Pediatric ASP Toolkit

The threat of antimicrobial resistance is a global health priority and must be addressed through global coordinated efforts. Many of the resources provided in this Toolkit refer to data and practices specific to the United States; however, antibiotic stewardship implementation in resource-limited settings faces additional challenges functioning with weak health systems where resources to combat antibiotic resistance may not be sufficient.

The following resources have been developed specifically targeting international resource-limited settings:

• CDC Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings
• Antimicrobial Stewardship in health-care facilities in low- and middle-income countries: a WHO practical toolkit 2019
• WHO Competency-Based Approach Modules for Antibiotic Stewardship
• Antibiotic Stewardship interventions in hospitals in low- and middle-income countries: as systematic review
• WHO Global Action Plan on Antimicrobial Resistance 2015
• WHO Antimicrobial Resistance: A Manual for Developing National Action Plans 2016
  • WHO: Library of National Action Plans
• Global AMR Surveillance System (GLASS)
  • AMR Surveillance in low and middle-income settings – A roadmap for participation in GLASS

Published data on antibiotic consumption, globally:

• WHO Report on Surveillance of Antibiotic Consumption
• Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) Point Prevalence Study

Examples of successful antibiotic stewardship initiatives:

At the national level:

• In Chile, restriction of over-the-counter sale of antibiotics to those with medical prescription in September 1999 led to a substantial decrease in consumption by 2002. However, since 2002 antibiotic consumption has increased to pre-intervention levels; this was attributed to lack of reinforcement measures (Bavestrello et al 2011).
• In 2012, medical societies came together in Chennai, India and developed the “Chennai Declaration” which comprised national recommendations and an action plan to address the challenge of antimicrobial resistance in India. It represented a bold national commitment to antibiotic stewardship and infection control across India. (Holmes et al 2013).

Additional References:

• Lucien MAB, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, Cerpa M, Joseph GA, Maki G, Zervos MJ, Dely P, Boncy J, Sati H, Rio AD, Ramon-Pardo P. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. Int J Infect Dis. 2021 Mar;104:250-254. doi: 10.1016/j.ijid.2020.12.087. Epub 2021 Jan 9. PMID: 33434666; PMCID: PMC7796801.
• Pierce J, Apisarnthanarak A, Schellack N, Cornistein W, Maani AA, Adnan S, Stevens MP. Global Antimicrobial Stewardship with a Focus on Low- and Middle-Income Countries. Int J Infect Dis. 2020 Jul;96:621-629. doi: 10.1016/j.ijid.2020.05.126. Epub 2020 Jun 4. PMID: 32505875; PMCID: PMC7271868.
• Dharmapalan, D. and Gavhane, JB.  Utility of WhatsApp media to promote judicious use of antimicrobials in resource-limited settings. Indian Journal of Child Health,2020; 7(10): 412-414. 
• Hijazi K, Joshi C, Gould IM. Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries. Expert Rev Anti Infect Ther. 2019 Aug;17(8):621-634. doi: 10.1080/14787210.2019.1640602. Epub 2019 Jul 15. PMID: 31282277
• Kakkar AK, Shafiq N, Singh G, Ray P, Gautam V, Agarwal R, Muralidharan J, Arora P. Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems. Front Public Health. 2020 Apr 28;8:140. doi: 10.3389/fpubh.2020.00140. PMID: 32411647; PMCID: PMC7198767.
• Kalaba M, Kosutic J, Godman B, Radonjic V, Vujic A, Jankovic S, Srebro D, Kalaba Z, Stojanovic R, Prostran M. Experience with developing antibiotic stewardship programs in Serbia: potential model for other Balkan countries? J Comp Eff Res. 2018 Mar;7(3):247-258. doi: 10.2217/cer-2017-0055. Epub 2018 Feb 21. PMID: 29465263.
• Brink AJ, et al. Antimicrobial stewardship across 47 South African hospitals: an implementation study. Lancet Infect Dis, 2016. 16(9):p1017-25.
• Goff DA, et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fall. Lancet Infect Dis, 2017. 17(2): e56-63.
• Holloway KA, Rosella L, Henry D. The impact of the WHO Essential Medicines policies on inappropriate use of antibiotics. PLOS ONE, 2016. 11(3):pe0152020.
• Saied T, et al. Antimicrobial stewardship to optimize the use of antimicrobials for surgical prophylaxis in Egypt: a multicenter pilot intervention study. Am J Infect Control, 2015. 43(11): e67-71.
• Cox JA, et al. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect, 2017. 23(11):p 812-18.
• Pisano J, et al. Social Media as a tool for antimicrobial stewardship. Am J Infect Control, 2016. 44(11):p 1231-36.