Anti-Microbials In Society (AMIS): a Global Interdisciplinary Research Hub

我们对抗生素的使用已经升级。我们通常在治疗人类和动物感染时最清楚抗生素的使用。然而，它们的使用更为广泛。我们经常使用它们来降低免疫系统脆弱人群的感染风险，在养殖牲畜中，控制感染，促进生长，甚至在作物种植中。这种广泛使用与抗生素耐药性（AMR）上升有关。流通中的抗生素化学物质的数量被认为是导致细菌之间选择压力的原因，这样一些感染就无法用以前有效的药物治疗了。这可能对健康和经济产生巨大影响。然而，科学家们强调，在许多情况下缺乏使用抗生素的证据。例如，据估计，至少50%的人类抗生素使用没有临床效益。决策者一致认为，我们必须减少对这些药物的依赖。但如何?人们经常呼吁努力改变最终用户的行为，但迄今为止还没有产生遏制耐药性出现和蔓延所需的广泛影响。在这项研究中，我们提出抗生素以如此深刻的方式嵌入我们的社会经济基础设施，以至于试图简单地改变患者，医生和农民的行为对于我们对其使用的潜在依赖是外围的。我们建议，通过了解抗生素与我们今天的生活、机构和基础设施交织在一起的方式，我们可以找到替代抗生素使用的方法，同时最大限度地减少意想不到的后果。例如，试图减少一种抗生素的使用往往会增加另一种抗生素的使用。全部停用抗生素可能需要更系统的干预，比如延长恢复时间。然而，这样做可能会对劳动力和与药品生产和销售联系在一起的经济体产生其他后果。我们需要密切关注已经采取的减少抗生素使用的措施，了解它们的后果，并在不同的环境中发挥潜在的新干预措施。如果我们能够确定在不同情况下减少对抗生素依赖的有效措施，这将比改变最终用户行为的一刀切的努力更具成本效益和更及时。抗生素耐药性问题是全球性的，预计将对低收入和中等收入国家造成最严重的后果。在这些环境中，需要减少抗生素的使用，这是一项特别的挑战，因为市场填补了支离破碎的卫生系统的空白。报告描述了可及性过度平衡，即许多需要抗微生物药物的人得不到治疗，而这些药物通常被不必要地使用。尽管在低收入和中等收入国家进行了数十年的药物合理使用研究和规划，但这种情况仍然存在。我们需要新的方法来揭示抗生素在我们社会中的重要性，以理解为什么有针对性地使用抗生素的必要性如此难以实施。这个项目提出了一种超越传统的社会、生物或临床科学领域的新方法。该项目旨在启动AMIS中心，这是一个国际公认的卓越中心，负责在社会上开展、实施和传播高质量的抗微生物药物研究，并在泰国和乌干达开展两项初步研究，目标如下：了解抗生素在日常生活和基础设施中的作用。评价限用抗生素对急诊护理的影响。本项目将培养一批临界数量的研究人员，对抗生素耐药性进行高质量的研究，提供高质量的比较证据，表明我们对抗生素的依赖性质，并提出抗生素替代品的建议，以尽量减少意想不到的后果。

Our use of antibiotics has escalated. We are often most aware of antibiotic use when we treat infections - for people, and animals. However, their use is more widespread. We use them routinely to reduce risks of infection amongst people with vulnerable immune systems, in farming livestock, to manage infection and to promote growth and even in crop farming. This widespread use is linked to a rise in antibiotic resistance (AMR). The amount of antibiotic chemicals in circulation is held responsible for driving selection pressure amongst bacteria such that some infections become untreatable with previously effective drugs. This can have dramatic consequences for both health and economics. And yet, scientists have emphasised the lack of evidence for using antibiotics in many scenarios. For example, it is estimated that at least 50% of human antibiotic usage has no clinical benefit.Policy makers are agreed that we must reduce our reliance on these medicines. But how? Efforts to change end user behaviour are often called for but thus far have not had the widespread impacts required to curb the emergence and spread of resistance. In this research, we propose that antibiotics are embedded within our socioeconomic infrastructure in such a deep way that attempts simply to change behaviour of patients, physicians of farmers are peripheral to our underlying dependency on their use. We suggest that by understanding the ways in which antibiotics are intertwined with our lives, institutions and infrastructures today we may identify ways to replace their use while minimising unintended consequences. For example, attempts to reduce use of one antibiotic often increases the use of another. Removing antibiotics all together may require a more systemic intervention such as the promotion of recovery time. In so-doing, however, other consequences could occur for the workforce and for economies tied up with pharmaceutical production and sales. We need to look closely at measures that have already been taken to reduce antibiotic use and understand what their consequences have been, as well as play out potential new interventions in different settings. If we are able to identify effective measures to reduce reliance on antibiotics in different scenarios, this will be more cost effective and timely than one-size-fits-all efforts to change end user behaviour.The issue of AMR is global, and is expected to have most severe consequences for low and middle income countries (LMICs). The need to reduce use of antibiotics in these settings presents a particular challenge, where markets fill the gaps of fractured health systems. An access-excess balance is described whereby many in need of antimicrobials remain untreated while these medicines are commonly used unnecessarily. This scenario persists despite decades of research and programmes into the rational use of medicines in LMICs. New approaches are needed to uncover the significance of antibiotics in our societies, to understand why the imperative to target their use so difficult to enact.This project presents a fresh approach beyond the traditionally delineated domains of social, biological or clinical sciences. The project aims to launch the AMIS Hub, an internationally recognised centre of excellence for developing, implementing and disseminating high quality research on antimicrobials in society, and two initial studies in Thailand and Uganda with the following objectives:1. To understand the roles of antibiotics in every-day life and infrastructure2. To evaluate the impact on care of imperatives to restrict antibiotics3. To identify and rehearse counterfactuals to antibiotic use This project will generate a critical mass of researchers undertaking high quality research into AMR, high quality comparative evidence indicating the nature of our reliance on antibiotics and recommendations for alternatives to antibiotics that will minimise unintended consequences.