The clinical burden of antibiotic-resistant bacteria, commonly referred to as antimicrobial resistance (AMR), is on the rise globally, albeit disproportionately in many low-income and middle-income countries (LMICs) where access to effective antimicrobials is scarce.¹ Across all countries, overuse and misuse of antibiotics in humans, animals, and food systems pose great challenges to the continued effectiveness of these antimicrobials. Inadequate infection prevention and a lack of good surveillance and antimicrobial-use data are further driving AMR.

The practice of antimicrobial stewardship has not been effectively adopted in some high-income countries (HICs) and many LMICs. Stewardship models, which were developed in HICs with a primary goal of cost containment and curtailing AMR, require substantial human and financial resources for proper implementation. Stewardship can limit unnecessary antibiotic use and reduce the risk of related adverse events, improving patient outcomes, limiting the development of resistance, and resulting in cost savings to health-care systems. The objective of this Personal View is to present the concept of sustainable access—an approach that emphasises the need to ensure that all patients who need an antibiotic receive the correct one at the right time, for the right duration, and at an affordable price. Unfortunately, clinicians are often faced with a suboptimal antibiotic formulary, little information to identify whether the use of an antibiotic is appropriate, and situations where speed of decision making and of delivering the drug to the patient is critical. This tension requires us to consider new access and stewardship models, including those that respond to contexts with limited financial, health system, and human resources.

 

Authors 

Jennifer Cohn MD, Prof Marc Mendelson PhD, Prof Souha S Kanj MD, Nusrat Shafiq DM, Icaro Boszczowski MD, Ramanan Laxminarayan PhD

 

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