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Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

Van Katwyk, S. R.; Grimshaw, J. M.; et al (2019) C2

BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc...e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. more

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WHO guidelines on use of medically important antimicrobials in food-producing animals

World Health Organization WHO (2017) C_WHO

These guidelines present evidence-based recommendations and best practice statements on use of medically important antimicrobials in food-producing animals, based on the WHO list of critically important antimicrobials for human medicine (WHO CIA List). These guidelines aim primarily to help preserve... more

Monitoring global progess on addressing AMR

World Health Organization WHO (2018) C_WHO

The global tripartite self-assessment survey of country progress in addressing antimicrobial resistance (AMR) is a component of a broader approach for monitoring and evaluation of the global action plan on AMR. This report analyses the results of the second tripartite self-assessment survey

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Tunisie Plan National de Lutte contre l'Antibioresistance 2019-2023

République Tunienne - Ministére de la santé Food and Agriculture Organization of the United Nations FAO and World Health Organization WHO (2019) C_WHO

L'antibiorèsistance constitue actuellment un problème de santè puplique en Tunisie. En effet, depuis une quinzaine d'anneés, notre pays fait face á un accroissment global des rèsistances bactériennes aux agents antimicrobiens. Ce phénoméne qui concerne également la majorité des pays, est ... more

Recommendations for Implementing Antimicrobial Stewardship Programs in Latin America and the Caribbean: Manual for Public Health Decision-Makers

Pan American Health Organization PAHO (2018) C2

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... more

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Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Hsia Y., B. R Lee, A. Versporten, et al The Lancet (2019) C2

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.... more

Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV
recommended

World Health Organization WHO (2020) C_WHO

Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. This disease is highly endemic in some regions of North America, Central America, and South America and is also reported in certain countries of Asia and Africa. It often affects people with impaired immunity, including people ... more

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Recent Advances in the Management Strategies for Buruli Ulcers

Popa G.; Muntean Al., Popa M. (2023) CC

Buruli ulcer (BU) is a bacterial skin infection that is caused by Mycobacterium ulcerans and mainly affects people who reside in the rural areas of Africa and in suburban and beach resort communities in Australia.

Guidelines Infeksi Saluran Kemih

Indonesian Urological Association (2007) C1

Guidelines for Therapy and Management of Urinary Tract Infection

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Rapid clinical advice

Sentinel Project (2016) C2

The use of Delamanid and Bedaquiline for Children with Drug-Resistant Tuberculosis.

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Diagnostics to support the eradication of yaws—Development of two target product profiles

Fongwen, N.; Handley, B.; Martin, D. et al. PLoS Neglected Tropical diseases (2022) CC

Yaws is targeted for eradication by 2030, using a strategy based on mass drug administration (MDA) with azithromycin. New diagnostics are needed to aid eradication. Serology is currently the mainstay for yaws diagnosis; however, inaccuracies associated with current serological tests makes it difficu... more

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Antibiotic Use for Sepsis in Neonates and Children: 2016 Evidence Update

Fuchs A., J. Bielickia, S. Mathur, et.al. World Health Organization (2016) C_WHO

Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries (LMIC) [1]. Hospital infection also remains a major cause of mortality in children despite progress encountered in the last decades.

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Serious Childhood Problemes in Countries Limited Resources

WHO (2004)

Background book on Management of the Child with a Serious Infection or Severe Malnutrition

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Global update on HIV treatment 2013: Results, impact and opportunities

World Health Organization; UNICEF; UNAIDS (2013)

Chapter 1 provides new data on the latest developments in the global treatment effort, highlighting positive trends as well as aspects that require improvement. Chapter 2 summarizes the impact of the scale-up in reducing AIDS-related mortality and new HIV infections. Chapter 3 examines the sequence ... more

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Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Panel on Antiretroviral Guidelines for Adults and Adolescents Department of Health and Human Services (2019) C2

Provide guidance to HIV care practitioners on the optimal use of antiretroviral (ARV) agents for the treatment of HIV infection in adults and adolescents.

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The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings

Centers for Disease Control and Prevention CDC (2018) C_CDC

Antibiotic stewardship refers to coordinated efforts and activities that seek to measure and improve use of antibiotics. Implementation of ASPs has demonstrated positive public health and clinical impacts including reducing costs, lengths of hospital stays, and the burden of antibiotic resistance wh... more

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National Guidelines for the Management of Viral Hepatitis

Spearman, CWN; MW Sonderup, Y Pillay et al. National Department of Health South Africa (2020) CC

Viral hepatitis is defined as inflammation of the liver cells due to viral infection. The burden of liver disease in South Africa is mostly underestimated as viral hepatitis, in particular chronic infection, is a silent and neglected cause of morbidity and mortality. However, the burden of disease i... more

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Technology and Market Landscape Hepatitis C Medicines, August 2017
recommended

A.Hill, T. Swan and K.Timmermans World Health Organisation (WHO); UNITAID (2017) C_WHO

Direct acting antivirals (DAAs) have revolutionized treatment for hepatitis C. Combi- nations of DAAs can cure infection with HCV in 12 weeks, are highly effective and have limited side-effects. Affordability of DAAs has improved significantly, but access remains lim- i... more

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Implementing the SAFE Strategy for Trachoma Control

Center for Disease Control and Prevention CDC (2006) CC

Trachoma causes more vision loss and blindness than any other infection in the world. This disease is caused by Chlamydia trachomatis bacteria. Other variants or strains of these bacteria can cause a sexually transmitted infection (chlamydia) and disease in lymph nodes. This is photomicrograph ... more

WHO Guidelines for Malaria- 14 March 2023

World Health Organisation (WHO) (2023) C_WHO

The conditionality of this recommendation is largely driven by the current higher unit cost of pyrethroid-PBO ITNs compared to pyrethroid-only LLINs and therefore the uncertainty of their cost-effectiveness. Furthermore, as PBO is less wash-resistant than pyrethroids, its bioavailability declines ... more

Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV recommended

Technology and Market Landscape Hepatitis C Medicines, August 2017 recommended

Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV
recommended

Technology and Market Landscape Hepatitis C Medicines, August 2017
recommended