Three global projects tackling antimicrobial resistance
Around the world, antimicrobial resistance, or AMR, is an ever-increasing threat. If not addressed as a matter of urgency, it could kill over 300 million people prematurely globally by 2050. Our network of researchers AMR at Leeds is tackling this growing global crisis.
What is AMR?
Antimicrobial agents, such as antibiotics, are our primary means of treating infectious diseases in humans and animals. Unfortunately, these drugs are rapidly becoming less effective, as microbes evolve to resist their effects, a phenomenon referred to as antimicrobial resistance or AMR.
Although a process that can occur naturally, the problem is being made worse by the overuse, misuse and improper disposal of antimicrobial drugs across human, animal and environmental sectors.
At the same time, development of antimicrobial drugs has stalled over the past thirty years.
AMR threatens to reverse decades of human medical progress, turning routine surgery and cancer chemotherapy into high-risk procedures.
One of the key ways we can tackle this challenge is to find ways to stop using antibiotics when they aren’t needed, or won’t be effective, and to use the right type of antibiotic for the condition. “The right drug for the right bug.”
We’re looking at three interventions in Pakistan, China and Nepal that are helping to change the way antibiotics are used.
Changing behaviour in healthcare
Researchers Professor John Walley, Dr Rebecca King and Dr Joe Hicks have been working with healthcare partners in Pakistan and China to change behaviour around prescribing of antibiotics and help patients understand how to take them effectively.
This work has been shown to reduce unnecessary antibiotic use and is now influencing policy and practice in both countries.
Providing effective community-based TB care in Pakistan
Resistance to antibiotics is a widescale problem among patients with Tuberculosis (TB).
Many patients are treated throughout life with the same type of antibiotics which makes resistance more likely to develop and doesn’t always tackle the different infections the patients might contract.
In Pakistan, with ministry of health partners, we developed a case management guide, training and recording system for doctors treating patients in community-based drug-resistant TB care.
In rural Pakistan, most patients access community-based care rather than hospital-based care, as it is more accessible.
The doctors were trained to diagnose the secondary infections effectively, and to treat them with the right type of drugs. Enhancing the knowledge of the doctors in this way was found to be acceptable, feasible and as effective as hospital-based care.
This approach has now been embedded within health policy and practice in Pakistan, and is being scaled up across the country, with cure rates above the global average. We have conducted similar research in China, and an intervention trial is ongoing.
Treating respiratory infections in children in China
In China, we worked with health bureau partners to develop an intervention which has successfully reduced unnecessary prescribing of general antibiotics among children with upper respiratory tract infections.
Upper respiratory tract infections are viral infections (like the common cold) and so antibiotics are not necessary, unless the doctor suspects a bacterial infection.
We conducted a randomised, controlled trial in 25 rural primary care clinics. We developed a clinical guide and training for doctors to help them identify when the condition needed treating with antibiotics and supporting information to caregivers. Doctors also arranged prescribing review meetings with patients.
In the intervention facilities, there was a reduction of (unnecessary) prescribing by 40% among 2–14 year-old children with upper respiratory tract infections.
At our 12-month follow up, we found the intervention had a sustained effect in reducing unnecessary prescribing compared to the control group.
Community arts against antibiotic resistance in Nepal
This project, by Professor Paul Cooke, Dr Rebecca King and collaborators at research agency HERD International (Nepal), used participatory film-making as its key method to engage communities with the issue of AMR.
We worked in two sites within the Kathmandu valley, one urban and one peri-urban. We ran week-long training sessions where community members were introduced to the concept of AMR and explored their own relationship with this challenge.
Alongside AMR education, workshops taught participants how to use film-making equipment, develop storylines, create clear messages and cut their final product.
This allowed the groups to co-produce six short films describing local experiences of AMR in action and suggesting behavioural changes the community could make to modify AMR risks, such as not sharing antibiotics either with each other or to treat livestock.
Films were shared during community showcasing events where local people and government officials were invited to attend.
Health professionals within our team supported this methodology by designing a pilot. This enabled us to gain local knowledge and understanding to help inform the main project. We met local people on a smaller scale, allowing us to scope the needs of our community and to understand their use of language around AMR, antibiotics and illness more generally. This facilitated the development of a much stronger intervention which was specifically tailored to the needs of each community.
The identification of the research sites was guided by our Nepali team members from HERD international. We worked with 44 individuals across both sites however our showcasing events allowed the project to reach a further 231 individuals (excluding the families of original participants).
The project has allowed us to understand the lived experiences of our focal communities in relation to AMR.
The films have been used to facilitate discussion on AMR with the Nepalese Ministry for Health and Population at an international conference in June 2019. The Ministry have since invited our HERD colleagues to support the development of the country’s antimicrobial resistance (AMR) action plan and to support and advise on other AMR-related policies.
