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Table 3 Suggested strategies to reducing antimicrobial usage in human and animal health, and conserving their effectiveness

From: A review of animal health and drug use practices in India, and their possible link to antimicrobial resistance

Reference Description of proposed AMR strategies
CDDEP [81] Reducing the need for antibiotics use (improved water, sanitation, immunization); hospital infection control; change incentives that encourage antibiotic use to incentives that encourage antibiotic stewardship; reduce and eventually phase out antibiotic use in agriculture; educate and inform health professionals, policy makers, and the public on sustainable use of antibiotics.
CDDEP [4] Tracking rates of veterinary antibiotic use, resistance and residues through a nationwide surveillance and monitoring system; changing incentives to discourage unnecessary antibiotic use in animals (without jeopardizing animal or human health); education of farmers, veterinarians, and consumers on the dangers of antibiotic resistance; and phasing out the sub-therapeutic use of antibiotics in animals
Garg and Mohanta [28] Educating farmers and other stakeholders on appropriate use of antibiotics; reducing the need for antibiotics through good husbandry practices and use of alternative medicines (herbal, probiotics etc.); allowing for withdrawal period to pass before products are sold; and enacting of laws that ban or restrict the use of antibiotics in animals.
Parikh [63] Education on rational use of drugs; regulate over-the-counter availability of drugs; develop guidelines at the local, national and regional levels; improved hygiene and infection control; regular surveillance of data and antibiograms to guide antibiotic selection; antibiotic stewardship; culture tests before antibiotics are administered; measuring outcomes to evaluate effectiveness of policies.
Ghafur et al. [8] Ban on over- the-counter drug sales; expanding the network of accredited laboratories and developing low cost diagnostics; issuance of antibiograms at pre-defined intervals by microbiology laboratories; reduce erroneous reporting through use of standardized laboratories; establishment of national antibiotic resistance surveillance system; evaluate levels of use of antibiotics in animal health; observing drug withdrawal periods; and monitoring of AMR in food animals.
GARP [82] Surveillance for both AMR and antibiotic use; increased use of diagnostic tools; strengthening of infection control committees; continuing education for pharmacists and health staff; checklists for surgical procedures; improving antibiotic supply chains and quality; regulate veterinary use of antibiotics (ban non-therapeutic use of antimicrobials and observance of drug withdrawal periods).
Lee et al. [83] Initiation of internship programs for postgraduate students; education of healthcare professionals; reductions in the amount of antibiotics used in agriculture; and promotion of antimicrobial stewardship activities