A paper in this week's Lancet estimates that 39 million people will die by 2050 due to antimicrobial resistance. I would like to highlight the contribution of inappropriate use of antibiotics associated with failure to access and apply relevant, reliable healthcare information, and to recognise the many achievements of the HIFA Project on Prescribers and Users of Medicines https://www.hifa.org/projects/prescribers-and-users-medicines
Citation, extracts and comment from me below.
CITATION: Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050
The Lancet September 16, 2024
GBD 2021 Antimicrobial Resistance Collaborators
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2824%290...
EXTRACTS
'Cumulatively from 2025 to 2050, our reference scenario forecasts 39·1 million (33·0–46·0) deaths attributable to AMR...
'It is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.'
COMMENTS (NPW): A systematic review by the HIFA Project on Prescribers and Users of Medicines, in association with the London School of Hygiene and Tropical Medicine, concluded: Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle income settings. This includes, importantly, information to guide appropriate selection and use of antibiotics.
How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review. Chris Smith, Michelle Helena van Velthoven, Nguyen Duc Truong, Nguyen Hai Nam, V Phan Anh, Tareq Mohammed Ali AL-Ahda, Osama Gamal Hassan, Basel Kouz, Nguyen Tien Huy, Malcolm Brewster, Neil Pakenham-Walsh. BMJ Global Health 2020;5:e002094. Published on 2nd April 2020
https://gh.bmj.com/content/5/4/e002094
Several years ago, WHO noted: “Globally, many prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.”
This situation has presumably evolved with more health workers having access to the internet, but I am unaware of any evidence that such access is leading to better antibiotic stewardship across the world. Indeed, it is relatively easy to get reliable information about a specific antibiotic, if one knows where to look. But it is not so easy to get guidance on how to select antibiotics for different clinical contexts. And even where such information is available, it may not be in a language or format that prescribers (or users) will find easy to use.
Back in 2017 the HIFA Project on Prescribers and Users of Medicines worked with UK Medicines Information on a scoping review of the issues, and we concluded that 'Given the very limited evidence base and the huge importance of the subject, a proposal to hold a multi-stakeholder meeting in 2018 is being discussed further with the BMA, WHO and others to address the question: “How can we better meet the information needs of prescribers and users of medicines in low- and middle income countries?”
This meeting never happened due to lack of funding. The cost of such a meeting would have been minuscule compared to the costs of AMR itself.
'The World Bank estimates that AMR could result in US$ 1 trillion additional healthcare costs by 2050, and US$ 1 trillion to US$ 3.4 trillion gross domestic product (GDP) losses per year by 2030.'
https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
Given the eye-watering financial and human cost of AMR, and the centrality of inappropriate prescribing, it is extraordinary that there is as yet no financial support to address the information needs of prescribers and users of antibiotics.
For further information on the HIFA Project on Prescribers and Users of Medicines, contact me at: neil@hifa.org
Many thanks, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
