The Woolcock Institute of Medical Research, Kim Ma, Ha Noi, Vietnam.
National Institute of Hygiene and Epidemiology, Hai Ba Trung, Hanoi, Vietnam.
J Antimicrob Chemother. 2021 Apr 13;76(5):1117-1129. doi: 10.1093/jac/dkaa556.
Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.
抗菌药物耐药性（AMR）是一个全球性重大问题，抗菌药物管理对于解决 AMR 的出现至关重要。AMR 的负担不成比例地影响到低收入和中等收入国家（LMICs），这些国家在监测和管理耐药病原体方面的能力最薄弱。社区中抗生素使用管理不善是 AMR 的一个主要驱动因素，特别是在 LMICs 中，但基于社区的干预措施在抗菌药物管理研究中被忽视，而这些研究往往在高收入环境中进行，或者在医院中进行。我们审查了在 LMICs 中测试或实施基于社区的抗菌药物管理策略的研究人员和政策制定者可获得的证据。我们对这些证据进行了批判性评估，提出了建议，并确定了研究需求的突出领域。我们发现，在我们的环境中，多方面、以教育为重点的干预措施可能最有效。我们还证实，基于社区的管理干预研究的质量和数量有限，最迫切需要关于微生物学、临床和经济可持续性的研究。
