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Featured Expert: Esmita Charani, PharmD, PhD – Senior Lead Research Pharmacist at the Imperial College London and Adjunct Professor at Amrita Vishwa Vidyapeetham University in India

As we learned from the COVID-19 pandemic, microorganisms don’t recognize international borders. With AMR also being a worldwide issue, antimicrobial stewardship (AMS) interventions are necessary to help mitigate the emergence and spread of antibiotic resistant bacteria and improve patient outcomes.

We sat down for a virtual interview with Dr. Esmita Charani, Senior Lead Research Pharmacist at the Imperial College London, and Adjunct Professor at Amrita Vishwa Vidyapeetham University in India, to learn what her research on global narratives for antimicrobial stewardship can teach us about the importance of resource equity, and the many challenges countries face in the fight against AMR. 


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Understanding Barriers to Antimicrobial Stewardship

In an open online course referenced in Dr. Charani’s research, a team of international experts gathered insight from 3,000 learners in 114 countries to better understand their unique barriers to AMS. Charani shares that some of the most common challenges are healthcare professionals such as nurses and pharmacists not being considered in initiatives, insufficient resources, and a lack of education, awareness, and public engagement. An absence of training often forces those in charge of stewardship in their organization to improvise.

The challenges to antimicrobial stewardship can be even greater in Low- and Middle-income Countries (LMICs). A vital component to slowing the emergence and spread of antibiotic resistant pathogens is understanding the socioeconomic drivers for diseases among global populations. As Dr. Charani explains, in low resource settings, large portions of the population do not have access to adequate healthcare, increasing the likelihood of ill health. This lack of access is especially pronounced for diagnostics, which leads to additional challenges in determining appropriate treatment for patients and tracking infectious diseases.

“In many countries, patients have direct access to antibiotics without prescription or oversight from a healthcare professional, skipping the crucial step that diagnostics serve in providing appropriate treatment.”

One of the biggest drivers for the emergence and spread of AMR is the misuse and overuse of antibiotics. Dr. Charani notes that in many countries, patients have direct access to antibiotics without prescription or oversight from a healthcare professional, skipping the crucial step that diagnostics serve in providing appropriate treatment. Although this type of antibiotic use is not the largest contributor to antibiotic consumption globally, antibiotics are no substitute for the expertise and diagnostic tools available to healthcare professionals. Patients without proper access to healthcare are at much greater risk for adverse health outcomes.

In addition to healthcare access, people in LMICs often face a range of environmental challenges, such as contaminated water, that add to health burdens. This complex range of issues that affect the infectious disease landscape highlights the need for a One Health approach to stewardship and patient care. One way to contribute to such an approach, Dr. Charani advises, is to advocate for greater equity in the availability of resources and care among all countries.

Implementing Effective Antimicrobial Stewardship Interventions

Dr. Charani explains that a global perspective is crucial in the development of plans for antimicrobial stewardship. When considering interventions, it is vital that we understand where the burden of disease is greatest and where resources are most limited. Interventions should account for location, healthcare settings with varying socioeconomic status, and diverse populations. “Unless we are able to address and manage antimicrobial resistance in those settings, we will not be able to address it anywhere. It's about working toward more equitable solutions,” says Dr. Charani. Stewardship objectives must also ensure that roles beyond prescribing physicians are involved in plans for optimizing antibiotic use, including laboratory professionals, pharmacists, nurses, and the public.

According to Dr. Charani, the keys to addressing barriers to antimicrobial stewardship are collaboration, equitable distribution of resources, and, importantly, leveraging the expertise of researchers in LMICs.

“There is a lot of expertise in these parts of the world that is not being used to its full potential when it comes to research in any field, as well as in infectious diseases,” she notes. These individuals often have a deep understanding of the challenges their countries face when trying to initiate stewardship, and they can help guide policies for targeted improvement in those settings. Additionally, strategies such as academic allyship, research, interconnectivity with policymakers, and campaigning to the public can all support global efforts in stewardship.

Addressing AMR requires a unified approach that considers the burden of disease in all countries, as well as an assessment of the resources and tools available, including diagnostics. Equitable resource allocation—in the form of education, funding, policy, and effective medicines—is an essential component to fighting back against antimicrobial resistance on a global scale. “We need to make sure that we collaborate with each other around the world on this issue,” Dr. Charani says, “that we learn from each other, and that we support each other in being able to implement interventions that are going to be long-lasting.”


Opinions expressed in this article are not necessarily those of bioMérieux.