Cycles of antibiotic use and emergent antimicrobial resistance in the South African tuberculosis programme (1950-2021): A scoping review and critical reflections on stewardship.

IF 2.3 3区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Global Public Health Pub Date : 2024-01-01 Epub Date: 2024-05-21 DOI:10.1080/17441692.2024.2356623
Rene Raad, Justin Dixon, Martin Gorsky, Graeme Hoddinott
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引用次数: 0

Abstract

The emergent threat of antimicrobial resistance (AMR) has resulted in debates around the use and preservation of effective antimicrobials. Concerns around AMR reflect a history of increasing dependence on antibiotics to address disease epidemics rooted in profound structural and systemic challenges. In the context of global health, this process, often referred to as pharmaceuticalisation, has commonly occurred within disease programmes, of which lessons are vital for adding nuance to conversations around antimicrobial stewardship. Tuberculosis (TB) is a notable example. A disease which accounts for one-third of AMR globally and remains the leading cause of death from a single infectious agent in many low - and middle-income countries, including South Africa. In this scoping review, we chart TB science in South Africa over 70 years of programming. We reviewed published manuscripts about the programme and critically reflected on the implications of our findings for stewardship. We identified cycles of programmatic responses to new drug availability and the emergence of drug resistance, which intersected with cycles of pharmaceuticalisation. These cycles reflect the political, economic, and social factors influencing programmatic decision-making. Our analysis offers a starting point for research exploring these cycles and drawing out implications for stewardship across the TB and AMR communities.

南非结核病计划(1950-2021 年)中的抗生素使用周期和新出现的抗菌药耐药性:范围审查和对管理的批判性思考。
抗菌素耐药性(AMR)的威胁日益突出,引发了关于使用和保护有效抗菌素的辩论。对 AMR 的担忧反映了人们越来越依赖抗生素来应对疾病流行的历史,而这一问题的根源在于深刻的结构性和系统性挑战。在全球卫生领域,这一过程通常被称为制药化,通常发生在疾病防治项目中,其中的经验教训对于增加围绕抗菌药物管理的对话的细微差别至关重要。结核病(TB)就是一个明显的例子。结核病占全球 AMR 的三分之一,在包括南非在内的许多中低收入国家,结核病仍是单一传染源导致死亡的主要原因。在这篇范围综述中,我们描绘了南非 70 年来的结核病科学计划。我们回顾了已发表的有关该计划的手稿,并批判性地反思了我们的发现对管理工作的影响。我们确定了针对新药供应和耐药性出现的计划应对周期,这些周期与制药周期相互交织。这些周期反映了影响计划决策的政治、经济和社会因素。我们的分析为探索这些周期的研究提供了一个起点,并为整个结核病和急性呼吸道感染社区的管理工作提供了启示。
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来源期刊
Global Public Health
Global Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
6.50
自引率
3.00%
发文量
120
期刊介绍: Global Public Health is an essential peer-reviewed journal that energetically engages with key public health issues that have come to the fore in the global environment — mounting inequalities between rich and poor; the globalization of trade; new patterns of travel and migration; epidemics of newly-emerging and re-emerging infectious diseases; the HIV/AIDS pandemic; the increase in chronic illnesses; escalating pressure on public health infrastructures around the world; and the growing range and scale of conflict situations, terrorist threats, environmental pressures, natural and human-made disasters.
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