Antimicrobial stewardship in a resource-poor setting

Low- and middle-income countries (LMICs) face a high burden of infection and, commonly, colliding epidemics of HIV, malaria, tuberculosis, and other bacterial diseases. The resulting high usage of antimicrobials, inappropriate prescribing, and use of falsified or counterfeit medicines drives antimicrobial resistance. Stewardship programmes need to be developed within the social and cultural norms of the country, and take cognizance of competing health needs, which may prove important barriers. A situational analysis of the country’s resources and challenges with respect to antimicrobial resistance and the need for regional and international collaboration to effect change are important first steps to establishing a programme. Identifying, developing, and unifying stewardship champions aids in the translation of policy into practice. Leadership at the highest level is required in partnership with national government. While resource limitations are a significant barrier to stewardship programmes, concentrating on low-hanging fruit allows LMICs to develop meaningful programmes to combat antimicrobial resistance.