Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Potential Strategies to Improve Antimicrobial Utilisation in Hospitals in Bangladesh Building on Experiences Across Developing Countries

“…Antimicrobial resistance (AMR) is a growing problem worldwide, leading to increased morbidity, mortality and costs [1][2][3][4][5][6] , with the overall costs of AMR typically exceeding the costs of the different antibiotics prescribed and dispensed 7 . AMR is particularly important in lower-and middle-income countries (LMICs) as these countries have the highest burden of infectious diseases with growing rates of resistant organisms [8][9][10][11][12] . The concerns with AMR have resulted in multiple initiatives internationally, regionally and nationally, to reduce resistance rates, which include country specific National Action Plans (NAPs) [13][14][15][16][17] .…”

“…The introduction of ASPs within hospitals has appreciably reduced inappropriate antibiotic use and costs 10,67,[82][83][84][85] . In their recent review, Majumder et al (2020) discussed the nine core elements of any ASP, and how they align with the ten essential services of public health, endorsed within the Bangladesh NAP and the GARP-Bangladesh National Working Group 10,18,19 (Figure 2). A critical element of any ASP is a shared responsibility among all key stakeholders within a hospital 10 .…”

“…In their recent review, Majumder et al (2020) discussed the nine core elements of any ASP, and how they align with the ten essential services of public health, endorsed within the Bangladesh NAP and the GARP-Bangladesh National Working Group 10,18,19 (Figure 2). A critical element of any ASP is a shared responsibility among all key stakeholders within a hospital 10 . Researchers in LMICs are starting to assess adherence to national strategies in hospital facilties to further reduce AMR rates 86 , and we see this continuing.…”

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study

“…It is recommended that, to achieve the antimicrobial stewardship (AMS) goals effectively, an AMS team minimally includes contributions of either an infectious disease (ID) specialist physician, a microbiologist (if available) and a pharmacist. An ID physician supervises the overall function of the ASP and makes recommendations to the ASP team [6]. Pharmacists evaluate antibiotic consumption, participate in Drug and Therapeutics Committee [7] and AMS committee meetings [7,8].…”

Potential strategies to reduce inappropriate prescribing and dispensing of antimicrobials in Bangladesh building on the experiences in other developing countries

“…This is important with up to 80% or more of patients in LMICs receiving antibiotics unnecessarily for ARIs [21][22][23] . This over-use of antibiotics has been exacerbated by the COVID-19 pandemic [24][25][26] , with studies suggesting high rates of antibiotic utilisation, including broad spectrum antibiotics, even without proven bacterial infections [27][28][29] . Overall, less than 10% of COVID 19 patients appear to have concomitant fungal or bacterial infections necessitating antimicrobials 30 , which could be as low as 3.2% in some studies 31,32 .…”