One Health Trust President Dr. Ramanan Laxminarayan co-authored a Personal View that discusses the challenges faced by low- and middle-income countries (LMICs) in responding to antibiotic resistance. Issues such as access to novel antibiotics, a lack of bacterial resistance surveillance and data on antibiotic use, and insufficient resources to implement antimicrobial stewardship – usually designed according to the availability of resources in high-income countries – all limit the ability of LMICs to mount effective measures to prevent and reduce the burden of antibiotic resistance.

The authors of this article call for a new model for antibiotic availability and use in LMICs. First, evidence-based guidance should direct clinical decision-making regarding antibiotic use, particularly in the context of severe bacterial infections. A similar approach was taken during the introduction of the novel tuberculosis drug bedaquiline, which was accompanied by clear, evidence-based recommendations for use when it became available in early adopter countries. The authors emphasize the idea that the response to antibiotic resistance in LMICs should include the availability of Reserve antibiotics and novel antibiotic combinations, the appropriate use of which will promote their ability to successfully target bacterial pathogens.

The implementation of such a model will require adaptation to local contexts, such as national political will, governance, and resources. Interdisciplinary advisory and implementation teams should be organized at the national level to ensure that stewardship is informed by local perspectives and investment.

Read the full article published in The Lancet Infectious Diseases here.