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Antimicrobials
represent one of the major interventions to reduce mortality in
low-income countries (LIC), and in many of such countries they constitute
a substantial part of the overall health budget. The effectiveness
of these drugs is diminishing due to the emergence and spread of
bacterial resistance. Resistance to antimicrobials is now a worldwide
problem which may be particularly serious in LIC where resistance
rates were found even higher than in industrialised countries, and
where alternative antimicrobials are often not available or too
expensive. Increased
resistance rates are found not only among infectious pathogens,
but also in the resident indigenous microbiota of healthy people.
The high prevalence of antimicrobial resistance observed in LIC
is likely due to several factors, including both irrational use
of antimicrobials and unique environmental conditions, such as crowding
and poor sanitation. Many factors contribute to irrational use of
antimicrobials: lack of laboratory facilities to guide prescribing,
uninformed self-medication due to the widespread availability of
non-prescription antimicrobials, and sub-optimal therapeutic regimes,
due to lack of finances to complete treatment courses or to the
use of substandard drugs. However
the recent findings of high prevalence of antimicrobial resistance
in commensal bacteria from human population of a remote rural community
of South America which has very low human antimicrobial consumption
raise the question about the role of other factors (e.g. non-human
use of antimicrobials) in favouring the emergence and spreading
of antimicrobial resistance. To
reduce antimicrobial consumption, multi-faceted interventions are
needed. They should include education of providers and measures
to improve the public’s knowledge about the risks and benefits of
antimicrobial therapy. Surveillance of antimicrobial resistance
is of critical importance both to provide information on the magnitude
and trends in resistance and to monitor the effect of interventions.
Development and strengthening of local laboratory and standardization
of techniques and data interpretation are essential. Irrational
use and bacterial resistance to antimicrobials are major public
health problems amplified in low-income countries. Objectives: The
main objective is the development of a conceptual framework of the
dynamics of antimicrobial use and resistance in healthy children
in urban and remote rural areas of Bolivia and Peru. According to
the findings an intervention strategy involving local health services
in addressing the public will be developed and implemented. It will
be evaluated on antimicrobial use and bacterial resistance trends
in the intervention group compared to the control group by using
household surveys and applying an innovative and robust resistance
screening method of the commensal microbiota. The project will contribute
to the development of evidence based antimicrobial policy at national
and international levels. · To
describe antimicrobial use in households with healthy children aged
6-72 month in four urban communities and two remote rural communities
in Bolivia and Peru with a triangulation approach using household
interviews, focus-group discussions and antimicrobial bio-activity
test of urine samples (HAUS). ·
To
investigate the occurrence of antimicrobial resistance in tracer
bacteria isolated from the commensal microbiota of healthy children
aged 6-72 month from the selected communities by a rapid resistance
screening method validated by standard susceptibility test (ARS). · To
investigate the resistant mechanisms and genotypes of selected resistant
isolates, with special emphasis on resistance determinants of clinical
relevance and useful as markers in molecular epidemiology. · To
assess factors influencing antimicrobial use and antimicrobial resistance
in the selected communities including current pharmaceutical regulatory
framework, quality of antimicrobials, agricultural and veterinary
use of antimicrobials and bacterial contamination in water sources
(IF). · To
develop a contextualised intervention package including education
and peer network strategies whereby providers (doctors and pharmacists)
in the public and private sectors are engaged in developing and
implementing an urban community directed information, education
communication (IEC) campaign based on the obtained results. · To
evaluate the impact of the intervention package on antimicrobial
use and antimicrobial resistance in an intervention group compared
to a control group and to exploit and disseminate the project results.
Expected
results: · Improvement
of public’s understanding about the risks and benefits of antimicrobial
therapy. · Advanced
knowledge of the interrelationship between human antimicrobial use
and resistance epidemiology taking influencing factors into account. · Monitoring
strategies for antimicrobial use and antimicrobial resistance to
support the governmental institutions involved in public health
and drug policy making. · Intervention
package strategies documented feasible and effective for improving
rational use of antimicrobials in low-income setting. Potential
applications: The results
will provide evidence-based improvements of the community health
services related to antimicrobial use and resistance and propose
the utilised simple screening method for routine analysis of antimicrobial
resistance with implications for national and international surveillance
and control. The results of the developed strategies will be disseminated
to policy makers and researchers worldwide. |
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