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Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

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  • Susan Rogers Van Katwyk
  • Jeremy M Grimshaw
  • Miriam Nkangu
  • Ranjana Nagi
  • Marc Mendelson
  • Monica Taljaard
  • Steven J Hoffman

Abstract

Background: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. Methods and findings: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. Conclusions: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. Protocol registration: PROSPERO CRD42017067514. In a systematic review, Susan Rogers Van Katwyk and colleagues assess policy interventions intended to reduce antimicrobial overuse.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Susan Rogers Van Katwyk & Jeremy M Grimshaw & Miriam Nkangu & Ranjana Nagi & Marc Mendelson & Monica Taljaard & Steven J Hoffman, 2019. "Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map," PLOS Medicine, Public Library of Science, vol. 16(6), pages 1-17, June.
  • Handle: RePEc:plo:pmed00:1002819
    DOI: 10.1371/journal.pmed.1002819
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    Cited by:

    1. Özçelik, Ece A & Doucet, Cédric & Kang, Hyunjin & Levy, Noémie & Feldhaus, Isabelle & Hashiguchi, Tiago Cravo Oliveira & Lerouge, Aliénor & Cecchini, Michele, 2022. "A comparative assessment of action plans on antimicrobial resistance from OECD and G20 countries using natural language processing," Health Policy, Elsevier, vol. 126(6), pages 522-533.
    2. Ashok J. Tamhankar & Ramesh Nachimuthu & Ravikant Singh & Jyoti Harindran & Gautam Kumar Meghwanshi & Rajesh Kannan & Nachimuthu Senthil Kumar & Vikrant Negi & Lijy Jacob & Sayan Bhattacharyya & Krush, 2019. "Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries," IJERPH, MDPI, vol. 16(24), pages 1-17, December.
    3. Ashok J. Tamhankar & Cecilia Stålsby Lundborg, 2019. "Antimicrobials and Antimicrobial Resistance in the Environment and Its Remediation: A Global One Health Perspective," IJERPH, MDPI, vol. 16(23), pages 1-7, November.
    4. Gotham, Dzintars & Moja, Lorenzo & van der Heijden, Maarten & Paulin, Sarah & Smith, Ingrid & Beyer, Peter, 2021. "Reimbursement models to tackle market failures for antimicrobials: Approaches taken in France, Germany, Sweden, the United Kingdom, and the United States," Health Policy, Elsevier, vol. 125(3), pages 296-306.
    5. Niklas Harring & Eva M. Krockow, 2021. "The social dilemmas of climate change and antibiotic resistance: an analytic comparison and discussion of policy implications," Palgrave Communications, Palgrave Macmillan, vol. 8(1), pages 1-9, December.

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