1. Essential Drugs and Medicines Policy
WHO global strategy to contain antimicrobial resistance: prioritisation of interventions
ICIUM 2004
K.A.Holloway
Essential Drugs and Medicines Policy
WHO Geneva

2. WHO, Dept. Essential Drugs and Medicines Policy
WHO Global strategy Identifies 67 interventions targeted at different groups
Prescribers and dispensers
Patients and the general public
Hospitals
Governments and health systems
Pharmaceutical industry
Non-human uses of antimicrobials
International aspects
WHO, Dept. Essential Drugs and Medicines Policy

3. Prioritising interventions
Multidisciplinary groups at country / regional level
done in EMRO & SEARO and with Nepal officials
group members agreed 32 interventions for prioritisation & scored (0,1,2) each intervention for feasibility & importance
interventions were plotted on a graph & compared
Three specialist expert groups at WHO/HQ level
experts sat in specialist groups for (1) prescribers & dispensers (2) hospitals & (3) government & health systems
each group prioritised interventions for their target groups
comparison was done of different expert groups’ priorities to identify interventions common to different target groups
WHO, Dept. Essential Drugs and Medicines Policy

4. 32 interventions to contain AMR prioritised in regions
WHO, Dept. Essential Drugs and Medicines Policy

5. Prioritization of interventions by the 11 members of EMRO antimicrobial resistance task force25
Feasible and relevant 8 4 6 3 2 1 20 4 5 3 3 5 1 3 2 1 3 11 12 9 4 3 1 2 2 2 1 5 15 1 7
Importance 2 10 10
Key: group targeted by interventions A
patients, families, communities B
prescribers and dispensers
Not feasible or relevant C
health systems 5 D
govt. policies, strategies, regulations E
pharmaceutical industry F
non-human antimicrobial use 5 10 15 20 25
Feasibility

6. Prioritization of interventions by 7 staff members of SEARO15 1 14 1 1 4 3 3 8 13 1 3 3 2 1 2 2 5 12 3 4 3 4 2 2 11 2 5 12 9 6 10
Feasible and relevant 10 9 7
Importance 8 5 1 7 11
Key: group targeted by interventions 6 A
patients, families, communities 5 B
prescribers and dispensers 4
Not feasible or relevant C
health systems 3 D
govt. policies, strategies, regulations 2 E
pharmaceutical industry 1 F
non-human antimicrobial use 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Feasibility
WHO, Dept. Essential Drugs and Medicines Policy

7. Prioritization of interventions by 15 health officials in Nepal3 4 2 25 3 1 2 3 3 1 1 5 5 1 3 11 13 2 4 4 3 2 8 1 5 1 6 9 20 10 12 2 2
Feasible and relevant 7
Importance 15
Key: group targeted by interventions A
patients, families, communities B
prescribers and dispensers
Not feasible or relevant C
health systems D
govt. policies, strategies, regulations E
pharmaceutical industry F
non-human antimicrobial use 10 15 20 25
Feasibility
WHO, Dept. Essential Drugs and Medicines Policy

8. WHO/HQ priorities (1) Fundamental interventions
Make containment of AMR a national priority including:
creation of a national task force,
allocation of resources to implement interventions to contain antimicrobial resistance,
development of indicators to monitor and evaluate the impact of an antimicrobial resistance strategy.
Designate or develop reference microbiology laboratory facilities to co-ordinate effective, epidemiologically-sound, surveillance of AMR among common pathogens in the community, hospitals and other health care facilities
WHO, Dept. Essential Drugs and Medicines Policy

9. WHO/HQ priorities (2) High Priority Interventions
Patient education on preventing infection (immunization, vector control, use of bed-nets, etc.) and reducing trans-mission of infection (hand-washing, food hygiene, etc.)
Prescriber and dispenser (including drug sellers) education on appropriate antimicrobial use, containment of AMR, disease prevention and infection control
Targeted UG & PG education for all health workers & vets on accurate diagnosis & management of common infections
Develop, update and use STGs & treatment algorithms
Infection Control Programmes in hospitals
WHO, Dept. Essential Drugs and Medicines Policy

10. WHO/HQ priorities (3) High Priority Interventions
Good quality diagnostic laboratories that provide:-
microbiology lab. services appropriate to the level of hospital
appropriate diagnostic tests, bacterial identification, antimicrobial susceptibility tests of key pathogens with relevant timely reporting
Limiting availability of antimicrobials to prescription-only status, except in special circumstances where they may be dispensed on the advice of a trained health care professional
Ensuring only antimicrobials meeting international standards of quality, safety & efficacy are granted marketing authorisation
WHO, Dept. Essential Drugs and Medicines Policy

11. Problems with prioritisation
People prioritised according to their specialities and expertise
agricultural interventions were not prioritised in the exercise in Geneva
the prioritisation of which interventions are most important and feasible was based on opinion and not evidence of which there is very little
WHO, Dept. Essential Drugs and Medicines Policy

12. WHO, Dept. Essential Drugs and Medicines Policy
Conclusions (1) Five interventions deemed important & feasible by all groups
training prescribers and dispensers and using guidelines and formularies
establishing infection control committees and guidelines for antimicrobial use
developing national drug policies, essential drug lists and standard treatment guidelines
ensuring undergraduate and post graduate training on antimicrobial resistance
ensuring that drugs are produced according to GMP standards and are of adequate quality
WHO, Dept. Essential Drugs and Medicines Policy

13. WHO, Dept. Essential Drugs and Medicines Policy
Conclusions (2)
A national task force with budget is needed to carry out & coordinate the 5 interventions
There is a need to evaluate all interventions for their effectiveness & cost-effectiveness in containing antimicrobial resistance
In order to evaluate interventions, it is necessary to do linked surveillance of antimicrobial resistance and use
WHO, Dept. Essential Drugs and Medicines Policy

14. Key lessons, policy implications and future research
There is expert consensus that a national task force and national public reference lab are regarded as fundamental to containing AMR
There is widely differing opinion and a profound lack of evidence concerning which strategies to contain AMR should have highest priority
Policy implications
Lack of evidence for prioritising interventions to contain AMR hampers the development of coordinated national approaches to containing AMR
Future research
Rigorous evaluation of interventions to contain AMR must be conducted in order to identify which strategise are most cost-effective
Sustainable, reliable and affordable surveillance systems need to be researched and developed in order that interventions can be evaluated.
WHO, Dept. Essential Drugs and Medicines Policy