ICIUM 2004 AMR track summary

1. ICIUM 2004 AMR track summary Rapporteurs Thomas Sorensen, Kurien Thomas, Stephan Harbath, Urmila Thatte, Mohan Joshi, Sally Pearson Track Coordinators Kathleen Holloway, Visanu Thamlikitkul

2. What have we learnt based on evidence (1) ? • AMR is a major world-wide problem • promoted by poor infection control and irrational AB use and compounded by the lack of approp. diagnostic tools • not given sufficient priority in the health political agenda • needs multidisciplinary multisectoral approach • standard methodology needed to monitor and compare antimicrobial resistance and use over time • to provide the evidence for advocacy at global, national and local levels • surveillance is more sustainable than RCT to evaluate policy impact • very difficult in resource poor setting

3. What have we learnt based on evidence (2) ? • High irrational antimicrobial use in pharmacies and by non-trained drug sellers is a serious problem • few studies done and data collection may be difficult • surrogate client visits good method • regulation accompanied by education can be effective in changing behaviour resource poor settings • Targeted interventions can change antimicrobial use behaviour at local and national levels • in private pharmacies, communities, schools, children • if they are multi-component & involve all stakeholders • there are no competing financial incentives

4. Recommendations for immediate policy (1) • Develop targeted multi-component interventions • appropriate to the health care system and regulatory framework • to include monitoring and feedback of antimicrobial use and infection control through formal organisations • High priority areas to contain AMR • address infection control in hospitals particularly hand hygiene practices and the use of invasive devices • develop and implement guidelines on antimicrobial surgical prophylaxis in hospitals • antimicrobial use by drug sellers through interventions that do not compromise retailer profits nor patient access • Develop regulatory approaches to reserving certain antimicrobials in order to prevent misuse and lengthen useful life

5. Recommendations for immediate policy (2) • Start the process of including AMR containment in the UG and CME/CPD curricula • Promote DTCs as a way of improving hospital and primary health care practices • Establish time series surveillance programs especially by countries with sufficient infrastructure • Examine the impact of community interventions • small interventions on the wider population • one-time educational interventions • the greater effectiveness of a child as novel educator • Encourage knowledge transfer between countries • Labs participating in surveillance should all participate in external QA

6. Recommendations for long-term policy (1) • programs and interventions should be long-term and multi-disciplinary and multi-sectoral • equitable national, regional and local responsive approaches are needed • based on longitudinal data • continuously supported • interventions tailored to the local situation • manage financial incentives to prescribers and drug sellers to improve use of antibiotics • reduce perverse incentives and increase positive ones • include AMR containment in UG & PG curricula

7. Recommendations for long-term policy (2) • Compare the effectiveness of behavioural versus regulatory change interventions in different settings • Involve the private sector and pharmaceutical sector in containing AMR • Ensure surveillance data is used for action • Develop consumer empowerment methods based on pilot successes • Identify effective sustainable interventions that can be scaled up • Expand surveillance systems to include non-human use

8. Key research questions (1) • What is the burden of disease and costs of AMR? • What is the cost-effectiveness of interventions to contain AMR? • How can we assess the impact of non-human use on AMR? • What are the best regimens for safety, efficacy and minimal resistance? • Can a locally-based surveillance system be implemented and maintained? • What indicators do we need for evaluating surveillance systems and the impact of interventions on AMR? • What are the best ages and their impact within and outside the family group for transmitting AMR messages?

9. Key research questions (2) • What are the best ways to involve industry? • How do we identify determinants of excess antimicrobial use and high resistance? • Can we link improved infection control and improved antimicrobial use to reduced resistance? • What would be an effective system-wide approach to achieve sustainable behaviour change in drug sellers? • Which near-patient rapid diagnostic tests could impact on AMR? • Demonstrate that antimicrobial overuse can be safely reduced without harming patients • What is the lower limit of AB prescribing?