The Lancet has just published a Series on Antimicrobial Resistance: The need for sustainable access to effective antibiotics.
Published: May 23, 2024
https://www.thelancet.com/series/antibiotic-resistance
Summary and comments from me below.
Executive Summary
Access to effective antibiotics is essential to every health system in the world, however, antimicrobial resistance (AMR) threatens this backbone of modern medicine and is already leading to deaths and disease which would have once been prevented. This Series highlights that, although AMR can affect anyone throughout the life course, the very young, very old and severely ill are the ones suffering the most. Through novel modelling data, this Series shows how stopping infections through improved vaccination and water and sanitation can not only prevent a significant proportion of deaths due to AMR in low- and middle-income countries, but also reduce the use of antibiotics to preserve its effectiveness. The Series also addresses how a rethink of drug development is needed to support investment in antibiotic, diagnostics, and vaccine development according to the burden of infection and resistance. Lower drug development costs will also make antibiotics more affordable and accessible. Finally, the authors argue for the need of targets to trigger political commitment and accelerate progress in addressing AMR.
Sustainable Access to Effective Antibiotics An Executive Summary for The Lancet’s Series
https://www.thelancet.com/pb/assets/raw/Lancet/stories/series/antimicrob...
“For too long, the problem of AMR has been seen as either not urgent or too difficult to solve. Neither is true”, says co-author Prof. Ramanan Laxminarayan.
COMMENTS (NPW): I have reviewed briefly the articles in this series and I find that the emphasis is on vaccination, water and sanitation, new antibiotic development, and access to antibiotics. The inappropriate use of antibiotics is barely mentioned and I could find no mention at all about the need to improve the availability and use of reliable information on antibiotics for prescribers and consumers.
Several years ago the World Health Organization stated: ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ https://www.hifa.org/projects/prescribers-and-users-medicines
HIFA and Nagasaki University's systematic review in 2020 concluded there is 'a lack of up-to-date and relevant medicine information in low and lower middle-income settings'. https://gh.bmj.com/content/5/4/e002094
There remains an urgent need to improve the availability and use of reliable information for prescribers and users of antibiotics. Information on individual antibiotics is relatively easy to find for those with access to the internet. What is more important - and largely missing - is information to support antibiotic stewardship, including an understanding of when and how it is appropriate to use (or not to use) antibiotics, and which antibiotic to select for any individual clinical context. Strengthening access to antibiotics without strengthening stewardship will just make the problem worse and will result in millions of avoidable deaths.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
