scholarly journals Unsafe “crossover-use” of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action

2021 ◽  
Author(s):  
Kayley D. McCubbin ◽  
John W. Ramatowski ◽  
Esther Buregyeya ◽  
Eleanor Hutchinson ◽  
Harparkash Kaur ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Focus Group ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
Regulatory Action ◽  
Health Concern ◽  
Drug Shop ◽  
Human Consumption ◽  
Human Use

AbstractSince the introduction of antibiotics into mainstream health care, resistance to these drugs has become a widespread issue that continues to increase worldwide. Policy decisions to mitigate the development of antimicrobial resistance are hampered by the current lack of surveillance data on antibiotic product availability and use in low-income countries. This study collected data on the antibiotics stocked in human (42) and veterinary (21) drug shops in five sub-counties in Luwero district of Uganda. Focus group discussions with drug shop vendors were also employed to explore antibiotic use practices in the community. Focus group participants reported that farmers used human-intended antibiotics for their livestock, and community members obtain animal-intended antibiotics for their own personal human use. Specifically, chloramphenicol products licensed for human use were being administered to Ugandan poultry. Human consumption of chloramphenicol residues through local animal products represents a serious public health concern. By limiting the health sector scope of antimicrobial resistance research to either human or animal antibiotic use, results can falsely inform policy and intervention strategies. Therefore, a One Health approach is required to understand the wider impact of community antibiotic use and improve overall effectiveness of intervention policy and regulatory action.

scholarly journals Antimicrobial Resistance and Environmental Health: A Water Stewardship Framework for Global and National Action

Antibiotics ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 63
Author(s):  
Rachel A. Kaiser ◽  
Lina Taing ◽  
Himesh Bhatia
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
World Health ◽  
Low Income Countries ◽  
Environmental Drivers ◽  
Environmental Waters ◽  
Health Crisis ◽  
Environmental Objectives

Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship.

scholarly journals Knowledge, Attitudes and Practices of Veterinarians Towards Antimicrobial Resistance and Stewardship in Nigeria

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 453
Author(s):  
Usman O. Adekanye ◽  
Abel B. Ekiri ◽  
Erika Galipó ◽  
Abubakar Bala Muhammad ◽  
Ana Mateus ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Action Plan ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Health Concern ◽  
Attitudes And Practices ◽  
Laboratory Services ◽  
Knowledge Attitudes And Practices

Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner’s inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.

scholarly journals Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

2021 ◽  
Author(s):  
ESF Orubu ◽  
A Najwa ◽  
C Ching ◽  
S Bu Jawdeh ◽  
J Anderson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Low Cost ◽  
Antibiotic Use ◽  
Current Status ◽  
War Wounds ◽  
Low Income Country ◽  
Antimicrobial Sensitivity ◽  
Important Solution ◽  
Amoxicillin Clavulanate

AbstractAntimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multi-faceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last five years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices and stewardship in Yemen, supported by a non-systematic scoping literature review and a key informant interview. Participants (96%, n=57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), Antimicrobial Sensitivity Tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of low-cost AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

73 Antimicrobial Resistance, Agriculture, and the One Health Continuum

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 40-40
Author(s):  
Ed Topp
Keyword(s):  
Antimicrobial Resistance ◽  
Direct Contact ◽  
One Health ◽  
Animal Health ◽  
Health Concern ◽  
Health And Wellness ◽  
Transdisciplinary Approach ◽  
Health Concept ◽  
The One

Abstract The One Health concept specifies that the microbiomes of humans and animals are connected, both through direct contact, and indirectly through the environment. Managing the flow of microorganisms of human or animal health concern across the One Health continuum requires a transdisciplinary approach to address problems at the intersection of people, animals, and their environments. This presentation will use the management of antimicrobial resistance as an example of how a One Health approach can identify and develop solutions to improve the health and wellness of people, animals, and the environment.

scholarly journals Emergence and evolution of antimicrobial resistance genes and mutations in Neisseria gonorrhoeae

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Koji Yahara ◽  
Kevin C. Ma ◽  
Tatum D. Mortimer ◽  
Ken Shimuta ◽  
Shu-ichi Nakayama ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Neisseria Gonorrhoeae ◽  
Acquired Resistance ◽  
Antibiotic Use ◽  
Health Concern ◽  
Fluoroquinolone Resistance ◽  
Resistance Mutations ◽  
Treatment Regimens ◽  
Antimicrobial Resistance Genes ◽  
Sequence Types

Abstract Background Antimicrobial resistance in Neisseria gonorrhoeae is a global health concern. Strains from two internationally circulating sequence types, ST-7363 and ST-1901, have acquired resistance to third-generation cephalosporins, mainly due to mosaic penA alleles. These two STs were first detected in Japan; however, the timeline, mechanism, and process of emergence and spread of these mosaic penA alleles to other countries remain unknown. Methods We studied the evolution of penA alleles by obtaining the complete genomes from three Japanese ST-1901 clinical isolates harboring mosaic penA allele 34 (penA-34) dating from 2005 and generating a phylogenetic representation of 1075 strains sampled from 35 countries. We also sequenced the genomes of 103 Japanese ST-7363 N. gonorrhoeae isolates from 1996 to 2005 and reconstructed a phylogeny including 88 previously sequenced genomes. Results Based on an estimate of the time-of-emergence of ST-1901 (harboring mosaic penA-34) and ST-7363 (harboring mosaic penA-10), and > 300 additional genome sequences of Japanese strains representing multiple STs isolated in 1996–2015, we suggest that penA-34 in ST-1901 was generated from penA-10 via recombination with another Neisseria species, followed by recombination with a gonococcal strain harboring wildtype penA-1. Following the acquisition of penA-10 in ST-7363, a dominant sub-lineage rapidly acquired fluoroquinolone resistance mutations at GyrA 95 and ParC 87-88, by independent mutations rather than horizontal gene transfer. Data in the literature suggest that the emergence of these resistance determinants may reflect selection from the standard treatment regimens in Japan at that time. Conclusions Our findings highlight how antibiotic use and recombination across and within Neisseria species intersect in driving the emergence and spread of drug-resistant gonorrhea.

scholarly journals Antimicrobial resistance and antibiotic use in Timor-Leste: building surveillance capacity with a One Health approach

2020 ◽  
Vol 44 ◽  
Author(s):  
Joshua R Francis ◽  
Nevio Sarmento ◽  
Anthony D K Draper ◽  
Ian Marr ◽  
Shawn Ting ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Antibiotic Use ◽  
Timor Leste

scholarly journals Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India

2021 ◽  
Vol 19 (1) ◽  
pp. 2206
Author(s):  
Anita Kotwani ◽  
Jyoti Joshi ◽  
Anjana S. Lamkang ◽  
Ayushi Sharma ◽  
Deeksha Kaloni
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Health Concern ◽  
Public Healthcare ◽  
Evidence Based ◽  
Self Medication ◽  
Middle Income ◽  
Awareness Campaigns ◽  
The Government ◽  
And Behavior

Background: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population. Objective: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions. Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis. Results:  Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money.  Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics. Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

scholarly journals Antibiotic Use: A Cross-Sectional Study Evaluating the Understanding, Usage and Perspectives of Medical Students and Pathfinders of a Public Defence University in Malaysia

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 154 ◽  
Author(s):  
Mainul Haque ◽  
Nor Azlina A. Rahman ◽  
Judy McKimm ◽  
Massimo Sartelli ◽  
Golam Mohammad Kibria ◽  
...  
Keyword(s):  
Medical Students ◽  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Small Data ◽  
Sectional Study ◽  
Cross Sectional ◽  
Study Population ◽  
National Defence

Background: Antimicrobial prescribing behaviors are often influenced by the local culture and prescribing appropriateness of medical doctors and other health care professionals. Globally, antimicrobial utilization practices have a profound impact on antimicrobial resistance and are a tremendous public health concern. The aim of this survey was to explore the knowledge and attitudes of medical students from the National Defence University of Malaysia regarding antimicrobial usage and antimicrobial resistance. Research design and methods: This was a cross-sectional study. The study population consisted of undergraduate medical students in each year group from the National Defence University of Malaysia. Students receive limited formal training on the use of antibiotics in their curriculum, and most of this learning is opportunistic whilst on clinical placement. Universal sampling was used as the study population was small. Data were collected utilizing a previously validated instrument regarding antibiotic use. Simple descriptive statistics were used to generate frequencies and percentages with SPSS V21. This research was approved by the Centre for Research and Innovation Management, National Defence University of Malaysia. Results: 206 questionnaires were distributed with a response rate of 99.03%, 54% (110) male, and 46% (94) female. Out of the respondents, 65% (132) had used antibiotics in the last year. Respondents displayed a moderate level of knowledge about antibiotics. Conclusions: This study revealed that the older the student was, or when the year of study and total knowledge score was higher, the students were less likely to stop antimicrobials when they felt better or use leftover antibiotics without consulting a doctor. Therefore, the nearer the students were to graduation, the better their knowledge and skills were, and this translated into their own behaviors regarding use of antimicrobials. This finding has clear implications for curriculum design and the inclusion of formal teaching throughout the medical program on antimicrobial use and antimicrobial resistance (AMR). However, more research is needed on this topic, including the prescribing habits and antibiotic use of practicing doctors.

scholarly journals Genomic Characterization of Antimicrobial Resistance in Food Chain and Livestock-Associated Salmonella Species

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 872
Author(s):  
Thobeka P. Mthembu ◽  
Oliver T. Zishiri ◽  
Mohamed E. El Zowalaty
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Food Chain ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Health Concern ◽  
Salmonella Spp ◽  
Food Animal ◽  
Genomic Characterization

The rising trend of antimicrobial resistance (AMR) by foodborne bacteria is a public health concern as these pathogens are easily transmitted to humans through the food chain. Non-typhoid Salmonella spp. is one of the leading foodborne pathogens which infect humans worldwide and is associated with food and livestock. Due to the lack of discovery of new antibiotics and the pressure exerted by antimicrobial resistance in the pharmaceutical industry, this review aimed to address the issue of antibiotic use in livestock which leads to AMR in Salmonella. Much attention was given to resistance to carbapenems and colistin which are the last-line antibiotics used in cases of multi drug resistant bacterial infections. In the present review, we highlighted data published on antimicrobial resistant Salmonella species and serovars associated with livestock and food chain animals. The importance of genomic characterization of carbapenem and colistin resistant Salmonella in determining the relationship between human clinical isolates and food animal isolates was also discussed in this review. Plasmids, transposons, and insertion sequence elements mediate dissemination of not only AMR genes but also genes for resistance to heavy metals and disinfectants, thus limiting the therapeutic options for treatment and control of Salmonella. Genes for resistance to colistin (mcr-1 to mcr-9) and carbapenem (blaVIM-1, blaDNM-1, and blaNDM-5) have been detected from poultry, pig, and human Salmonella isolates, indicating food animal-associated AMR which is a threat to human public health. Genotyping, plasmid characterization, and phylogenetic analysis is important in understanding the epidemiology of livestock-related Salmonella so that measures of preventing foodborne threats to humans can be improved.

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