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Abstract

Purpose

Antibiotic resistance (AR) is a global health crisis that is attracting focussed attention from healthcare, public health, governmental agencies, the public, and food producers. The purpose of this paper is to describe the work in Washington State to combat resistance and promote antimicrobial stewardship from a one health perspective.

Design/methodology/approach

In 2014, the Washington State Department of Health convened a One Health Steering Committee and two workgroups to focus on AR, the One Health Antimicrobial Stewardship work group and the One Health Antimicrobial Resistance Surveillance work group. The group organized educational sessions to establish a basic understanding of epidemiological factors that contribute to resistance, including antibiotic use, transmission of resistant bacteria, and environmental contamination with resistant bacteria and antibiotic residues.

Findings

The authors describe the varied uses of antibiotics; efforts to promote stewardship in human, and animal health, including examples from the USA and Europe; economic factors that promote use of antibiotics in animal agriculture; and efforts, products and next steps of the workgroups.

Originality/value

In Washington, human, animal and environmental health experts are working collaboratively to address resistance from a one health perspective. The authors are establishing a multi-species resistance database that will allow tracking resistance trends in the region. Gaps include measurement of antibiotic use in humans and animals; integrated resistance surveillance information; and funding for AR and animal health research.

Details

International Journal of Health Governance, vol. 21 no. 3
Type: Research Article
ISSN: 2059-4631

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Article

Fiona J. Cooke, Bryony Dean Franklin, Wendy Lawson, Ann Jacklin and Alison Holmes

Antibiotic resistance presents a major public health challenge at local, national and international levels. At a local level, the challenge is to tackle the antibiotic

Abstract

Antibiotic resistance presents a major public health challenge at local, national and international levels. At a local level, the challenge is to tackle the antibiotic stewardship agenda, within the clinical governance framework, across all professional groups and specialities. This paper presents the response to this challenge in a large multi‐site NHS trust. The approach focuses around a multi‐disciplinary antibiotic steering group, in which a dedicated infectious diseases pharmacist plays a key role. Proposes seven key elements for a successful antibiotic stewardship programme and discuss examples of local action. These elements are: strong leadership; dedicated individuals with responsibility for leading on antibiotic use; integration into pre‐existing trust structures; harnessing existing resources to deliver change; obtaining local data on prescribing patterns and resistance; communication; and education and training. All pillars of clinical governance are supported by the multi‐disciplinary approach described.

Details

Clinical Governance: An International Journal, vol. 9 no. 4
Type: Research Article
ISSN: 1477-7274

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Article

Quintin A. McKellar

Antibiotics are used in animals to cure disease and prevent suffering. Bacterial populations in animals which are exposed to these antibiotics may be selected for…

Abstract

Antibiotics are used in animals to cure disease and prevent suffering. Bacterial populations in animals which are exposed to these antibiotics may be selected for resistance. There is a concern that spread of these bacteria in the food chain to humans may result in the establishment of antibiotic resistant bacteria in people which will prove difficult or impossible to treat with conventional drugs. It is clear that antibiotics must be used carefully to reduce the development of resistance and that steps should be taken to reduce the transfer of bacteria from animals to man.

Details

Nutrition & Food Science, vol. 99 no. 4
Type: Research Article
ISSN: 0034-6659

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Article

Maika Furukawa, Naoaki Misawa and John E. Moore

Antibiotic resistance (ABR) has now become a major global public health issue. New legislation has recently been introduced in Northern Ireland from April 2017, requiring…

Abstract

Purpose

Antibiotic resistance (ABR) has now become a major global public health issue. New legislation has recently been introduced in Northern Ireland from April 2017, requiring domestic households to recycle all domestic food waste items. Resulting increases in the volume of such waste which is collected by the local council has driven technologies for the safe recycling of such material including commercial composting. Little is known about the antimicrobial resistance (AMR) profile of such composted food waste materials and hence the purpose of this paper is to characterise total AMR in bacteria isolated from such composted domestic food waste and to consider the potential public health consequences of such material.

Design/methodology/approach

Finished compost containing food waste material was obtained in the Spring 2017 from a local authority recycling amenity site, which freely distributes such material to the public. Total culturable populations of bacteria were isolated from the composted material and antibiotic susceptibility to six classes of antibiotics, namely florfenicol, fluoroquinolone, aminoglycoside, lincosamide, tetracycline and β-lactam was examined.

Findings

ABR was greatest for lincomycin > tobramycin > minocycline/amoxycillin > ciprofloxacin > florfenicol. In this study, there was one compost, which showed complete resistance to all antibiotics tested. No compost displayed complete antibiotic sensitivity. Two composts were considered pan-resistant, whilst four were considered multi-resistant.

Originality/value

This study showed that the total ABR profile of food waste compost is significant, with bacterial populations within the compost having ABR to several classes of antibiotics, which are important and sometimes critical to human health. The application of such materials to enrich and fertilise garden soils in significant volumes inadvertently allows for the artifical and man-made transfer of AMR bacteria and their genes to new environments, which have been hitherto niave to the presence of such AMR properties. The application of such compost horticulturally to enrich soils used to cultivate flowers, fruits and vegetables may have important consequences for human and animal health. Urgent work is now needed to quantify the fate of such antibiotic resistant bacteria from compost to their new environment and risk assessments made to estimate the carriage through to human health.

Details

British Food Journal, vol. 120 no. 11
Type: Research Article
ISSN: 0007-070X

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Article

Susan Hopkins

– The purpose of this paper is to highlight the local, national and global actions from the UK to reduce the impact of antimicrobial resistance (AMR) on human health.

Abstract

Purpose

The purpose of this paper is to highlight the local, national and global actions from the UK to reduce the impact of antimicrobial resistance (AMR) on human health.

Design/methodology/approach

Synthesis of UK government policy, surveillance and research on AMR.

Findings

Activities that are taking place by the UK government, public health and professional organisations are highlighted.

Originality/value

This paper describes the development and areas for action of the UK AMR strategy. It highlights the many interventions that are being delivered to reduce antibiotic use and antimicrobial resistant infections.

Details

International Journal of Health Governance, vol. 21 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

Content available
Article

Santhosh J. Thattil and T.A. Ajith

Severe bacterial infection is a major cause of neonatal morbidity and mortality worldwide. Geographical-based demographic laboratory and clinical data are required to get…

Abstract

Purpose

Severe bacterial infection is a major cause of neonatal morbidity and mortality worldwide. Geographical-based demographic laboratory and clinical data are required to get a conclusion about the bacterial infection and their antibiotic susceptibility for the empiric antibiotic treatment in infants who presented with suspected infection. This study was aimed to find the most prevalent bacterial infection and antibiotic sensitivity among infants in the post-neonatal period presented at a tertiary care centre in South India.

Design/methodology/approach

A cross-sectional study was designed among infants (29 days to 1 year old) presented with suspected infection in the paediatric department. Infants with positive culture report were analysed for the bacteriological and antibiotic profile from the medical records. Antibiotic sensitivity was determined for the isolated bacteria according to standard procedure and data statically analysed.

Findings

Total of 218 samples (138 male and 80 female) were analysed. Most of the samples (171/218, 78.4%) were throat swab (p = 0.0247). Only one sample was cerebrospinal fluid from case of meningitis. Sample from upper RTI was major (162/218, 74.3%) with male dominance followed by stool samples from cases of diarrhoea (22/218, 10.0%). Staphylococcus aureus was the major organism identified in 46/171 (26.9 %) throat swabs. The most sensitive antibiotic against bacteria isolated from throat swab and CSF was gentamicin and cloxacillin. Netilmicin and piperacillin plus tazobactam were the sensitive antibiotics against bacteria isolated from stool, ear secretion and urine samples.

Research limitations/implications

Short duration and small sample size representing the population was the major limitations of this study. Furthermore, a multicentre population based study is warranted to develop a protocol/policy/rational use of antibiotics in the clinical setting for the empiric therapy.

Practical implications

Practicing good hygiene in child care is the best way to prevent infection. Community-based awareness and education should be given to parents in order to follow good hygiene in child care regularly. Furthermore, avoid delay in seeking treatment and provide the medicine prescribed at the right time and in the right dose to limit the morbidity and bacterial resistance.

Social implications

Despite the empirical antibiotic treatment in subjects presented with infection in the post-neonatal period, awareness about the exclusive breastfeeding, maternal and neonatal immunizations and antibiotic prophylaxis in case of suspected infection are warranted to reduce the incidence of infection. Furthermore, keeping the baby's environment clean, keeping safe distance from people who are unwell or avoiding contact with infected people are major home-based activities to protect infants from common infectious diseases. Changing diaper at frequent intervals can reduce the UTI and washing child's and caregiver's hands frequently can prevent food bone and respiratory infections.

Originality/value

Upper RTI was the prevalent bacterial infection followed by diarrhoea in infants in the post-neonatal period. Klebsiella pneumoniae was the common organism identified in the overall report followed by E. coli and S. aureus. Community-based awareness should be provided to follow good hygiene regularly in child care. Furthermore, avoid delay in seeking treatment and provide the medicine prescribed at the right time and in the right dose to limit the morbidity and bacterial resistance.

Details

Journal of Health Research, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0857-4421

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Article

D.P. Doessel

Presents a brief account of the development of antibiotics so as to put such drugs in perspective. Then the issue of antibiotic resistance is considered and Tisdell’s…

Abstract

Presents a brief account of the development of antibiotics so as to put such drugs in perspective. Then the issue of antibiotic resistance is considered and Tisdell’s economic analysis of the phenomenon is presented. Emphasis is placed on the inter‐generational trade‐off that is associated with this important social issue. The paper concludes by discussing Australia’s institutional arrangements for funding pharmaceutical, and hence antibiotic, expenditures.

Details

International Journal of Social Economics, vol. 25 no. 6/7/8
Type: Research Article
ISSN: 0306-8293

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Article

Allan D. Spigelman, Shane Rendalls, Mary-Louise McLaws and Ashleigh Gray

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings…

Abstract

Purpose

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings for other jurisdictions.

Design/methodology/approach

Non-systematic review of literature from websites of national, state and territory health departments and interviews with key stakeholders for Australian strategies to reduce antimicrobial resistance.

Findings

In July 2015 all states and territories in Australia adopted the National Antimicrobial Resistance Strategy 2015-2019, which is built on the World Health Organization policy package to combat antimicrobial resistance. This strategy represents “the collective, expert views of stakeholders on how best to combat antimicrobial resistance in Australia. It will also support global and regional efforts, recognising that no single country can manage the threat of antimicrobial resistance alone”. It combines quantitative and qualitative monitoring strategies with frameworks and guidelines to improve management of the use of antimicrobial resistant drugs. Prior to this, health services and states developed and implemented initiatives aimed at monitoring and improving prescribing practices. Development of the national strategy has encouraged and fostered debate within the Australian health system and a raft of new policy initiatives.

Research limitations/implications

Surveillance strategies are in place to monitor impact and trends at jurisdictional and sector levels. However, actual impact on antimicrobial resistance and prescribing practices remains to be seen as existing initiatives are expanded and new initiatives implemented.

Practical implications

This overview of key Australian initiatives balancing quantitative and qualitative surveillance, accreditation, research, education, community awareness and price signals on antibiotic prescribing practices may be valuable to health systems in developing local strategies.

Originality/value

The authors provide an up to date overview of the context, strategies and aims of antimicrobial stewardship in Australia.

Details

International Journal of Health Governance, vol. 21 no. 3
Type: Research Article
ISSN: 2059-4631

Keywords

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Article

Jan Michael Alexandre Cortez Bernadas

Drawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and…

Abstract

Purpose

Drawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and information sources for antibiotics among at-risk yet understudied populations in urban and economic margins in the Global South.

Design/methodology/approach

Given the exploratory purpose of this paper, it used qualitative approach specifically focus group discussions with mothers, guardians and female senior citizens from Manila, Philippines.

Findings

Antibiotics had multiple meanings – from purposes and modes of acquisition to side-effects. Experiences with antibiotics were not only tied to financial difficulties, but also in administering antibiotics to children or wards and managing side-effects. Furthermore, medical doctors were the most accessed and preferred sources of antibiotics-related information.

Originality/value

To date, this paper is one of the few to argue that knowing the conditions into which antibiotics are situated in the Global South is critical for strengthening global public health campaigns and policies against antimicrobial resistance a and reducing global health inequity.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 1
Type: Research Article
ISSN: 2056-4902

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Article

Christian William Callaghan

This paper aims to argue that certain insights offered by Kuhn and Foucault may be of use to those seeking to resist a global paradigm of inequality in access to the…

Abstract

Purpose

This paper aims to argue that certain insights offered by Kuhn and Foucault may be of use to those seeking to resist a global paradigm of inequality in access to the outcomes of pharmaceutical development. It is further argued that these relationships are not independent of certain power relationships. This critical review seeks to highlight certain of these power relationships, and to suggest how they might be better managed to ensure more equitable outcomes for those in society that are most vulnerable to innovation failure.

Design/methodology/approach

This research takes the form of a critical review paper, seeking to develop theory though a synthesis of literature.

Findings

Unlike market incentives, it might be the research process itself that is most vulnerable to stakeholder resistance to slow and unequal delivery of life-saving pharmaceutical development. Given that a lack of responsiveness to societal needs can itself be considered unethical, Kuhnian theory predicting pharmaceutical innovation failure is related to what Foucault describes as a system of oppression, whereby power relationships disadvantage those most vulnerable and powerless.

Research limitations/implications

Given the rise of movements like citizen science and participant-led research, as well as new ethical frameworks premised on increasing accountability in science, Foucault’s principles are considered to echo a general trend towards the democratisation of science, and towards increasing the responsiveness of pharmaceutical development to societal needs.

Originality/value

A novel synthesis of literature is undertaken, offering useful theoretical insights into how social actors might contribute to enabling a more responsive system of international healthcare business.

Details

critical perspectives on international business, vol. 15 no. 1
Type: Research Article
ISSN: 1742-2043

Keywords

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