Using clinical data to inform local action against antimicrobial resistance

Antimicrobial resistance (AMR) is a major global health challenge. Recent data from the Wellcome supported Global Research on Antimicrobial Resistance (GRAM) study showed that in 2019, about 1.27 million deaths were caused by AMR. Annual deaths from AMR are higher than HIV or Malaria. Unless there are changes in our behaviours, this number will only increase over time.

The inappropriate use of antibiotics is a major driver of AMR. Although this is a global issue, antibiotic use is incredibly complex, with a rich set of multi-sectoral influences including beliefs and behaviours around their use, their availability and guidelines for prescribing which vary locally and nationally.

Wellcome is dedicated to ensuring the appropriate, evidence-based use of these precious medicines. As part of this effort, we are working with partners to support research that will develop tools, interventions and practices to help prescribers, consumers and policy makers improve antibiotic use for people’s health.?

Interventions to address AMR must be context specific

Due to the wide variability of antibiotic use globally, a one-size-fits-all approach to making improvements will fall short of the mark. Any interventions, policies or guidelines must be setting and context specific. Key to making interventions contextually relevant, is gathering, scrutinising and truly understanding data on how antibiotics are prescribed and consumed at national and local levels in both the primary care and hospital settings.

In recent years, considerable efforts and progress have been made to improve the generation and collection of global data on antibiotic consumption, the spread of drug-resistant pathogens and their impact on people and communities. These data are used to inform global committees on the scale of the problem, the clinical burden of resistant infections and help develop guidelines on antibiotic prescribing.

However, these high-level data and strategies may not seem locally relevant and may not be representative of the situation and specific needs in individual countries. Often, data from low-and-middle-income countries (LMICs) are lacking, meaning that solutions and policies that are developed are also not appropriate for areas with the greatest burden of drug-resistant infections.

Currently no specific tools or systems are available to provide individual LMICs with an integrated assessment on the local availability of antibiotics, their own antibiotic prescribing patterns, and data from community sales, hospital use and total overall consumption – the main measures of antibiotic use. These tools would enable national governments and local policy makers to make decisive and effective actions to optimise antibiotic use and help reduce the spread of resistance.?

A potential solution

This month sees the start of a new Wellcome-funded and co-developed project, ADILA (Antimicrobial Resistance, Prescribing, and Consumption Data to Inform Country Antibiotic Guidance and Local Action). The project aims to develop a suite of simple but informative tools to help LMICs make the best possible use of existing AMR surveillance data to guide local action. It is led by Professor Mike Sharland at St George’s, University of London, with support from a large multi-disciplinary team of researchers, data-modellers and policymakers in a range of countries including?Australia, Cambodia, Indonesia, Malawi, Kenya, Singapore, Switzerland, Thailand and UK. The project will work in close collaboration with the World Health Organization.

During the project the team will use a range of modelling methods to study relevant existing datasets on clinical management, antibiotic resistance, antibiotic consumption, and clinical outcomes. The information and outcomes produced will be used to develop simple systems that aim to provide countries with a more comprehensive assessment of their own patterns of antibiotic use. It is recognised that there are many issues with limited data from all sectors. But the goal is to make optimal use of a wide range of existing data sets to develop ?tools that can be used to inform, support and shape the development of individual, locally relevant policies, guidelines and targets to help reduce total levels of inappropriate antibiotic use. Each of the tools developed will be piloted nationally in partner countries to test their feasibility and understand potential barriers to their integration into decision making processes.?

Methodology and specific objectives

ADILA will be funded by Wellcome for a period of 3.5 years, and work is split into 3 modules.

Modules 1 and 2 focus on data identification, analysis and modelling and run concurrently. Module 1 centres on hospital level clinical and microbiology data, including information gathered from other Wellcome supported studies (including GRAM and ACORN – A Clinically Oriented Antimicrobial Resistance Surveillance Network). Module 2 explores primary care optimal antibiotic prescription and consumption data including comparisons of actual prescription levels with suggested guidelines and potential impact on patient outcomes.

The final module encompasses piloting and testing of tools developed in Modules 1 and 2 and capacity building in partner countries. Communication and engagement with a range of stakeholders in partner countries is key to effective implementation of the tools – conversations will be ongoing throughout the duration of the project.

The availability of the tools that will emerge from ADILA will be another step towards enabling and empowering decision makers in countries with limited resources to design and implement local policies better adapted to their own local settings. Local level AMR action, driven and owned by individual countries rather than top-down from a global level is a key priority for the Infectious Disease health challenge area. This work will allow for the creation and use of more meaningful guidelines and targets and support greater national ownership of and commitment to tackling AMR.

If you would like to learn more about our strategy and plans for optimising antibiotic use, please visit the Drug-Resistant Infections page on our website.

You can follow the progress of ADILA via the project website or by following us on Twitter (@Wellcome_AMR).?