Coverage of policies to improve antimicrobial stewardship in low and middle income countries: Results from the first Global Survey of Experts on Antimicrobial Resistance

Abstract

Background Antimicrobial resistance (AMR) constitutes a major threat to global health security. While antimicrobial misuse or overuse is a one of the main drivers for AMR, little is known regarding the extent to which this is due to a lack of national government-led efforts to enforce rational antimicrobial use in low and middle-income countries (LMICs). Methods To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and slowing the spread of AMR through expert’s lens, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures as reported by experts were compared to across countries and also compared to estimates collected in the 2020-21 World Health Organization organized Tripartite AMR Country Self-assessment Survey (TrACSS). Results A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR. Conclusions Gaps in the implementation and enforcement of policies to reduce the risk of AMR in many LMICs remain large. Improved monitoring of national efforts as well as increased national efforts in the areas of enforcement and monitoring of antibiotic use are urgently needed to reduce inappropriate use and overuse in LMICs and to slow the spread of AMR globally.