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Efficient and secure supply chains are vital for effective health services worldwide. In low- and middle-income countries, the accessibility, affordability and availability of essential medicines, including antimicrobials, remain challenging. Ineffective supply chains often cause antimicrobial shortages, leading to inappropriate use of alternative agents and increasing the risk of antimicrobial resistance. Shortages, coupled with insecure supply chains, also encourage the infiltration of substandard and falsified medicines, leading to suboptimal treatment and further promoting antimicrobial resistance. Addressing antimicrobial supply-chain issues should be considered a key component of antimicrobial stewardship programmes. We have explored the link between medicine supply chains and antimicrobial use in seven focus countries: Kenya, Malawi, Nigeria, Sierra Leone, Uganda, United Republic of Tanzania and Zambia. We explored country medicine supply-system structures, national medicine supply-chain policy documents and global study reports. Our aim was to develop evidence-based strategies to enhance the effectiveness and efficiency of the medicine supply chains in supporting antimicrobial stewardship efforts. Better management of medical supply chains involves rational selection, quantification, forecasting, procurement, storage, distribution, use and stock management of antimicrobials. Important supply-chain considerations include pooled procurement networks to ensure consistent pricing of quality-assured antimicrobials, and improved resource utilization and information exchange among relevant stakeholders. We propose adaptable recommendations for integrating medicine supply chains as an essential part of antimicrobial stewardship programmes, with a call for action at the local, regional and national levels in low- and middle-income countries. Partout dans le monde, les performances des services de sante dependent de l'efficacite et de la securite des chaines d'approvisionnement. Mais dans les pays a revenu faible et intermediaire, l'accessibilite et la disponibilite des medicaments a prix abordable, y compris des antimicrobiens, representent toujours un defi. Linefficacite des chaines d'approvisionnement entraine souvent des penuries d'antimicrobiens et, par consequent, un recours a des alternatives inappropriees et une augmentation du risque de resistance aux antimicrobiens. Ces penuries, alliees a des chaines d'approvisionnement peu fiables, favorisent egalement l'introduction de medicaments falsifies et de qualite inferieure, alterant l'efficacite du traitement et renforcant encore davantage la resistance aux antimicrobiens. Resoudre les problemes lies aux chaines d'approvisionnement en antimicrobiens devrait donc figurer parmi les priorites des programmes de gestion des antimicrobiens. Le present document s'interesse au lien entre les chaines d'approvisionnement en medicaments et l'utilisation d'antimicrobiens dans sept pays cibles: le Kenya, le Malawi, le Nigeria, l'Ouganda, la Republique-Unie de Tanzanie, la Sierra Leone et la Zambie. Pour chacun de ces pays, nous avons examine les structures du systeme d'approvisionnement en medicaments, les documents relatifs a la politique d'approvisionnement national et les rapports d'etudes globaux. Notre objectif consistait a developper des strategies fondees sur des donnees factuelles, afin d'ameliorer le fonctionnement et l'efficacite des chaines d'approvisionnement en medicaments et de contribuer ainsi aux efforts de gestion des antimicrobiens. Une meilleure logistique requiert une certaine rationalite dans la selection, la quantification, la planification, l'approvisionnement, le stockage, la distribution, l'utilisation et la gestion des stocks d'antimicrobiens. Dans ce contexte, plusieurs elements sont importants tels que les reseaux d'achats groupes, qui assurent la stabilite des prix pour des antimicrobiens de qualite garantie, ou encore l'optimisation des ressources et l'echange d'informations entre les acteurs concernes. Nous formulons des recommandations ajustables en vue de rendre les chaines d'approvisionnement en medicaments incontournables dans les programmes de gestion des antimicrobiens, avec un appel a agir a l'echelle locale, regionale et nationale dans les pays a revenu faible et intermediaire. Unas cadenas de suministro eficientes y seguras son vitales para la eficacia de los servicios sanitarios en todo el mundo. En los paises de ingresos bajos y medios, la accesibilidad, asequibilidad y disponibilidad de los medicamentos esenciales, incluidos los antimicrobianos, sigue siendo un reto. Con frecuencia, las cadenas de suministro ineficaces provocan escasez de antimicrobianos, lo que conlleva un uso inadecuado de agentes alternativos y aumenta el riesgo de resistencia a los antimicrobianos. La escasez, sumada a la inseguridad de las cadenas de suministro, tambien favorece la infiltracion de medicamentos de calidad inferior y adulterados, lo que conduce a un tratamiento suboptimo y fomenta aun mas la resistencia a los antimicrobianos. Abordar los problemas de la cadena de suministro de antimicrobianos se deberia considerar un componente clave de los programas de administracion de antimicrobianos. Hemos explorado la relacion entre las cadenas de suministro de medicamentos y el uso de antimicrobianos en siete paises seleccionados: Kenia, Malawi, Nigeria, Sierra Leona, Uganda, Republica Unida de Tanzania y Zambia. Exploramos las estructuras de los sistemas de suministro de medicamentos de los paises, los documentos de politica nacional sobre la cadena de suministro de medicamentos y los informes de estudios globales. Nuestro objetivo era desarrollar estrategias basadas en evidencias para mejorar la eficacia y la eficiencia de las cadenas de suministro de medicamentos en apoyo de los esfuerzos de administracion antimicrobiana. Una mejor gestion de las cadenas de suministro de medicamentos implica la seleccion racional, la cuantificacion, la prevision, la adquisicion, el almacenamiento, la distribucion, el uso y la gestion de las existencias de antimicrobianos. Entre las consideraciones importantes sobre la cadena de suministro se incluyen las redes de adquisicion mancomunada para garantizar precios coherentes de antimicrobianos de calidad garantizada y una mejor utilizacion de los recursos e intercambio de informacion entre las partes interesadas pertinentes. Proponemos recomendaciones adaptables para integrar las cadenas de suministro de medicamentos como parte esencial de los programas de administracion de antimicrobianos, con una llamada a la accion a nivel local, regional y nacional en los paises de ingresos bajos y medios., Introduction Antimicrobial resistance disproportionately affects low- and middle-income countries. (1) An often-missing component of governance surrounding antimicrobial resistance in many countries is medicine procurement and inventory control. Antimicrobial stewardship programmes, [...]

Objectives: To examine public beliefs about antibiotics, AMR, and knowledge of antibiotic use, and how these relate to self-reported antibiotic use. Methods: Two hundred and fifty participants from 23 countries completed a cross-sectional, online survey assessing beliefs about antibiotics and AMR, knowledge of antibiotics, and antibiotic use. Descriptive statistics, Mann–Whitney U tests and Spearman's ρ correlations were used to understand relationships between outcomes. Key findings: Respondents generally viewed antibiotics positively, with particularly strong beliefs regarding their benefit (M = 16.48 out of 20, SD = 2.62) and few concerns regarding their harm (M = 3.98 out of 10, SD = 1.82). Greater benefit beliefs about antibiotics were associated with fewer concerns about their overuse (P <.0001) and harm (P <.0001). Stronger perceived importance of AMR was associated with greater beliefs about the benefits of antibiotics (P =.006), greater concerns about their overuse (P =.009), and increased knowledge of appropriate use (P =.006). Those who reported inappropriately using their last antibiotics had greater concerns about overuse (P =.12) and less knowledge regarding appropriate use (P =.015), compared to those who did not. Conclusions: Generally, the public tends to view antibiotics as having strong benefits and have few concerns about their harm, which may have implications for inappropriate use. These initial findings highlight beliefs that could be targeted in messages to reduce inappropriate demand for antibiotics. [ABSTRACT FROM AUTHOR]

The plans for a new antimicrobial utilization and resistance national surveillance programme, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions were published in 2013. Since then, England has published an annual surveillance report including outlining progress against the ambitions of the UK national action plans on antimicrobial resistance (2013 to 2018 and 2019 to 2024). A decade later we provide a brief update on progress so far, with a focus on key highlights from the latest report published in November 2022. We also provide our recommendations for areas of focus as we move into the next decade. From an initial focus on antibiotic consumption and resistance, the report now includes surveillance data for antifungals, antivirals (including novel agents, such as those targeting SARS-CoV-2) and antimalarials. Evaluation of key stewardship interventions including professional and public engagement initiatives are also reported, as well as progress against NHS England's (NHSE's) improvement measures. [ABSTRACT FROM AUTHOR]