19
rational use of antibiotics based on an standard antibiotic prescription plan (as recommended by regulatory authorities), establish infection prevention and control
committee, good microbiology practices and monitoring of usage of antibiotics and
antimicrobial resistance and critical checkpoints within their own premises (Uchil
et al. 2014). Strengthening of healthcare systems with these regulations even in low
income countries/regions with limited medical assistance would be required for
effective mitigation of antimicrobial resistance.
Another crucial component of preventive measures for mitigating antimicrobial
resistance is surveillance, which also helps to design control strategies in clinical
settings. Effective surveillance and prevention of leakage of antibiotics mitigates a
large fraction of antibiotic resistance menace. It generates important and reliable
data which is useful to understand the pattern of antimicrobial resistance and design
strategies and national policies towards regulated drug prescription and corresponding emergence of antimicrobial resistance against particular class of antibiotics
(Pereko et al. 2016). Many global partnership programmes, such as Global Action
Plan, have called for such surveillance task forces and partnerships for exchange of
information over the current status and the drift of antibiotic resistance over long
periods of time (Duse, 2011; Leung et al. 2011). These programmes need to be both
national and international, to allow for intersectoral cooperation and application of
regulations. The point-of-care pathology labs and/or healthcare clinics are the point
of contact for patients and can provide crucial data about the antibiotic susceptibility and the antibiotic prescription pattern. This has been practiced in many countries
and is complemented by information of antibiotic resistance in that locality.
Antimicrobial resistance is steadily evolving and thus requires continuous surveillance to catch the problem in time. Also, this data provides the trend of evolution of
antibiotic resistance in terms of quantifiable parameters such as antibiotic resistance
genes, antibiotic resistance bacteria and predictive models for antibiotic resistance.
This information can also be used to identify critical breakpoints to aid in updating
national policies, antibiotic prescription patterns and guidelines for standard treatment (Critchley and Karlowsky 2004). Globally, many regional surveillance systems exist such as INSAR-India, ESAC-European Union, NARMS-USA,
SASCM-South Africa, etc. But, given the interconnectivity of the modern world and
rapid spread of antimicrobial resistance, it is required that there is global cooperation, such as GLASS – WHO for effective mitigation of the problem and efficient
surveillance is effectively established.
All these precautions and regulative measures can be complimented only with
innovative solutions against resistant pathogens and rapid discovery of more potent
antibiotics. These are required in conjunction with novel technologies to improve
drug delivery and strategies to bypass biofilm barriers, which further decrease efficacy of drugs against resistant and persistent microbes. Apart from strategies and
regulations posed from the stakeholders belonging to healthcare, many steps have
been suggested by economists to reduce the usage of antibiotics in agriculture. One
suggestion is to impose a ban on the use of antibiotics in agriculture and recommend
farmers for improving hygiene and living conditions of the animals. Another suggestion (more practical solution) is to charge a user fee on antibiotics intended for
1 Antimicrobial Resistance Paradigm and One-Health Approach
rational use of antibiotics based on an standard antibiotic prescription plan (as recommended by regulatory authorities), establish infection prevention and control
committee, good microbiology practices and monitoring of usage of antibiotics and
antimicrobial resistance and critical checkpoints within their own premises (Uchil
et al. 2014). Strengthening of healthcare systems with these regulations even in low
income countries/regions with limited medical assistance would be required for
effective mitigation of antimicrobial resistance.
Another crucial component of preventive measures for mitigating antimicrobial
resistance is surveillance, which also helps to design control strategies in clinical
settings. Effective surveillance and prevention of leakage of antibiotics mitigates a
large fraction of antibiotic resistance menace. It generates important and reliable
data which is useful to understand the pattern of antimicrobial resistance and design
strategies and national policies towards regulated drug prescription and corresponding emergence of antimicrobial resistance against particular class of antibiotics
(Pereko et al. 2016). Many global partnership programmes, such as Global Action
Plan, have called for such surveillance task forces and partnerships for exchange of
information over the current status and the drift of antibiotic resistance over long
periods of time (Duse, 2011; Leung et al. 2011). These programmes need to be both
national and international, to allow for intersectoral cooperation and application of
regulations. The point-of-care pathology labs and/or healthcare clinics are the point
of contact for patients and can provide crucial data about the antibiotic susceptibility and the antibiotic prescription pattern. This has been practiced in many countries
and is complemented by information of antibiotic resistance in that locality.
Antimicrobial resistance is steadily evolving and thus requires continuous surveillance to catch the problem in time. Also, this data provides the trend of evolution of
antibiotic resistance in terms of quantifiable parameters such as antibiotic resistance
genes, antibiotic resistance bacteria and predictive models for antibiotic resistance.
This information can also be used to identify critical breakpoints to aid in updating
national policies, antibiotic prescription patterns and guidelines for standard treatment (Critchley and Karlowsky 2004). Globally, many regional surveillance systems exist such as INSAR-India, ESAC-European Union, NARMS-USA,
SASCM-South Africa, etc. But, given the interconnectivity of the modern world and
rapid spread of antimicrobial resistance, it is required that there is global cooperation, such as GLASS – WHO for effective mitigation of the problem and efficient
surveillance is effectively established.
All these precautions and regulative measures can be complimented only with
innovative solutions against resistant pathogens and rapid discovery of more potent
antibiotics. These are required in conjunction with novel technologies to improve
drug delivery and strategies to bypass biofilm barriers, which further decrease efficacy of drugs against resistant and persistent microbes. Apart from strategies and
regulations posed from the stakeholders belonging to healthcare, many steps have
been suggested by economists to reduce the usage of antibiotics in agriculture. One
suggestion is to impose a ban on the use of antibiotics in agriculture and recommend
farmers for improving hygiene and living conditions of the animals. Another suggestion (more practical solution) is to charge a user fee on antibiotics intended for
1 Antimicrobial Resistance Paradigm and One-Health Approach