Cohn Jennifer, Mendelson Marc, Kanj Souha S, Shafiq Nusrat, Boszczowski Icaro, Laxminarayan Ramanan
Global Antibiotic Research and Development Partnership, Geneva, Switzerland.
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Lancet Infect Dis. 2024 Sep;24(9):e584-e590. doi: 10.1016/S1473-3099(24)00070-7. Epub 2024 Mar 11.
This Personal View discusses the challenges faced, especially by low-income and middle-income countries (LMICs), in responding to the growing burden of bacterial antimicrobial resistance. Many patients in LMICs lack access to effective and affordable treatments needed to successfully treat patients. Meanwhile, traditional antimicrobial stewardship models face implementation challenges due to financial, health system, and human resource constraints. These constraints call for a paradigm shift from traditional high-income country-style antimicrobial stewardship, which is often resource intensive and aimed at cost containment, to a broader concept of sustainable access. We suggest a model of context-adapted stewardship that continues to emphasise providing the right antibiotic, at the right time, for the right duration, and at an affordable price. Taking lessons from other disease areas, including tuberculosis, we identify interventions such as task shifting to various health-care workers and the implementation of a hub-and-spoke model to support appropriate use of antibiotics, to enable optimal access and maximisation of scarce resources.
这篇个人观点文章讨论了尤其是低收入和中等收入国家（LMICs）在应对日益增长的细菌抗微生物药物耐药性负担方面所面临的挑战。许多低收入和中等收入国家的患者无法获得成功治疗患者所需的有效且负担得起的治疗方法。与此同时，由于财政、卫生系统和人力资源方面的限制，传统的抗微生物药物管理模式面临实施挑战。这些限制要求从传统的高收入国家式抗微生物药物管理模式（这种模式通常资源密集且旨在控制成本）转向更广泛的可持续获取概念。我们建议一种因地制宜的管理模式，该模式继续强调在正确的时间、以正确的疗程、以可承受的价格提供正确的抗生素。借鉴包括结核病在内的其他疾病领域的经验教训，我们确定了一些干预措施，如将任务转移给各类医护人员以及实施轮辐式模式以支持抗生素的合理使用，从而实现最佳获取并最大限度地利用稀缺资源。
