The threat of antimicrobial resistance is a global health priority and must be addressed through global coordinated efforts. Many of the resources provided in this Toolkit refer to data and practices specific to the United States; however, antibiotic stewardship implementation in resource-limited settings faces additional challenges functioning with weak health systems where resources to combat antibiotic resistance may not be sufficient.

The following resources have been developed specifically targeting international resource-limited settings:

Published data on antibiotic consumption, globally:

Examples of successful antibiotic stewardship initiatives:

At the national level:

  • In Chile, restriction of over-the-counter sale of antibiotics to those with medical prescription in September 1999 led to a substantial decrease in consumption by 2002. However, since 2002 antibiotic consumption has increased to pre-intervention levels; this was attributed to lack of reinforcement measures (Bavestrello et al 2011).
  • In 2012, medical societies came together in Chennai, India and developed the “Chennai Declaration” which comprised national recommendations and an action plan to address the challenge of antimicrobial resistance in India. It represented a bold national commitment to antibiotic stewardship and infection control across India. (Holmes et al 2013).

Additional References:

  • Brink AJ, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis, 2016. 16(9):p1017-25.
  • Goff DA, et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fall. Lancet Infect Dis, 2017. 17(2): e56-63.
  • Mendelson M, et al. Maximizing access to achieve appropriate human antimicrobial use in low-income and middle-income countries. Lancet, 2016. 387(10014):p188-98.
  • Bebell LM and Muiru AN. Antibiotic use and emerging resistance: how can resource-limited countries turn the tide? Global Health. 2014. 9(3):p347-58.
  • Nguyen KV, et al. Antibiotic use and resistance in emerging economies: a situation analysis for Vietnam. BMC Public Health, 2013. 13(1):e1158.
  • Laxminarayan R, Heymann DL. Challenges of drug resistance in the developing world. BMJ, 2012. 344:e1567.
  • Holloway KA, Rosella L, Henry D. The impact of the WHO Essential Medicines policies on inappropriate use of antibiotics. PLOS ONE, 2016. 11(3):pe0152020.
  • Saied T, et al. Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: a multicenter pilot intervention study. Am J Infect Control, 2015. 43(11): e67-71.
  • Cox JA, et al. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect, 2017. 23(11):p 812-18.
  • Pisano J, et al. Social Media as a tool for antimicrobial stewardship. Am J Infect Control, 2016. 44(11):p 1231-36.