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[NAIROBI] Hospital-based antimicrobial stewardship (AMS) programmes that have adequate support from senior managers and governments are urgently needed in Africa and the other developing world to help tackle antimicrobial resistance, infectious disease experts say.
According to the experts, the lack of uniform global criteria on antimicrobial use is hindering the implementation of AMS programmes, especially in hospitals located in developing countries.
The experts from 13 countries including Argentina, Kenya, India, South Africa, Switzerland, United Kingdom and the United States have defined uniform actions for hospitals to preserve the effectiveness of antimicrobials worldwide and tackle antimicrobial resistance, according to a statement from the European Society of Clinical Microbiology and Infectious Diseases published last month (3 April).

“Low- and middle- income countries neither have the surveillance networks to detect and measure AMR nor health-care infrastructure…”

Gunturu Revathi, Aga Khan University Hospital

The seven core elements of the actions include the leadership role of senior managers of hospitals towards AMS programmes, accountability and responsibilities, actions that promote responsible use of antimicrobials or medicines, and continuous surveillance and feedback on antimicrobial use, the statement adds.
The actions also include 29 checklists on essential and minimum standards relevant to both high and low-to-middle income countries (LMICs) for hospital-based AMS programmes.

AMS programmes in all hospitals worldwide is a major necessity due to the threat posed by antimicrobial resistance (AMR), says Céline Pulcini, an expert involved in creating the actions and a professor of infectious diseases in Nancy University Hospital and University of Lorraine, France.

Having a good starting point is vital in helping identify which measures must be implemented, Pulcini adds.
According to Gunturu Revathi, head of microbiology at Kenya-based Aga Khan University Hospital, AMR is a very serious problem globally.
 “Low- and middle- income countries neither have the surveillance networks to detect and measure AMR nor health-care infrastructure to manage the patients suffering from drug-resistant bacterial infections,” she tells SciDev.Net.
Treatment of patients with resistant infections, according to Revathi, is five times more expensive. The poorly-funded public health facilities in LMICs cannot meet the challenge of AMR.
The reasons accounting for antimicrobial resistance, she notes, include irrational use of antibiotics in human medicine and agriculture, easy access to antibiotics in pharmacies without prescriptions and the lack of legal mechanisms to curtail irrational antibiotic use. 

Figure 1. Annual national expenditure on antibiotics global scene, 2010
Annual national expenditure on antibiotics global scene
Source: (2010)
Moses Alobo, programme, manager of Grand Challenges Africa at the African Academy of Sciences (AAS), says that strengthening global AMR surveillance is critical as it is the basis for informing global strategies, monitoring the effectiveness of public health and detecting new trends and threats.

According to Alobo, good antimicrobial stewardship programmes promote surveillance of antimicrobials, thus helping reduce unwanted side effects and benefitting patients.    
Jay Berkley, a principal investigator at the Kenya Medical Research Institute with expertise in infectious diseases, says AMS programmes must be backed by true government commitment, community health education and mandatory pre-service and in-service training and accreditation of hospitals and clinics. “In many ways it will be made difficult where health systems, including the supply chain and basic facilities such as sinks for hand washing are weak,” he says, adding that AMS programmes are critical to LMICs because antimicrobial resistance disproportionately affects resource-poor areas that lack diagnostics and have patients who are unable to afford alternative expensive drugs.

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk