Understanding antibiotic use: practices, structures and networks

Tompson, Alice; Manderson, Lenore Hilda; Chandler, Clare I R

doi:10.1093/jacamr/dlab150

Cited by 42 publications

(32 citation statements)

References 111 publications

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“…35 Our findings add to a small but growing body of work that locates antibiotic use as emergent of political and economic structures and systems, thereby decentring behaviour as the focal point of antibiotic use trends. 42 The amoxicillin stories showed both the centrality of antibiotics to outpatient care and their persistent under-funding in LMICs not only by national governments but also the northern donors on whom public sector care in many LMICs has been rendered dependent. Thus, residents like Sisi Betty in Harare, Zimbabwe, were forced toward the informal sector in the frequent occurrence that this drug was out of stock.…”

Section: Discussionmentioning

confidence: 99%

“…Taking systems as stewards seriously means stepping outside the entrenched ‘grooves’ within which we collectively have come to operate and to design-out our reliance on antibiotics (and narrower techniques for evaluating their use) from the architecture of global healthcare. 42 50 This is a tremendous challenge and will require bold interdisciplinary collaborations, including the emerging field of implementation science 58 to develop stewardship strategies for particular LMICs. However, this is far more likely than narrow behavioural approaches to result in sustainable reductions in use both within and beyond formal prescriber settings.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

et al. 2021

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BackgroundAs concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.DesignThis article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.ResultsThe most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.ConclusionsOur findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

et al. 2021

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“…More details on how qualitative methodologies can be used in, and contribute to, the AMS/AMR research can be found elsewhere (M. Wanat, M. Santillo, A. J. Borek, C. C. Butler, S. Tonkin-Crine, ‘The value, challenges and practical considerations when conducting qualitative research on antimicrobial stewardship in primary care’, under review). 14 , 43 …”

Section: Introducing Behavioural Science and Qualitative Methodologie...mentioning

confidence: 99%

How can behavioural science contribute to qualitative research on antimicrobial stewardship in primary care?

Borek

Santillo

Wanat

et al. 2022

JAC-Antimicrobial Resistance

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Antibiotic use (and misuse) accelerates antimicrobial resistance (AMR), and addressing this complex problem necessitates behaviour change related to infection prevention and management and to antibiotic prescribing and use. As most antibiotic courses are prescribed in primary care, a key focus of antimicrobial stewardship (AMS) is on changing behaviours outside of hospital. Behavioural science draws on behaviour change theories, techniques and methods developed in health psychology, and can be used to help understand and change behaviours related to AMR/AMS. Qualitative methodologies can be used together with a behavioural science approach to explore influences on behaviour and develop and evaluate behavioural interventions. This paper provides an overview of how the behavioural science approach, together with qualitative methods, can contribute and add value to AMS projects. First, it introduces and explains the relevance of the behavioural science approach to AMR/AMS. Second, it provides an overview of behaviour change ‘tools’: behaviour change theories/models, behavioural determinants and behaviour change techniques. Third, it explains how behavioural methods can be used to: (i) define a clinical problem in behavioural terms and identify behavioural influences; (ii) develop and implement behavioural AMS interventions; and (iii) evaluate them. These are illustrated with examples of using qualitative methods in AMS studies in primary care. Finally, the paper concludes by summarizing the main contributions of taking the behavioural science approach to qualitative AMS research in primary care and discussing the key implications and future directions for research and practice.

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“…With the release of new antibiotics comes the inevitable, widespread development of resistance in target bacteria (Aslam et al, 2021). The development of resistance and other financial factors have resulted in a failure of new antibiotic discovery with only limited numbers of new compounds being developed each year (Tompson et al, 2021). This is not only an issue regarding human health, but it also affects agriculture practices (Zalewska et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Plant Natural Products as Antimicrobials for Control of Streptomyces scabies: A Causative Agent of the Common Scab Disease

et al. 2022

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The common scab disease caused by Streptomyces scabies, a soil-dwelling Gram-positive bacterium, is an economically important disease of potatoes and other tuber crops. The lack of effective treatments against this disease accounts for large economic losses globally. Plant extracts were screened to find several that effectively inhibited Streptomyces scabies growth in culture. Seven tinctures showed the greatest inhibition of S. scabies growth by reducing pathogen growth in culture by 75% or more. These extracts were myrrh, garlic, cayenne, barberry, frankincense, wild indigo root, and lavender. Myrrh extract from Commiphora myrrha, a resin made from tree sap, showed strong antibacterial activity by reducing the growth of S. scabies to 13% of the control. Additionally, a flavonoid library was screened to identify several compounds that were effective to control the pathogen growth. The flavonoids that showed the greatest inhibition of Streptomyces scabies growth were sophoraflavanone G, jaceosidin, baicalein, and quercetin. Minimum inhibitory concentrations for the effective flavonoids were calculated to be 6.8 ± 0.4 μM, 100.0 ± 2.1 μM, 202.9 ± 5.3 μM, and 285.2 ± 6.8 μM, respectively. The mean lethal doses for these flavonoids against Streptomyces scabies were 2.0 ± 0.1 μM, 22.6 ± 0.5 μM, 52.9 ± 1.3 μM, and 37.8 ± 1.0 μM, respectively. A live/dead assay showed complete cell death in the presence of sophoraflavanone G indicative of a bactericidal mechanism for flavonoid action on Streptomyces scabies. Scanning electron and transmission electron microscopy imaging showed damaged cell membrane morphologies when Streptomyces scabies was exposed to these flavonoids. Mycelia appeared as flat and deflated structures with contents seen as spewing from branching hyphae with numerous holes and tears in the membrane structure indicative of cell death. Sophoraflavanone G showed the greatest potency and potential as a natural antibiotic from the library of tested flavonoids. These results suggest that these plant compounds act on the pathogen through a bactericidal mechanism involving cell membrane destabilization and disruption leading to cell death.

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Understanding antibiotic use: practices, structures and networks

Cited by 42 publications

References 111 publications

Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

How can behavioural science contribute to qualitative research on antimicrobial stewardship in primary care?

Plant Natural Products as Antimicrobials for Control of Streptomyces scabies: A Causative Agent of the Common Scab Disease

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