Governance and Stewardship of Antibiotics
A key strand to the work in Edinburgh on AMR is understanding how antibiotic use can be governed and regulated at the global level and the challenges to implementing evidence-based policies in countries across the world.
Theme leader: Professor Devi Sridhar
Highlights in this theme
Global Governance of Antimicrobial Resistance - a One Health Approach
AMR, particularly resistance to antibiotics, poses grave risks which no country can avoid without global collective action.
This stream of work led by Prof Devi Sridhar (Edinburgh) in collaboration with the Blavatnik School of Government at Oxford University and Chief Medical Officer Dame Sally Davies looks at how global governance can be enhanced to ensure progress is made in a number of key areas:
- convening negotiations and setting global standards and targets in human health, agriculture and the environment
- conducting surveillance and monitoring progress towards goals in antibiotic use, resistance levels and antimicrobial production
- building norms and public knowledge about the true scale of AMR and the economic consequences
- financing alternatives and innovations such as new vaccines, diagnostics and therapies
- collaborating with the private sector where possible
- ensuring accountability to consumers and citizens. It also examines the strengths of the existing tripartite UN arrangements for AMR and what steps might be needed to further action on AMR at the global level.
ePrescribing-Based Antimicrobial Stewardship Programme (ePAMS+)
The ePAMS programame is a £2.5 million multidisciplinary collaboration to develop and evaluate a multifaceted intervention (ePAMS+) that incorporates technical, behavioural and organisational components to safely reduce inappropriate antibiotic use in adult medical in-patients.
It is funded by the National Institute of Health Research.
The Programme is led by Professor Aziz Sheikh in the Usher Institute for Population Health Sciences and Informatics, alongside colleagues at the Universities of Edinburgh, Birmingham, Warwick, Bristol, Newcastle, York; Harvard University; Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Free London NHS Foundation Trust and NHS England.
ePAMS consists of four work packages which seek to address a number of questions:
Work Package 1: Planning, developing, optimising, and carrying out qualitative feasibility
Work Package 2: Establishing the feasibility of evaluating ePAMS+ through a hybrid cluster-randomised stepped-wedge trial
Work Package 3: Evaluating the effectiveness of ePAMS+ in reducing antibiotic use in adult medical in-patients: a hybrid cluster
Work Package 4: Estimating the cost-effectiveness of ePAMS+
For more details about the Programme please visit their website.
DOSA - Diagnostics for One Health and User Driven Solutions for AMR
Lack of appropriate diagnostic methods is one of the major reasons for in appropriate and overuse of antibiotics.
In the £3million Diagnostics for One Health and User Driven Solutions for AMR (DOSA) project, led by the University of Edinburgh and the IIT Delhi, researchers from India and UK with background in social sciences, technology innovation, and experts in different community settings, are coming together to jointly address this issue.
They are studying current practices, user behaviours, social and economic reasons behind antibiotic consumption in India.
Based on a user mapping study, they plan to formulate target product profiles i.e., specification of the diagnostic test for three communities setting.
- urinary tract infections in human health
- mastitis (infection of cows' udder) in dairy sector
- antibiotic residue detection in water from the environment.
Development of new technologies
Currently, due to lack of appropriate diagnostic technologies, doctors are prescribing broad spectrum antibiotics empirically (i.e. in a trial and error fashion) and farmers are using huge quantities of antibiotics in agriculture and fish farming without appropriate guidance and monitoring.
Development of these diagnostic methods will help to reduce the unnecessary consumption, blind prescription and release of antibiotics.
DOSA Project team
The project is led by Till Bachmann in the Division of Infection and Pathway Medicine at the University of Edinburgh, alongside Edinburgh colleagues Alice Street (School of Social and Political Science) and and Dominic Moran (Global Academy of Agriculture and Food Security), and UK collaborators at the Universities of Bradford, Southampton and University of the Arts London.
Indian partners include the Indian Institute of Technology Delhi; the Centre for Cellular and Molecular Platforms Bangalore; ICAR-Central Institute of Fisheries Technology, Cochin, Kerala; ICAR-National Dairy Research Institute, Karnal, Haryana; Silchar Medical College and Assam University, Silchar, Assam.
Antimicrobial Steward: David Dockrell, Professor of Infection Medicine, Centre for Inflammation Research, Queen's Medical Research Institute
David Dockrell has nearly 30 years experience as an Infection Medicine clinician scientist.
He has been involved in antimicrobial stewardship throughout this period and is involved with local infection control and antimicrobial policies along with colleagues in NHS Lothian. He also works with colleagues in pharmacy to implement efficient and cost-effective antimicrobial usage, including in antivirals.
He has previously contributed to regional antimicrobial policies in NHS England. His current national roles include as a Member of the Commission on Human Medicines Anti-infectives committee since 2009.
He has authored or edited national guidelines for antimicrobial therapy for the British HIV Association and the British Infection Association and has served as editor for national guidelines on Opportunistic Infections in HIV for the last ten years.
He is an original applicant and has served on the management committee for the national training programme in AMR funded by the Medical Research Foundation, is an advisor on projects for CarbX/Wellcome Trust, and contributor to the UKRI Cross Council Initiative on AMR.