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[2 minute read]

An international collaboration involving Oxford Population Health researchers will combine multiple datasets to support localised targets for optimising antibiotic usage.

Antimicrobial resistance (AMR) describes disease-causing microorganisms (such as bacteria and viruses) that have evolved resistance to antimicrobial drugs. The World Health Organization has declared AMR as one of the top ten global public health threats facing humanity, and is urging all countries to rapidly reduce their use of antibiotics to help counter this. Recent years, however, have seen a marked rise in total antibiotic use, particularly in low- and middle-income countries, despite many countries having national action plans to tackle AMR. A key challenge is the lack of indicators linking antibiotic use and AMR at the level of individual healthcare facilities that could inform local or national guidelines on optimal antibiotic use.

To address this, Oxford Population Health researchers are contributing to an international project to develop simple open-access tools to guide the development of national and local policies to improve antibiotic prescribing.

The project, called AMR Data to Inform Local Action (ADILA), is being coordinated by the Centre for Neonatal and Paediatric Infections (CNPI), hosted by St George’s, University of London. The CNPI-AMR working group brings together experts on AMR, antibiotic usage modelling, and policy development, and focuses on exploring novel strategies to prevent disease caused by drug-resistant pathogens. ADILA will build on work from the Global Research on Antimicrobial Resistance (GRAM), hosted by the Centre for Tropical Medicine and Global Health at the University of Oxford. Through combining surveillance data, clinical information, and geospatial maps, GRAM has generated quantitative estimates of national and global AMR burdens. ADILA will combine these and other datasets with information on antibiotic use from healthcare settings to inform future policy interventions to combat AMR.

The main objective for ADILA is to assess the feasibility of developing “clinical antibiotic management tools” for hospitals and primary care (community) facilities. The researchers intend to integrate data on antibiotic prescribing, diagnostic test results, clinical outcomes, and the local burden of AMR, and use these to inform localised guidelines and targets for antibiotic use.

ADILA will also explore whether it is possible to model the relationship between the tendency to prescribe antibiotics for a condition of interest (such as lower respiratory tract infections) and adverse clinical outcomes, to assess whether there may be safe levels of prescribing. This will generate greater understanding about the trade-off between the immediate patient benefits of antibiotic use and the costs of not prescribing against the wider risk of AMR developing.

Dr Koen Pouwels, a Senior Researcher at the Health Economics Research Centre at Oxford Population Health, will be leading the work to develop an antibiotic management tool for primary care settings. This will draw on his previous work to determine antibiotic prescribing targets in English primary care facilities. In addition, Dr Pouwels will contribute his expertise in using mathematical, statistical, and machine learning approaches to model the development and health-economic impacts of healthcare-associated infections and AMR.

Dr Pouwels said: ‘Targets for reducing overall antibiotic prescribing are complex decisions that must take into account the partially competing objectives of assuring that individual patients receive the best treatment while preserving the effectiveness of antibiotics for future patients, potentially including the patient that is currently consulting. These decisions should also consider local rates of disease burden, and the importance of maintaining and providing access to antibiotics at an affordable cost, particularly for vulnerable populations. By helping countries to design surveillance systems and policies better adapted to the local setting, ADILA will support national ownership of and commitment to strategies to combat AMR.’