GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK.
GlaxoSmithKline, 252, Dr Annie Besant Road, Worli 400030, Mumbai, India.
J Antimicrob Chemother. 2022 Sep 6;77(Suppl_1):i35-i42. doi: 10.1093/jac/dkac215.
Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.
To review the situation with respect to AMR in Brazil and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Brazil and to improve patient outcomes.
National initiatives to address AMR, antibiotic use and prescribing in Brazil, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infections (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, along with local antibiotic availability.
In Brazil there have been some initiatives addressing AMR such as the National Action Plan for AMR, established in 2018. Antibiotic consumption in Brazil is high but a ban on over-the-counter sales of antibiotics has led to a decrease in consumption. Local antibiotic susceptibility testing needs to be increased and the Survey of Antibiotic Resistance (SOAR) study in Brazil will provide useful data for pathogens causing CA-RTIs. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Brazil, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.
抗菌药物耐药性（AMR）是对全球公共卫生的最大威胁之一。除其他因素外，耐药菌的选择是由抗生素的不当使用驱动的。由于不必要的抗生素处方，COVID-19 可能加剧了 AMR。需要了解国家层面的知识，以了解行动的选择。
审查巴西 AMR 情况及应对措施。确定需要更多信息的领域，将为巴西境内进一步降低 AMR 并改善患者结局提供行动号召。
确定了巴西应对 AMR、抗生素使用和处方以及药敏数据（特别是对关键的社区获得性呼吸道感染（CA-RTI）病原体肺炎链球菌和流感嗜血杆菌）的国家举措。还审查了当地常用的针对 CA-RTIs（社区获得性肺炎、急性中耳炎和急性细菌性鼻-鼻窦炎）的国家和国际抗生素处方指南，以及当地抗生素的供应情况。
巴西已经采取了一些措施来应对 AMR，例如 2018 年制定的国家 AMR 行动计划。巴西的抗生素消耗很高，但禁止在非处方销售抗生素导致消耗下降。需要增加当地抗生素药敏试验，巴西的抗生素耐药性调查（SOAR）研究将为引起 CA-RTIs 的病原体提供有用的数据。在制定当地指南时采用更标准化、更具包容性的方法，使用巴西社区获得性感染分离株的最新监测数据，可以使指南更符合当地临床医生的需求。这将为更合理地使用抗生素和提高患者的遵医嘱程度铺平道路。这反过来又可能限制 AMR 的发展并改善患者的临床结局。
