Antibiotic stewardship in agricultural communities in Africa and Asia: A unified One Health strategy to optimise antibiotic use in animals and humans

抗生素药物是治疗人类和动物细菌感染的重要资源。不幸的是，在世界各地，一些感染正在对用于治疗它们的抗生素产生抗药性。这可能导致未来疾病持续时间更长，死亡人数增加，治疗费用上升。由于农民在畜牧生产中依赖抗微生物药物来满足日益增长的需求，耐药性还威胁到生计。在这种情况下，受影响最大的将是低收入国家，那里传染病很常见，许多家庭缺乏经济保障。抗生素耐药性现在被认为是对全球健康的最大威胁之一。联合国大会呼吁各国政府采取一致行动，限制耐药性的发展和传播。世界卫生组织倡导通过开发新的抗微生物药物和更负责任地使用现有药物，采取紧急行动，进行研究和投资。不良的处方做法，如过度使用抗生素、部分剂量或不坚持整个疗程，都造成有利于耐药突变的选择和传播的情况。卫生工作者、药剂师、农民、护理人员和患者都可以帮助解决耐药性问题，方法是只在真正需要抗生素时分发抗生素，并使用适当数量的正确药物。因此，改善抗生素的使用最终涉及制定有效的干预措施，以指导卫生工作者、患者和农民作出治疗决定，以阻止滥用抗生素。在许多低收入国家，私营部门在提供卫生保健方面发挥着重要作用，大多数患者和农民依赖药店和非正规提供者获得药品——在控制抗生素滥用的战略中不能忽视私营部门。抗生素耐药性也不能通过孤立地关注一个部门来解决——需要一种全面的方法来有效控制动物和人类的抗生素。然而，对私营部门的监管是许多中低收入国家卫生系统公认的弱点。拟议的集群旨在解决这一挑战。我们将汇集以前由GCRF资助的六个项目所产生的知识和见解，比较影响非洲和亚洲一系列国家人类和动物抗生素使用的情况、规范、经验和动机，以确定能够阻止滥用这些宝贵药物和/或激励良好做法的程序。我们将特别关注从药店和农村农业地区的非正规提供者处购买的抗生素，这些地区获得医疗保健的机会有限。我们的项目还研究了私人提供者、政府卫生工作者和政府官员之间相互作用的影响，以便更好地了解低收入国家的卫生系统如何能够更有效地提高私人提供者提供的护理质量并改善治疗做法。我们将利用这一集体证据设计一项由相互加强的组成部分组成的总体干预战略，旨在打击滥用从药店购买的抗生素，并改善农村对人类和动物的治疗服务。这一策略将在未来的研究中得到检验。最终，我们制定的干预战略旨在对中低收入国家的国家政府、卫生部和农业部在制定和颁布应对抗生素耐药性威胁的国家计划方面具有价值。我们的研究结果也可用于加强农村地区的卫生服务。

Antibiotic medicines are a vital resource for treating bacterial infections both in humans and in animals. Unfortunately, all around the world, some infections are becoming resistant to the antibiotics used to treat them. This could lead to a future scenario in which illnesses last longer, deaths increase, and the cost of treatment rises. Resistance additionally threatens livelihoods due to farmers' reliance on antimicrobials in livestock production to meet growing demand. Under this scenario, the greatest impact will be felt in low-income countries, where infectious diseases are common and many families lack financial security. Antibiotic resistance is now considered to be one of the biggest threats to global health. The UN General Assembly has called for concerted action by every national government to limit the development and spread of drug resistance. The World Health Organization advocates urgent action, research and investment, through both the development of new antimicrobials and more responsible use of existing drugs.Poor prescription practices such as overuse of antibiotics, partial doses, or non-adherence to the full treatment course, all create situations which are conducive to the selection and spread of resistant mutations. Health workers, pharmacists, farmers, caregivers and patients can all help tackle resistance by only dispensing antibiotics when they are truly needed, and by using the right drug in the right quantities. Improving the use of antibiotics thus ultimately involves developing effective interventions to guide the treatment decisions made by health workers, patients and farmers to discourage indiscriminate use. The private sector plays an important role in provision of health care in many low-income countries, with a majority of patients and farmers depending on drug shops and informal providers for medicines - and cannot be overlooked in strategies to control misuse of antibiotics. Neither can antibiotic resistance be addressed by focusing on one sector in isolation - a holistic approach is needed for the effective control of antibiotics in animals and humans. Yet regulation of the private sector is an acknowledged weakness of the health system in many low-middle income countries. The proposed cluster aims to address this challenge. We shall pool the knowledge and insights that have been generated in six projects previously funded by GCRF, to compare the situations, norms, experiences, and motivations that affect antibiotic use in humans and animals across a range of countries in Africa and Asia - to identify processes that can deter misuse of these valuable medicines and/or incentivize good practice. Our particular focus will be on antibiotics purchased from drug shops and informal providers in rural agricultural areas with limited access to healthcare. Our projects also look at the influence of interactions between private providers, government health workers and public officials, to gain a better understanding of how health systems in low-income countries can more effectively raise the quality of care available from private providers and improve treatment practices. We shall use this collective evidence to design an overarching intervention strategy, comprised of mutually-reinforcing components, aimed at combatting misuse of antibiotics purchased from drug shops and improving rural treatment services for humans and animals. This strategy will be tested in future studies. Ultimately, the intervention strategies we develop are intended be of value to national governments, Ministries of Health and Ministries of Agriculture, in low-middle income countries in the formulation and enactment of national plans to counter the threat of antibiotic resistance. Our findings can also be used to strengthen health services in rural areas.