Optimising antimicrobial use in humans - review of current evidence and an interdisciplinary consensus on key priorities for research

Esmita Charani^{1

2}, Martin McKee³, Raheelah Ahmad⁴, Manica Balasegaram⁵, Candice Bonaconsa², Gemma Buckland Merrett⁶, Reinhard Busse⁷, Vanessa Carter⁸, Enrique Castro-Sanchez¹, Bryony D Franklin^{9

10}, Pantelis Georgiou¹¹, Kerri Hill-Cawthorne¹, William Hope¹², Yuichi Imanaka¹³, Andrew Kambugu¹⁴, Andrew Jm Leather¹⁵, Oluchi Mbamalu², M McLeod^{1

10}, Marc Mendelson², Mirfin Mpundu¹⁶, Timothy M Rawson^{1

17}, Walter Ricciardi¹⁸, Jesus Rodriguez-Manzano^{11

19}, Sanjeev Singh²⁰, Constantinos Tsioutis²¹, Chibuzor Uchea⁶, Nina Zhu¹, Alison H Holmes¹

Affiliations

¹ National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK.
² Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa.
³ London School of Hygiene and Tropical Medicine, London, UK.
⁴ School of Health Sciences City, University of London, UK.
⁵ The Global Antibiotic Research and Development Partnership, Geneva, Switzerland.
⁶ Drug-Resistant Infections Priority Programme,Wellcome Trust, London, UK.
⁷ Technische Universität Berlin, Berlin, Germany.
⁸ Stanford University Medicine X e-Patient Scholars Program 2017, Health Communication and Social Media South Africa, Africa CDC Civil Society Champion for AMR.
⁹ University College London School of Pharmacy, London, UK.
¹⁰ Imperial College Healthcare NHS Trust, Centre for Medication Safety and Service Quality, Pharmacy Department, London, UK.
¹¹ Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK.
¹² Department of Molecular and Clinical Pharmacology, University of Liverpool, UK.
¹³ Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁴ Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
¹⁵ King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK.
¹⁶ Ecumenical Pharmaceutical Network, Nairobi, Kenya.
¹⁷ Department of Bioengineering, Imperial College London, London, UK.
¹⁸ Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁹ Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London.
²⁰ Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi (Kerala), India.
²¹ Department of Internal Medicine and Infection Prevention and Control, School of Medicine, European University Cyprus, Nicosia, Cyprus.

PMID: 34557847
PMCID: PMC8454847
DOI: 10.1016/j.lanepe.2021.100161

Review

Optimising antimicrobial use in humans - review of current evidence and an interdisciplinary consensus on key priorities for research

Esmita Charani et al. Lancet Reg Health Eur. 2021.

. 2021 Jun 29:7:100161.

doi: 10.1016/j.lanepe.2021.100161. eCollection 2021 Aug.

Authors

Affiliations

¹ National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK.
² Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa.
³ London School of Hygiene and Tropical Medicine, London, UK.
⁴ School of Health Sciences City, University of London, UK.
⁵ The Global Antibiotic Research and Development Partnership, Geneva, Switzerland.
⁶ Drug-Resistant Infections Priority Programme,Wellcome Trust, London, UK.
⁷ Technische Universität Berlin, Berlin, Germany.
⁸ Stanford University Medicine X e-Patient Scholars Program 2017, Health Communication and Social Media South Africa, Africa CDC Civil Society Champion for AMR.
⁹ University College London School of Pharmacy, London, UK.
¹⁰ Imperial College Healthcare NHS Trust, Centre for Medication Safety and Service Quality, Pharmacy Department, London, UK.
¹¹ Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, UK.
¹² Department of Molecular and Clinical Pharmacology, University of Liverpool, UK.
¹³ Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁴ Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
¹⁵ King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK.
¹⁶ Ecumenical Pharmaceutical Network, Nairobi, Kenya.
¹⁷ Department of Bioengineering, Imperial College London, London, UK.
¹⁸ Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁹ Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London.
²⁰ Department of Infection Control and Epidemiology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi (Kerala), India.
²¹ Department of Internal Medicine and Infection Prevention and Control, School of Medicine, European University Cyprus, Nicosia, Cyprus.

PMID: 34557847
PMCID: PMC8454847
DOI: 10.1016/j.lanepe.2021.100161

Abstract

Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security.

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Conflict of interest statement

We declare no competing interests.

Figures

**Figure 1**
Current global funding bodies active in antimicrobial resistance research for humans and the broad themes under which funding is available

**Figure 2**
The antimicrobial drug supply chain indicating gaps in current systems and opportunities for research, adapted from the WHO framework for development and stewardship to combat antimicrobial resistance (AMR) R&D: research and development

**Figure 3**
The proposed timeline for the identified research priorities in optimising antimicrobial use in human

See this image and copyright information in PMC

References

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Optimising antimicrobial use in humans - review of current evidence and an interdisciplinary consensus on key priorities for research

Affiliations

Optimising antimicrobial use in humans - review of current evidence and an interdisciplinary consensus on key priorities for research

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources