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ABSTRACT
Background: Antibiotics have become the cornerstone for the treatment of infectious diseases and contributed significantly to the dramatic global health development during the last 70 years. Millions of people now survive what were previously life-threatening infections. But antibiotics are finite resources and misuse has led to antibiotic resistance and reduced efficacy within just a few years of introduction of each new antibiotic. The World Health Organization rates antibiotic resistance as a ‘global security threat’ impacting on global health, food security and development and as important as terrorism and climate change.
Objectives: This paper explores, through a scoping review of the literature published during the past 20 years, the magnitude of peer-reviewed and grey literature that addresses antibiotic resistance and specifically the extent to which “prevention” has been at the core. The ultimate aim is to identify know-do gaps and strategies to prevent ABR.
Methods: The review covers four main data bases, Web of Science, Medline, Scopus and Ebsco searched for 2000–17. The broader research field “antibiotic OR antimicrobial resistance” gave 431,335 hits. Narrowing the search criteria to “Prevention of antibiotic OR antimicrobial resistance” resulted in 1062 remaining titles. Of these, 622 were unique titles. After screening of the 622 titles for relevance, 420 abstracts were read, and of these 282 papers were read in full. An additional 53 references were identified from these papers, and 64 published during 2018 and 2019 were also included. The final scoping review database thus consisted of 399 papers.
Results: A thematic structure emerged when categorizing articles in different subject areas, serving as a proxy for interest expressed from the research community. The research area has been an evolving one with about half of the 399 papers published during the past four years of the study period. Epidemiological modelling needs strengthening and there is a need for more and better surveillance systems, especially in lower- and middle-income countries. There is a wealth of information on the local and national uses and misuses of antibiotics. Educational and stewardship programmes basically lack evidence. Several studies address knowledge of the public and prescribers. The lessons for policy are conveyed in many alarming reports from national and international organizations.
Conclusions: Descriptive rather than theoretical ambitions have characterized the literature. If we want to better understand and explain the antibiotic situation from a behavioural perspective, the required approaches are lacking. A framework for an epidemiological causal web behind ABR is suggested and may serve to identify entry points for potential interventions.
SPECIAL ISSUE:
Responsible Editor Peter Byass, Umeå University, Sweden
Responsible Editor Peter Byass, Umeå University, Sweden
Acknowledgments
Insightful and concrete input on substance and writing has been given by Professor Ingela Krantz (Infectious Disease Epidemiology), Associate Professor Lennart Freij (Clinical Infectious Diseases), MSc Anna Sandgren (Psychology), MSc Cecilia Tilli (Environmental and Water Engineering) and Dr Jennifer Stewart-Williams (Epidemiology and Biostatistics). I am also highly indebted to Jennifer for her skilful language editing.
Disclosure statement
This report has been supported by the Foundation to Prevent Antibiotic Resistance and the author is a board member of the Foundation. Views and conclusions in the report are the author´s only and do not necessarily coincide with those of the Foundation.
Paper context
Antibiotic resistance is a threat to global security alongside terrorism and climate change. This review documents increasingly alarming policy reports while stronger academic responses on evidence based preventive strategies are called for. Specifically, valid surveillance systems in low- and middle-income countries are lacking. The review also suggests a needed focus on population-based and inter-disciplinary research complementary to the current well-established biomedical and clinical approaches to tackle ABR.