Update on Antimicrobial Resistance

Expert Committee 31 March - 3 April 2003

Antimicrobial Resistance

Antimicrobial resistance refers to strains of micro-organism that are able to multiply in the presence of antimicrobial drug concentrations higher than in the concentrations in humans receiving therapeutic doses. The development of resistance is a natural biological phenomenon that has followed the introduction of every antimicrobial agent into clinical practice. Increased antimicrobial use is associated with increased rates of resistance and, hence, irrational overuse of antimicrobials is contributing to the increasing global problem of antimicrobial resistance. Antimicrobials are over-used world-wide at all levels of the health care system in amounts that are perhaps double what would be clinically indicated. Resistance rates vary locally depending upon local antimicrobial use.

The World Health Assembly has recognised antimicrobial resistance as a serious public health problem. The World Health Assembly Resolution of 1998 urged member states to develop measures to encourage appropriate and cost-effective use of antimicrobials. However the problem of resistance including multi-drug resistance has continued to grow while the development of new antimicrobials is decreasing. The WHO global strategy (WHO 2001) addresses this challenge by providing a framework of interventions to slow the emergence and reduce the spread of antimicrobial resistant micro-organisms.

More than 60 interventions were chosen and prioritised on the basis of invited expert opinion with wide review. It was agreed that an adequately funded multi-sectoral task force and reference laboratory, to conduct jointly surveillance of antimicrobial resistance and use, were fundamental to any national containment programme.

The interventions deemed most important were:

·  Patient education on preventing infection (immunization, bednets) and reducing transmission (hand washing, food hygiene)

·  Provider education on antimicrobial use, AMR containment, disease prevention, infection control

·  Targeted undergraduate and postgraduate education for all health workers and veterinary practitioners on accurate diagnosis and management of common infections

·  Development, updating and use of clinical guidelines and treatment algorithms

·  Infection Control Programmes in hospitals

·  Good quality diagnostic laboratories

·  Limitation of availability of antimicrobials to prescription-only

·  The granting of marketing authorisation only to antimicrobials meeting international standards of quality, safety and efficacy

Very few countries have a national antimicrobial resistance containment programme. Reduction of antimicrobial resistance has been observed in a few countries that have succeeded in significantly reducing antimicrobial consumption and improving infection control. Many countries do not base their choice of antimicrobials for an essential medicines list or standard treatment guidelines on epidemiologically sound antimicrobial resistance data even though this is crucial for ensuring best patient outcome and use of antimicrobials. Containing antimicrobial resistance and ensuring that patients are treated with the most effective antimicrobials requires the linked surveillance of antimicrobial resistance and consumption.

WHO is now supporting pilot projects to develop a feasible new model and methodology for linked surveillance of antimicrobial resistance and consumption and the local containment of antimicrobial resistance in developing countries.

Dr. Kathleen Holloway

Medical Officer PAR/EDM/WHO

20.2.03

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