The role of IPC, vaccination, and OTC distribution in AMR

I had the privilege of chairing a session in the BSAC Spring Conference webinars yesterday about the role of IPC, vaccination, and OTC distribution in AMR. The session had a talk from Professor Andreas Voss on IPC as a cornerstone of successful stewardship, Dr Elizabeth Klemm on prevention through vaccination, and Dr Abdul Ghafur on community pharmacy and the challenge of over-the-counter (OTC) distribution.

Andreas Voss made the case the preventing the transmission of microbes, especially in the hospital setting, is a key component of an antimicrobial stewardship programme. (Or is stewardship a key component of a successful IPC programme??) Andreas referenced a useful article in JIP by Martin Kiernan, outlining the role of IPC in preventing AMR. And made the case that so-called “horizontal” and “vertical” IPC strategies are required to support a successful stewardship programme.

Elizabeth Klemm gave an enlightening talk about the role of vaccination in preventing AMR. This is a fertile but not-often-discussed area of research and practice. There’s a nice review on the topic here in Nature Medicine and a report from WHO here. There’s a couple of angles through which vaccination can tackle AMR. Vaccines aimed at preventing bacterial infection have been effective in reducing AMR (e.g. pneumococcal vaccination), and vaccines aimed at preventing viral infection can indirectly reduce AMR. In the case of influenza vaccination, secondary bacterial infections are reduced, but also, there will be less undifferentiated respiratory infection arriving at the doorstep of healthcare providers, so less of a driver for emperic antibiotic therapy.

Abdul Ghafur joined us from Chennai where the COVID-19 situation is challenging to say the least right now. He told a passionate tale about the challenges of moving away from widespread OTC availability of antibiotics in India. Despite several attempts to ban and/or reduce OTC availability of antibiotics, a disappointing lack of progress has been made. This is due to a web of complex and inter-related factors. Some important discussion after the talk about how international collaboration that is contextualised locally could be one way to help to talk OTC distribution of antibiotics in India and elsewhere. Following the session, the panel discussed whether COVID-19 has derailed antimicrobial stewardship activities, and if so, how to get ourselves back on track. On the one hand, the COVID-19 pandemic has derailed our stewardship activities – healthcare providers have been through (or are going through) a period of rapid change to services and structures, meaning that the control of antimicrobial prescribing developed over many years has been lost in places. On the other hand, the prevention and management of infectious diseases has never been higher on the healthcare and political agenda than it is at the moment. So, we have an opportunity to use the renewed interest infectious diseases to make sure we have the building blocks in place for a successful IPC and antimicrobial stewardship programme.


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