Drug-resistant strains of bacteria are prevalent in both hospital and community settings; they cost billions of avoidable healthcare dollars and cause unnecessary disability and death. If left unaddressed, antibiotic resistance could recreate a pre-antibiotic era in which invasive surgeries are impossible, and people routinely die from simple bacterial infections.

CDDEP views antibiotic effectiveness as a shared resource: using an antibiotic now increases the opportunity for bacteria to develop resistance and thus reduces our ability to use that antibiotic in the future. Addressing antimicrobial resistance (AMR) is difficult because patients, physicians, hospitals, pharmaceutical companies, and agricultural users have insufficient incentives to act in ways that would conserve antibiotic effectiveness.

These challenges suggest the simultaneous deployment of multiple strategies: vaccination to prevent illness and reduce demand for antibiotics, aggressive hospital infection control, judicious prescribing and cycling of antibiotics, treatment with narrow-spectrum antibiotics, development of new antibiotics, AMR communication strategies, and coordinated federal policies that steward this resource.

AMR & the Drug Resistance Index

To better communicate the problem of antimicrobial resistance, researchers at CDDEP developed the Drug Resistance Index (DRI) which provides a snapshot of the effectiveness of antibiotic therapy by country. The DRI resembles stock market indices and combines antibiotic consumption measurements with resistance data to help compare aggregate resistance across time and between countries.

CDDEP researchers also worked to fill the gap in Antibiotic Stewardship Programs in low-and-middle-income countries (LMICs) by developing a checklist feasible to adopt globally in all healthcare facilities. The result was the Checklist for Hospital Antimicrobial Stewardship Programming (CHASP).

The seven core components of CHASP address:

  1. Senior hospital management and leadership
  2. Accountability and responsibility
  3. Access to infection management professionals
  4. Education and practical training
  5. Continuous monitoring and surveillance of stewardship activities
  6. Reporting and sharing of antimicrobial resistance and antimicrobial monitoring data
  7. Actions aimed at responsible antimicrobial use

Fighting AMR with GARP

CDDEP’s Global Antibiotic Resistance Partnership is developing actionable policy proposals for India, Kenya, South Africa, and Vietnam. Researchers are identifying weaknesses in how antibiotics are developed and regulated and how antibiotic use and resistance are tracked. The expertise developed in these five countries will be the core of a wider partnership that helps policymakers in other low- and middle-income countries control antibiotic resistance as part of a worldwide effort.

While “overuse” of antibiotics is widely accepted as a major health challenge, it is less well known that many people in low- and middle-income countries continue to die because they lack access to antibiotics. CDDEP’s Access Barriers to Antibiotics report makes several recommendations proposing action on antibiotic and diagnostics research and development, strengthening regulatory capacities, encouraging the development and diversification of quality local manufacturing, exploring innovative funding to reduce out-of-pocket payments, raising awareness, and improving clinical treatment guidelines.