What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review

Abstract

Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.

Overview and Evaluation of Existing Guidelines for Rational Antimicrobial Use in Small-Animal Veterinary Practice in Europe

“…In people, the ability of ASGs to cause a decrease in AMU without adversely affecting patient outcome has been established in low-and middle-income countries as well as in hospital inpatient and outpatient settings in the USA [83][84][85]. Few studies have described the adherence to guidelines and/or the effect of guidelines on antimicrobial prescription habits among small-animal veterinarians.…”

Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka

“…Future intervention efforts, therefore, need to be multifaceted to improve both antibiotic supply by health professionals and appropriate use by people. Although there are limited studies conducted in LMICs to evaluate educational interventions to improve appropriate antibiotic use in the community setting, a systematic review showed promising effects of multifaceted educational interventions in LMICs [53].…”

Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies

“…These tools can improve the knowledge translation from the guidelines to the physicians [ 40 ]. Interprofessional education, continuing professional development, or multifaceted, education-focused interventions are other proposals to improve adherence to recommendations [ 41 , 42 ]. A post-intervention analysis would then be appropriate to measure the effects of this intervention.…”