Addressing resistance to antibiotics in pluralistic health systems

Addressing resistance to antibiotics in pluralistic health systems

There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former, focusing on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. There is evidence that these markets have enabled people to treat many infections and reduce mortality. However, they also encourage overuse of antibiotics and behaviour likely to encourage the emergence of resistance.

The paper reviews a number of strategies for improving the use of antibiotics. It concludes that effective strategies need measures to ensure easy access to antibiotics, as well as those aimed at influencing providers and users of these drugs to use them appropriately.

Initiatives to improve antibiotic use in pluralistic health systems will entail changes in behaviour and in the ethical norms underpinning this behaviour at local, national and global levels. It will require active participation by a variety of actors in several inter-related interventions:

  • Generation of reliable surveillance data and production of treatment guidelines
  • Provision of reliable information and guidance to providers of antibiotics
  • Supply of good quality antibiotics at an affordable price
  • Development of new diagnostic technologies
  • Testing and taking appropriate models for treating common infections to scale
  • Empowering communities to make informed decisions
  • Advocacy, governance and coalition building
  • Learning approach to change management.
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