This comment will be focused mainly on human antimicrobial resistance (AMR). This can be a small contribution to the general problem but as it has been deeply studied in clinical ground, some issues merit to be considered. Antibiotics have reduced mortality in LMIC, but their misuse has contributed to the present problem, clearly expressed in the Spread cycle appearing in the Topic introduction. Specific rules for antibiotics uses are beyond this comment.
One of the starting points to consider is primary care for non-severe infections such as the common upper respiratory tract infections (URTIs) and acute diarrhea especially in children and youths. Only a minority of URTIs are of bacterial origin, despite this they frequently attract antibiotic prescription which can lead to a more severe and difficult to treat situation (1). Acute diarrhea is another generalized condition that frequently still receives antibiotics despite proven inefficacy (2, 3). It is important to spread the concept that acute fever rarely requires antibiotic administration. This knowledge should be enrooted both in the population and in primary care providers. Also basic information on adequate nutrition is most likely to be the best preventive circumstance at any age but especially in the first year of life by promoting a more generalized breast feeding, it should be taken into account that bovine lactoferrin does not prevent infections in early life (4). As important as this is the hand-hygiene. Additionally, providing information about antibiotic use risks (allergies, hardly recovery of microbiota…) whenever possible would be helpful. Development of ‘Antimicrobial stewardship’ programs (5) by (human and veterinary) Health Departments could be the first step for improving the use of this important tool so easily misused.
Answers to questions:
1: To reach individuals
2: Same way as antibiotics, but explaining that presently their resistance is not so widespread.
3: -
4: Ministry of Health and specific section/ persons dealing with health care providers (Med and Vet)
5: Ex-aequo Simple legislation and Primary Care Delivering local organization.
6: Ex-aequo Ministries of Health and the Regional Tripartite (FAO, OIE, WHO)
- Harris C, Mills R, Seager E et al. Pediatric Deaths in Tertiary Government Hospital Setting, Malawi. Paediatr Int Child Health 2019; 39(4): 240-8.
- Reiner RC and Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries 2000-2017: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395: 1779-801.
- Florez ID, Veroniki AA, Al-Khalifah R. et al. Comparative effectiveness and safety of Interventions for acute diarrhea and gastroenteritis in children: A systematic review and network meta-analysis. PLoS ONE Dec 5 2018, doi: 10.1371/journal.pone.0207701.
- Doyle L, Cheong J. Does bovine lactoferrin prevent late-onset neonatal sepsis? Lancet 2019; 393: 382-4
- Septimus EJ. Antimicrobial Resistance: An Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach. Med Clin North Am 2018; 102(5): 819-29.
Manuel Moya MD
University Miguel Hernández. Campus de S. Juan. Alicante. Spain
MM
Manuel Moya