Keeping It Real: Antibiotic Use Problems and Stewardship Solutions in Low- and Middle-income Countries

Area of Science:

• Global Health
• Infectious Diseases
• Public Health Policy

Background:

• Antimicrobial resistance (AMR) poses a significant global health threat.
• Effective antibiotic use management is crucial to slow AMR development.
• Antimicrobial stewardship (AMS) interventions in low- and middle-income countries (LMIC) face resource and feasibility challenges, especially with high child mortality rates.

Purpose of the Study:

• To identify unique antibiotic use problems encountered by clinicians in LMIC settings.
• To document real-world AMS solutions implemented in LMIC.
• To derive broader lessons for improving AMS across LMIC.

Main Methods:

• Qualitative study synthesizing clinician-reported antibiotic use issues.
• Collection and analysis of documented AMS interventions from LMIC.
• Cross-setting analysis to identify transferable solutions.

Main Results:

• Unique challenges in LMIC include diagnostic uncertainty, limited drug availability, and cultural factors influencing prescribing.
• Successful AMS strategies involve task-shifting, local guideline adaptation, and community engagement.
• Case studies demonstrate improved antibiotic use and potential for reduced AMR in resource-limited settings.

Conclusions:

• Tailored AMS interventions are essential for LMIC to address context-specific challenges.
• Sharing practical, adaptable solutions can strengthen global efforts against antimicrobial resistance.
• Addressing antibiotic use in LMIC is critical for both child survival and AMR containment.