Dr Esmita Charani
Research Lead for Practice Design and Engineering at the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Research Lead for Executive Committee of ESCMID ESGAP
Fellow in Infectious Diseases, Hopital Bichat, Université de Paris, Imperial College London
For sustained improvement in antibiotic prescribing we need to understand the factors that influence their usage.
The relationship that we have developed with antibiotics is complex and driven by many factors beyond health and disease. We have long considered antibiotics to be miracle drugs due to their ability to treat diseases, however, their overuse is now costing human lives. Antimicrobial resistance (AMR) is now a major threat to healthcare and our global economy, with burden of disease and death highest where there are least resources.
Antibiotic prescribing is a social process
Infectious diseases are becoming an increasing threat in human populations. Their management is the responsibility of clinicians across different specialties. It is estimated that up to one-third of antibiotic prescriptions may be inappropriate, and this widespread, inappropriate use puts patients at risk of AMR and treatment failure. Drug resistant infections and AMR are driven by sociocultural factors that require a multidisciplinary response.
For prescribers, the fear of risk of treatment failure in their patients often outweighs the risk of AMR.
In places where there is a lack of access to resources such as expertise in infectious diseases, laboratories and access to tests to diagnose infections, the likelihood of misusing antibiotics is much higher. For prescribers, the fear of risk of treatment failure in their patients often outweighs the risk of AMR. Additionally, entrenched hierarchies and social norms within healthcare mean that it remains difficult to challenge behaviours that result in inappropriate antibiotic use.
New drugs won’t fix the problem, unless we optimise use of existing ones
Much of the discourse on AMR remains around developing new agents but this can take a long time and require a lot of investment. Whilst it remains critical that we find new drugs, unless we understand how and why we continue to misuse existing antibiotics we will not make progress with managing the challenge of AMR
To do this, we need to:
- Develop strategies that are flexible to the needs of different context and populations.
- Build capacity for research into understanding how innovations can be implemented in different resource settings.
- Engage with patients and the public to raise awareness about the consequences of antibiotic use and misuse.
- Work with policy makers to ensure equitable access to effective drugs for all.