Access Not Excess

Action: Curb excessive use while ensuring access for people in need
Read our principles related to Access, Not Excess

Literature & Resources

Access Issues:

The access and excess dilemma: Part 5 of Antibiotic resistance – the need for global solutions
So, et al. | Lancet Infectious Diseases | 2013 (pp 15-19)

A challenge of antibiotic resistance is in ensuring access to these medicines when needed, but also the prevention of excessive use that may accelerate resistance, as outlined within the Lancet Infectious Diseases Commission on Antibiotic Resistance. This reading discusses strategic points of intervention from bench to bedside to address antibiotic resistance. These interventions must be focused on achieving access without excess, and include new treatment innovation, dissemination of effective antibiotic treatments, scale-up and implementation within the healthcare system through stewardship, and continued monitoring and assessment of these interventions with policy feedback and surveillance.

Access, excess, and ethics–towards a sustainable distribution model for antibiotics
Heyman, et al. | Upsala J of Med Sci | 2014

A sustainable model for antibiotic distribution aimed to improve access in low- and middle- income countries (LMICs) could be constructed using systems thinking of the entire health system, as suggested in this article. Interviewing stakeholders in various LMICs, this reading provides four themes for such a model to consider, including the barriers to rational access, the balance of access and excess, drawing upon similarities of other communicable diseases, and addressing issues with a health system-wide approach.

Conservation, Rational Use, & Stewardship

Antimicrobial Resistance Global Report on Surveillance
World Health Organization | 2014

This report shows global trends in antibiotic resistance, highlighting specific bacteria of international concern. It examines country- and regional-level data on nine bacterial strains, including common hospital- and community-acquired infections such as methicillin-resistant S. aureus (MRSA) and E. coli. The report describes health and economic burdens attributable to resistance and the emergence of resistance within WHO programs for tuberculosis, malaria, HIV, and influenza. The report is limited by the present gaps in worldwide surveillance. Tools and standards need to be developed and integrated for observation of AMR and its impacts on humans and the food chain.

Worldwide country situation analysis: response to antimicrobial resistance
World Health Organization | 2015

A questionnaire-based analytic tool was used to survey national leaders (with 133 responses out of 194 countries) within the six WHO regions on their national AMR plans, laboratory capacity to track resistance trends, access to medicines, prevention of antibiotic misuse, and general public awareness. Few countries had comprehensive, well-financed plans to monitor and combat antibiotic resistance, with only 34 out of 133 participating countries reporting comprehensive AMR plans. High-income regions reported higher rates of access to quality antimicrobials, and regions with concerns over counterfeit and low-quality medicines reported weaker regulatory authority or capacity to enforce national standards. All six regions reported overuse of antimicrobials as a problem, with several regions noting concerns over lack of prescription requirements or regulation of antimicrobials. Public awareness was also low, raising concerns that adequate standards will be ineffective without improved awareness.

Interventions to improve antibiotic prescribing practices for hospital inpatients
Davey, et al. | Cochrane Database Syst Rev | 2013

The effectiveness of restrictive versus persuasive interventions on antibiotic prescribing practices in hospital care was studied in a review of 89 studies. The analysis supported the use of restrictive interventions in the setting of urgent need, but found both persuasive and restrictive interventions to be equally effective after six months. Few of these studies (<6%) were conducted in low- and middle-income country settings.