The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
Infect Dis Poverty. 2022 Jun 30;11(1):78. doi: 10.1186/s40249-022-01000-z.
Mass drug administration (MDA) of antimicrobials has shown promise in the reduction and potential elimination of a variety of neglected tropical diseases (NTDs). However, with antimicrobial resistance (AMR) becoming a global crisis, the risks posed by widespread antimicrobial use need to be evaluated. As the role of the environment in AMR emergence and dissemination has become increasingly recognized, it is likewise crucial to establish the role of MDA in environmental AMR pollution, along with the potential impacts of such pollution. This review presents the current state of knowledge on the antimicrobial compounds, resistant organisms, and antimicrobial resistance genes in MDA trials, routes of these determinants into the environment, and their persistence and ecological impacts, particularly in low and middle-income countries where these trials are most common. From the few studies directly evaluating AMR outcomes in azithromycin MDA trials, it is becoming apparent that MDA efforts can increase carriage and excretion of resistant pathogens in a lasting way. However, research on these outcomes for other antimicrobials used in MDA trials is sorely needed. Furthermore, while paths of AMR determinants from human waste to the environment and their persistence thereafter are supported by the literature, quantitative information on the scope and likelihood of this is largely absent. We recommend some mitigative approaches that would be valuable to consider in future MDA efforts. This review stands to be a valuable resource for researchers and policymakers seeking to evaluate the impacts of MDA.
大规模药物给药 (MDA) 已显示出在减少和潜在消除多种被忽视的热带病 (NTD) 方面的潜力。然而，随着抗生素耐药性 (AMR) 成为全球危机，需要评估广泛使用抗生素带来的风险。由于环境在 AMR 出现和传播中的作用越来越受到重视，同样重要的是要确定 MDA 在环境 AMR 污染中的作用，以及这种污染的潜在影响。
本综述介绍了 MDA 试验中抗菌化合物、耐药生物和 AMR 基因的现状，这些决定因素进入环境的途径及其持久性和生态影响，特别是在这些试验最常见的中低收入国家。从少数直接评估阿奇霉素 MDA 试验中 AMR 结果的研究中可以明显看出，MDA 工作可以以持久的方式增加耐药病原体的携带和排泄。然而，非常需要研究 MDA 试验中使用的其他抗生素的这些结果。此外，尽管文献支持 AMR 决定因素从人类废物到环境及其随后的持久性的途径，但关于这种情况的范围和可能性的定量信息基本上是缺失的。我们建议在未来的 MDA 工作中考虑一些减轻影响的方法。
本综述对于寻求评估 MDA 影响的研究人员和政策制定者来说是一个有价值的资源。
