produits. Certains types de bactéries susceptibles de provoquer des infections ... graves chez les humains sont déjà devenus résistants à la plupart des traitements disponibles et très peu d’options prometteuses sont actuellement en cours de développement pour prendre le relais
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En mai 2015, en adoptant le Plan d’action mondial pour combattre la résistance aux antimicrobiens (« Plan d’action mondial »), la Soixante-Huitième Assemblée mondiale de la Santé a reconnu l’importance de cette ...attribute-to-highlight medbox">résistance en tant que problème majeur de santé publique. Le Plan propose des interventions pour lutter contre cette résistance, dont la réduction des usages inutiles d’antimicrobiens chez l’homme et chez l’animal. Il souligne aussi la nécessité d’une approche intersectorielle, « Un monde, une santé », pour endiguer cette résistance, impliquant des efforts de la part d’acteurs de nombreuses disciplines, dont les médecines humaine et vétérinaire
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Using antimicrobials responsibly is an essential component ofefforts to contain antimicrobial resistance (AMR), and to ensurethat patients receive appropriate treatment. The WHO global action plan on AMR emphasizes the importance of training healthc...are professionals in antimicrobial prescribing and stew-ardship (AMPS). There are several challenges, however, such asthe wide range of healthcare professionals involved in the pre-scribing process, and the heterogeneity of prescribing rights and practices of different professional groups within and between countries. One way to address these challenges is through developing competencies, which define the minimum standards that all antimicrobial prescribers should reach.
Clinical Microbiology and Infection 25 (2019) 13e19
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Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure optimal use of antimicrobials to improve patient outcomes, while limiting the risk of adverse events (including antimicrobial resistance (AMR)). Introduction of AMS prog...rammes in hospitals is part of most national action plans to mitigate AMR, yet the optimal components and actions of such a programme remain undetermined.
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