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WHO policy guidance on integrated antimicrobial stewardship activities

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Background

Universal access to high-quality and affordable antimicrobials is an essential component of universal health
coverage (UHC). Antimicrobials include antibiotics, antivirals, antifungals and antiparasitic medicines that are used
to prevent and treat infections in humans, animals and plants. Access to high-quality and affordable antimicrobials
to combat communicable diseases is a challenge in many settings affecting the quality of health care.

On the other hand, inappropriate use of antimicrobial agents across human, animal and environmental sectors is
among the main drivers of antimicrobial resistance (AMR). AMR occurs when bacteria, viruses, fungi and parasites
change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of
disease spread, severe illness and death. AMR also makes lifesaving medical procedures riskier to perform and has a
broader societal and economic impact which threatens the achievement of UHC and the Sustainable Development
Goals. The coronavirus disease (COVID-19) pandemic has further demonstrated the challenges of AMR.

Tackling AMR requires a comprehensive set of interventions. A study conducted by the Organisation for Economic
Co-operation and Development (OECD) suggests that simple measures to prevent infections such as vaccinations,
promoting hand hygiene and better hygiene in health-care facilities more than halves the risk of death and
decreases the health burden of AMR. Similarly, integrated delivery of policies that promote hospital hygiene,
antimicrobial stewardship (AMS), and the use of diagnostic tests to differentiate bacterial vs. viral infections and
mass media campaigns could significantly reduce the burden of drug-resistant infection and could save 1.6 million
lives by 2050 in the 33 countries included in the analysis. This study also estimated investment in these policies
would pay for themselves within a year and save up to US$ 4.8 billion per year. Optimizing the use of antimicrobial medicines across human, animal and plant health is a cornerstone of the Global
Action Plan for Antimicrobial Resistance.

WHO defines AMS as a coherent set of integrated actions which promote the responsible and appropriate use
of antimicrobials to help improve patient outcomes across the continuum of care. Responsible and appropriate
use of antimicrobials includes prescribing only when needed, selection of the optimal drug regimen, drug dosing,
route of administration and duration of treatment following proper and optimized diagnosis. These actions are
complemented by access to affordable and quality antimicrobials and interventions that prevent health-careassociated infections and community-acquired infections, including the implementation of core components
of infection prevention and control (IPC), enhancing water, sanitation and hygiene (WASH), and optimizing
vaccination coverage.

The WHO Thirteenth General Programme of Work (GPW 13) has identified AMR as a priority with significant
relevance to its Triple Billion targets of achieving UHC, addressing health emergencies and promoting healthier
populations. WHO has developed tools to assist AMS activities at health-care facility level in low- and middleincome countries, which have helped to advance implementation at national level as well as within health-care
facilities and clinical practice. However, effective implementation of AMS activities in health-care facilities
requires a comprehensive approach, beyond the facilities, at national policy and programme levels.

Purpose of the policy guidance

Member States have requested WHO policy guidance on how to facilitate the implementation of national AMS
activities in an integrated and programmatic approach. This policy guidance responds to that demand from
Member States and is anchored in public health guiding principles in the human health sector. It aims to provide
a set of evidence-based and pragmatic recommendations to drive comprehensive and integrated AMS activities
under the purview of a central national coordination unit, National AMR steering or coordinating committees or
other equivalent national authorities. The policy guidance complements the Global Action Plan, the WHO practical
toolkit for AMS programmes in health-care facilities in low- and middle-income countries and other WHO guidance
in surveillance, IPC and WASH.

Target audience of the policy guidance

The primary target audiences of this guidance are national policy-makers at ministries of health, national AMR
coordinating bodies such as national AMR steering or coordinating committees or other equivalent national
authorities who are responsible for the development, implementation and monitoring of the national action plans,
policies and standards for mitigating AMR in the human health sector. Subnational authorities and decisionmakers, technical experts and stakeholders supporting such programmes at all levels are also target audiences for
the policy guidance. The considerations included in this policy have important implications and relevance for the
strategic direction and human health sector-related activities of other sectors or ministries, such as those working
on quality of care in the human health sector, WASH, IPC, animal and plant health as well the environment.

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