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The purpose of this paper is to explore the current state of antimicrobial stewardship implementation and development within Canada at both a federal and provincial level.

Narrative review.

There have been several prominent conferences and reports in Canada regarding the development and implementation of antimicrobial stewardship programs over the past two decades. However, despite the knowledge that there is a need for standardization of programs across Canada with accurate mechanisms and infrastructure in place for implementation and evaluation of these programs, there is still a lack of consistency across the country. In addition pharmacy information regarding inpatient and outpatient antimicrobial use is not uniformly reliable. Recently, the Public Health Agency of Canada using the Pan-Canadian Public Health Network as a vehicle organized a task group to help facilitate the working relationships among the provincial, territorial and federal governments in terms of implementing antimicrobial stewardship programs. This network has the potential to enhance and standardize programs across the country.

This paper looks at Canadian policy regarding antimicrobial stewardship at a federal as well as provincial level. Historic conferences, reports and discussions are highlighted emphasizing the progressive changes over the past two decades and highlight many of the challenges that Canada continues to face.

The purpose of this paper is to report on recent developments concerning promotion of initiatives to contain the spread of resistance to antimicrobial drugs.

Narrative review.

In 2014, an American executive order made combating antimicrobial resistance a national priority. While this and other developments convey a message of growing urgency, the core elements required and challenges ahead are neither new nor unexplored. The quantity and quality of antimicrobial stewardship research over the past decade has added little to what already was known. Suppressing evolution of emerging drug resistance and containing emergence of resistant strains as on-going activities to maintain a balance might be a more realistic statement of the problem than framing it as winning a war. It remains to be seen how well those in the front lines of healthcare epidemiology and infection control shape framing of this problem before American federal and state agencies respond to their presidential directive by relaying marching orders through laws, rules, regulations, financial incentives and penalties. It remains to be seen whether the next decade will be more successful than the last given a more recent emphasis on the strategy of bundling small sets of practical key measures into effect, and the involvement of public health departments in support of antimicrobial stewardship. Unlike a generation ago, it also is clear that international trade and travel make this a global problem. America cannot be expected to resolve emerging drug resistance alone even if containment efforts within its own borders are successful, but like other developed countries it can be expected to have vested self-interests in promoting global solutions to this complex problem.

This report brings together recent American government policy decisions and insights from two noteworthy interdisciplinary conferences.

The purpose of this paper is to provide an overview of the perspectives of patient advisors (PAs) on the current state of antimicrobial resistance (AR) and stewardship in Canada and identifies next steps, with the goal of stimulating further collaboration for action between leaders and PAs as well as research.

The perspectives of PAs were gathered using an electronic online survey of 72 respondents. A search of peer reviewed literature and publicly available reports informed the development of the survey and the articulation of a more comprehensive viewpoint in this paper.

PAs view AR as a serious and growing public health threat. They believe sharing the responsibility for infection prevention and control and antimicrobial stewardship will help to control the problem. They see healthcare professionals as the most appropriate stakeholders to influence behaviors associated with appropriate antibiotic use, however, they also see value in public campaigns. Importantly, they identify several opportunities for PA contribution: education of care providers, patients, families, and the public; co-design and development of materials, policies, improvement initiatives, and research; and participation in and promotion of public campaigns.

Engaging PAs as partners at all system levels is becoming common practice. PAs bring a unique and complementary perspective that could contribute to antimicrobial stewardship efforts.

This paper begins to bridge a gap between literature and practice, and proposes that PAs can contribute to antimicrobial stewardship efforts.

For this themed issue, the purpose of this paper is to select papers that examine progress on addressing concerns raised in one of the Journal’s 2015 viewpoint articles.

The authors contributing to this issue describe the evolution, current state and challenges facing development of antimicrobial stewardship initiatives in their communities. This editorial summarizes concerns raised in the 2015 viewpoint and provides a link to newer information for each of these problems.

Progress is being made to build the political will for implementing initiatives that of necessity must span a wide swath of jurisdictions and national agencies in each country; the information resources necessary to maintain current awareness of evolving drug usage and resistance patterns; the infrastructure required to educate both public and professionals; and at least monitor if not ensure compliance.

The concepts and experiences reported in this issue can inform policy and governance development in countries that are not as far along the path, as well as contribute to a global dialogue on what works best for whom under what circumstances.

Details in this themed issue expand on overviews provided in a recent World Health Organization report. This Journal intends to contribute to the advancement of timely knowledge translation by welcoming more papers on this topic, papers at a level of detail like those in this issue, so that our readers can remain abreast of the changing global context.

Antimicrobial resistance is a public health threat even in countries exercising aggressive antimicrobial stewardship. A market failure is also causing lackluster innovation in antimicrobial medicines development. At the heart of the issue are antimicrobial stewardship guidelines that, rightfully, reserve innovative antimicrobials for emergency situations that arise due to multidrug-resistant organisms. This suppresses revenues and research and development (R&D) investment incentives of manufacturers. The public policy makers and researchers have taken aim at the problem. The researchers have published strategies to encourage the production of innovative antimicrobials, while policy makers have taken legislative steps to address the issue. Most notably, the USA enacted the Generating Antibiotic Incentives Now (GAIN) act in 2012 and the EU created a commission to formally study possible policy solutions. The paper aims to discuss these issues.

In this paper, the authors describe incentives that drive pharmaceutical R&D and review the impact of a number of R&D stimulus policies in other pharmaceutical markets. The authors also discuss which policy levers are useful to boost R&D of new antimicrobials.

The authors find that a policy focused on extending intellectual property rights, as implemented in the GAIN act, are unlikely to be impactful. Instead, the authors see a need for the revision of the procurement policy to move away from paying per prescription and toward licenses and advanced market commitment models. Further, the authors note that the importance of steadfast public investment in basic biomedical research as it has been repeatedly shown to boost innovation.

The authors hope that the work can support the refinement of the GAIN act and the EU efforts.

The purpose of this paper is to provide an overview of the content of the current issue of CGIJ.

The review is prepared by the review editor to highlight key points within each paper.

Enables readers to scan content and select articles of most interest or relevance to their needs.

–CGIJ is the only Emerald health journal providing this service to its readers.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

Worldwide situation analysis on antimicrobial resistance (AMR) released in 2015 by the World Health Organisation (WHO) has revealed inadequate capability to respond to AMR in African region. Report of antibiotics use and resistance in Tanzania revealed rising levels of healthcare associated Methicilin Resistant Staphylococcus aureus infections; while other studies have reported high prevalence of Expanded Spectrum Beta-Lactamase (ESBL). The purpose of this paper is to review the current situation of antimicrobial stewardship (AMS) in Tanzania using strengths, weaknesses, opportunities and challenges (SWOC) analysis.

General literature review was done on use of antimicrobials in Google Scholar, websites of key organisations including WHO, and grey literature. Conceptual framework designed by the authors was used to inform SWOC analysis of the Tanzanian health sector.

The SWOC analysis has revealed much strength in the Tanzanian health sector indicating that increasing investments in laboratory services, in medicines Regulatory Authority and Pharmacy Council, and strengthening management teams at all levels of service delivery, including Medicines and Therapeutics Committees; and strengthening advocacy on rational use of antimicrobials both in humans and livestock will improve AMS.

This is a general literature review. No interview of experts or use of questionnaires was used. However, based on the literature found and author’s experience in the health sector, the information contained is valid for consideration in making policy decisions about AMR in Tanzania.

Designing policy interventions to prevent development of AMR to commonly used antimicrobials.

Improving social wellbeing in the community through prevention of morbidity and mortality resulting from multi-resistant pathogens.

This is the authors original idea backed by available literature.

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.

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

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

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.