What are the most effective community-based antimicrobial stewardship interventions in low- and middle-income countries? A narrative review

  29 January 2021

Antimicrobial resistance (AMR) is a major global issue and antimicrobial stewardship is central to tackling its emergence. The burden of AMR disproportionately impacts low- and middle-income countries (LMICs), where capacity for surveillance and management of resistant pathogens is least developed. Poorly regulated antibiotic consumption in the community is a major driver of AMR, especially in LMICs, yet community-based interventions are neglected in stewardship research, which is often undertaken in high-income settings and/or in hospitals. We reviewed the evidence available to researchers and policymakers testing or implementing community-based antimicrobial stewardship strategies in LMICs. We critically appraise that evidence, deliver recommendations and identify outstanding areas of research need. We find that multifaceted, education-focused interventions are likely most effective in our setting. We also confirm that the quality and quantity of community-based stewardship intervention research is limited, with research on microbiological, clinical and economic sustainability most urgently needed.

Author(s): Thanh Tuan Lam, Duc Anh Dang, Huy Hoang Tran, Dung Van Do, Hien Le, Joel Negin, Stephen Jan, Guy B Marks, Thu Anh Nguyen, Greg J Fox, Justin Beardsley
Effective Surveillance  


Unrestricted financial support by:


Antimicrobial Resistance Fighter Coalition

Bangalore Bioinnovation Centre


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