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John M Conly
Correspondence: John M Conly email@example.com
Antimicrobial Resistance and Infection Control 2012, 1:10 doi:10.1186/2047-2994-1-10
(2012-03-30 09:58) USAID
An interesting "in a nut-shell" review. Not exactly a success story.
My take... Not rocket science, but some of the probable causes for limited impact
of interventions against inappropriate use of antimicrobials are that:
- It is often approached from a general perspective that fail to engage stakeholders,
i.e. decrease it "across the table", as opposed to aim for specific uses, e.g. "decrease
inappropriate use of antimicrobials in children under five with respiratory infections".
We chose the latter and did an eco-systemic analysis disclosing elements such as:
most out-patient care events are or children under five, due to respiratory infections
for which antimicrobials are prescribed in 71% of cases mostly unnecessarily; prescribers,
dispensers and parents were prone to do the right thing for the under-five (taking
the ill child to a health service, prescribing correctly, selling/buying the prescribed
dosage, adhering to treatment); and led to a multi-prong intervention (introducing
clinical guidelines, informing the community face to face and through media; improving
quality assurance/control of antimicrobials, and local capacity to monitor antimicrobial
For a description of the ecosystemic approach developed under USAID's South American
Infectious diseases Initiative see http://usaidsaidi.org/extras/SAIDI_APPROACH_lo_f_012411.pdf
and for technical reports, articles, materials produced under SAIDI see http://www.usaidsaidi.org/resources.shtml
- Top down, whole of organization interventions often do not include necessary restrictive
and enabling changes in working environment, are not sustained long enough, and fail
to elicit ownership and buy-in. Probably, ��motivated, enabled guerrilla�� approaches
sustained long enough will be better than approaches based on individual changes (as
most KAP interventions are).
Examples: The evidence-based intervention used to reduce the incidence of catheter-related
bloodstream infections reported by Provonost years ago - See http://www.nejm.org/doi/full/10.1056/NEJMoa061115
-, and the initiatives based on it (e.g infection zero); and article by Gastmeier
et al. in this journal http://www.aricjournal.com/content/1/1/8/abstract
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