Governments have a wide variety of policy options at their disposal to respond to the growing threat of antimicrobial resistance, but many of these approaches have not been rigorously evaluated, according to a new study published this week in PLOS Medicine by Susan Rogers Van Katwyk of the University of Ottawa, Canada, and colleagues.
Antimicrobial resistance (AMR) is on the rise due to persistent misuse and overuse of antimicrobials, and has already rendered some infections untreatable with existing drugs. In the new work, researchers systematically searched seven global databases for studies that clearly described and evaluated a government policy intervention aimed at reducing human antimicrobial misuse. They identified 69 published evaluations of such interventions carried out around the world.
Described in these 69 studies were 17 different types of policies that governments have deployed and tested to reduce antimicrobial use, including public awareness campaigns, antimicrobial guidelines, vaccination, and tailored regulations for prescribing and reimbursement. Unfortunately, most existing policy options have not been rigorously evaluated, which limits their usefulness in planning future policy interventions. Of the studies, only 4 had a randomized controlled design, the gold standard for medical interventions, while 35 used rigorous quasi-experimental designs and the remaining 30 were uncontrolled and descriptive. The current systematic review was unable to directly investigate the impact of the different interventions on AMR, but reductions in antimicrobial use are likely to lead to lower levels of resistance over time.
"To avoid future waste of public resources, and in line with WHO recommendations for national action on AMR, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published," the authors say.
This study was partially supported by the International Collaboration for Capitalizing on Cost?Effective and Life?Saving Commodities (i4C) that is funded through the Research Council of Norway's Global Health & Vaccination Programme (SJH; GLOBVAC Project #234608) and contract funding from the Public Health Agency of Canada (SJH). The Canadian funder provided input on the research question, but neither funder had any role in study design, data collection, data analysis, data interpretation, or writing of the report. SJH is additionally funded by the Canadian Institutes of Health Research and the Ontario Government's Ministry of Research, Innovation and Science. SRVK is supported by an Ontario Graduate Scholarship. JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake.
I have read the journal's policy and the authors of this manuscript have the following competing interests: SJH and MM have both advised several governments in their personal capacities on policy interventions that could be used to address antimicrobial resistance. The authors declare no financial relationships with any organisations that might have an interest in the submitted work.
Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, et al. (2019) Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. PLoS Med 16(6): e1002819. https://doi.org/10.1371/journal.pmed.1002819
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
Department of Health Research Methods, Evidence, and Impact, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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