Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research

TY - JOUR

T1 - Optimising antimicrobial use in humans – review of current evidence and an interdisciplinary consensus on key priorities for research

AU - Charani, Esmita

AU - McKee, Martin

AU - Ahmad, Raheelah

AU - Balasegaram, Manica

AU - Bonaconsa, Candice

AU - Merrett, Gemma Buckland

AU - Busse, Reinhard

AU - Carter, Vanessa

AU - Castro-Sanchez, Enrique

AU - Franklin, Bryony D.

AU - Georgiou, Pantelis

AU - Hill-Cawthorne, Kerri

AU - Hope, William

AU - Imanaka, Yuichi

AU - Kambugu, Andrew

AU - Leather, Andrew JM

AU - Mbamalu, Oluchi

AU - McLeod, M.

AU - Mendelson, Marc

AU - Mpundu, Mirfin

AU - Rawson, Timothy M.

AU - Ricciardi, Walter

AU - Rodriguez-Manzano, Jesus

AU - Singh, Sanjeev

AU - Tsioutis, Constantinos

AU - Uchea, Chibuzor

AU - Zhu, Nina

AU - Holmes, Alison H.

N1 - Funding Information: This work was supported by the Wellcome Trust. RA, CB, EC, AH, MM, SS, OM, and NZ acknowledge funding from the Economic and Social Research Council (ESRC) and the National Institute for Health Research ASPIRES project (Antibiotic use across Surgical Pathways: Investigating, Redesigning and Evaluating Systems) ( https://www.imperial.ac.uk/arc/aspires/ ). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimising antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study; collection, management, analysis, review, or approval of the manuscript; and decision to submit the manuscript for publication. RA, EC, AH, TMR and NZ acknowledge funding from the National Institute for Health Research, UK Department of Health [HPRU-2012-10047] in partnership with Public Health England. BDF and MMc acknowledge the NIHR Imperial Patient Safety Translational Research Centre. MMc is also supported by the ESRC. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, PHE or the Department of Health and Social Care. Funding Information: We thank the following expert panel group members for their valuable input: Adrian Brink (South Africa), Peter Borriello (UK), Peter Childs (UK), Nick Feasey (UK), Grant Hill-Cawthorne (UK), Steven J Hoffman (Canada), Izhar Hussain (Pakistan), Fran Husson (UK), Claas Kirchhelle (UK), Nathan Peiffer-Smadja (France), Mathieu Poirier (Canada), Michael Sharland (UK), Julia E Szymczak (USA), Karin Thursky (Australia), Paul Tambyah (Singapore), Charles Vincent (UK), Thomas G Weiser (USA), Yazdan Yazdanpanah (France), Shahidul Islam (Bnagladesh) and Samir Saha (Bangladesh). This work was supported by the Wellcome Trust. RA, CB, EC, AH, MM, SS, OM, and NZ acknowledge funding from the Economic and Social Research Council (ESRC) and the National Institute for Health Research ASPIRES project (Antibiotic use across Surgical Pathways: Investigating, Redesigning and Evaluating Systems) (https://www.imperial.ac.uk/arc/aspires/). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimising antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study; collection, management, analysis, review, or approval of the manuscript; and decision to submit the manuscript for publication. RA, EC, AH, TMR and NZ acknowledge funding from the National Institute for Health Research, UK Department of Health [HPRU-2012-10047] in partnership with Public Health England. BDF and MMc acknowledge the NIHR Imperial Patient Safety Translational Research Centre. MMc is also supported by the ESRC. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, PHE or the Department of Health and Social Care. Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8/1

Y1 - 2021/8/1

N2 - Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.

AB - Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.

UR - http://www.scopus.com/inward/record.url?scp=85111578342&partnerID=8YFLogxK

U2 - 10.1016/j.lanepe.2021.100161

DO - 10.1016/j.lanepe.2021.100161

M3 - Article

AN - SCOPUS:85111578342

SN - 2666-7762

VL - 7

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100161

ER -