WHO Global Strategy for

1 WHO/CDS/CSR/ : GENERALORIGINAL: ENGLISHWHO GlobalStrategy forContainmentof AntimicrobialResistanceWorld Health OrganizationWHO Global Strategy FOR CONTAINMENT OF ANTIMICROBIAL RESISTANCEWHOC opies can be obtained from the CDS Information Resource CentreWorld Health organization , 1211 Geneva 27, Switzerlandfax: +41 22 791 42 85 email: ENGLISHDISTRIBUTION: GENERALWHO GlobalStrategy forContainmentof AntimicrobialResistanceWorld Health OrganizationAcknowledgementsThe World Health organization (WHO) wishes to acknowledge with gratitude the significant supportfrom the United States Agency for International Development (USAID)

2 And additional assistance forthis work from the United Kingdom Department for International Development and the Ministry ofHealth, Labour and Welfare, Strategy is the product of collaborative efforts across WHO, particularly in the clusters of Commu-nicable Diseases, Health Technology and Pharmaceuticals, and Family and Community Health, withsignificant input from the staff at WHO Regional Offices and from many partners working with WHOworldwide. In particular, WHO would like to acknowledge the important contributions made to thedrafting of the Strategy by Professor W Stamm, Professor ML Grayson, Professor L Nicolle and Dr MPowell, and the generosity of their respective institutions Infectious Diseases Department, HarborviewMedical Center, University of Washington, Seattle, USA; Infectious Diseases and Clinical Epidemiol-ogy Department, Monash Medical Centre, Monash University, Melbourne, Australia.

3 Department ofInternal Medicine, University of Manitoba, Winnipeg, Canada; Medicines Control Agency, LondonUK that enabled them to spend time at also wishes to thank all those who participated and contributed their expertise in the consulta-tions (see Annex B) and those individuals and organizations that provided valuable comments on draftsof this document. World Health organization 2001 This document is not a formal publication of the World Health organization (WHO), and all rights are reserved by theOrganization.

4 The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, butnot for sale or for use in conjunction with commercial views expressed in documents by named authors are solely the responsibility of those designations employed and the presentation of the material in this document, including tables and maps, do not imply theexpression of any opinion whatsoever on the part of the secretariat of the World Health organization concerning the legal statusof any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

5 Dottedlines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recom-mended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the namesof proprietary products are distinguished by initial capital by minimum graphicsPrinted in SwitzerlandContentsiiiExecutive Summary1 Summary of recommendations for intervention3 Part A.

6 Introduction and background9 Introduction11 Antimicrobial resistance is a Global problem that needs urgent action11A Global problem calls for a Global response12 Implementation of the WHO Global Strategy13 Background15 What is antimicrobial resistance?15 Appropriate use of antimicrobials15 Surveillance of antimicrobial resistance15 The prevalence of resistance16 Conclusion16 Part B. Appropriate antimicrobial use and emerging resistance: issues and interventions19 Chapter 1. Patients and the general community21 Chapter 2.

7 Prescribers and dispensers25 Chapter 3. Hospitals31 Chapter 4. Use of antimicrobials in food-producing animals37 Chapter 5. National governments and health systems41 Chapter 6. Drug and vaccine development47 Chapter 7. Pharmaceutical promotion51 Chapter 8. International aspects of containing antimicrobial resistance55 Part C. Implementation of the WHO Global Strategy61 Introduction63 Prioritization and implementation63 Implementation guidelines66 Monitoring outcomes66 Summary67 Recommendations for intervention68 Tables71 Suggested model framework for implementation of core interventions76 References83 Annexes93 Annex A.

8 National Action Plans95 Annex B. Participation in WHO Consultations961 Executive Summary Resistance is only just beginning to be consid-ered as a societal issue and, in economic terms, asa negative externality in the health care decisions to use antimicrobials (takenby the consumer alone or by the decision-makingcombination of health care worker and patient)often ignore the societal perspective and the per-spective of the health service. The World Health Assembly (WHA) Resolu-tion of 1998 (1) urged Member States to developmeasures to encourage appropriate and cost-effective use of antimicrobials, to prohibit the dis-pensing of antimicrobials without the prescriptionof a qualified health care professional, to improvepractices to prevent the spread of infection andthereby the spread of resistant pathogens, tostrengthen legislation to prevent the manufacture,sale and distribution of counterfeit antimicrobialsand the sale of antimicrobials on the informalmarket.

9 And to reduce the use of antimicrobials infood-animal production. Countries were also en-couraged to develop sustainable systems to detectresistant pathogens, to monitor volumes and pat-terns of use of antimicrobials and the impact ofcontrol measures. Since the WHA Resolution, many countrieshave expressed growing concern about the prob-lem of antimicrobial resistance and some havedeveloped national action plans to address theproblem. Despite the mass of literature on anti-microbial resistance, there is depressingly little onthe true costs of resistance and the effectiveness ofinterventions.

10 Given this lack of data in the faceof a growing realization that actions need to betaken now to avert future disaster, the challenge iswhat to do and how to do it. The WHO Global Strategy for Containmentof Antimicrobial Resistance addresses this chal-lenge. It provides a framework of interventions toslow the emergence and reduce the spread of anti-microbial-resistant microorganisms through: Deaths from acute respiratory infections,diarrhoeal diseases, measles, AIDS, malaria andtuberculosis account for more than 85% of themortality from infection worldwide.