Governance and Stewardship of Antibiotics

AMR, particularly resistance to antibiotics, poses grave risks which no country can avoid without global collective action.

This stream of work led by Prof Devi Sridhar (Edinburgh) in collaboration with the Blavatnik School of Government at Oxford University and Chief Medical Officer Dame Sally Davies looks at how global governance can be enhanced to ensure progress is made in a number of key areas:

1.  convening negotiations and setting global standards and targets in human health, agriculture and the environment
2.  conducting surveillance and monitoring progress towards goals in antibiotic use, resistance levels and antimicrobial production
3.  building norms and public knowledge about the true scale of AMR and the economic consequences
4.  financing alternatives and innovations such as new vaccines, diagnostics and therapies
5.  collaborating with the private sector where possible
6.  ensuring accountability to consumers and citizens. It also examines the strengths of the existing tripartite UN arrangements for AMR and what steps might be needed to further action on AMR at the global level. 

Lancet paper - Global Governance of Antimicrobial Resistance

The ePAMS programame is a £2.5 million multidisciplinary collaboration to develop and evaluate a multifaceted intervention (ePAMS+) that incorporates technical, behavioural and organisational components to safely reduce inappropriate antibiotic use in adult medical in-patients.

It is funded by the National Institute of Health Research.

The Programme is led by Professor Aziz Sheikh in the Usher Institute for Population Health Sciences and Informatics, alongside colleagues at the Universities of Edinburgh, Birmingham, Warwick, Bristol, Newcastle, York; Harvard University; Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Free London NHS Foundation Trust and NHS England.

ePAMS consists of four work packages which seek to address a number of questions:

Work Package 1: Planning, developing, optimising, and carrying out qualitative feasibility           

Work Package 2: Establishing the feasibility of evaluating ePAMS+ through a hybrid cluster-randomised stepped-wedge trial           

Work Package 3: Evaluating the effectiveness of ePAMS+ in reducing antibiotic use in adult medical in-patients: a hybrid cluster           

Work Package 4: Estimating the cost-effectiveness of ePAMS+

For more details about the Programme please visit their website.

ePAMS Programme website

Profile of Aziz Sheikh

About ePAMS

Lack of appropriate diagnostic methods is one of the major reasons for in appropriate and overuse of antibiotics. 

In the £3million Diagnostics for One Health and User Driven Solutions for AMR (DOSA) project, led by the University of Edinburgh and the IIT Delhi, researchers from India and UK with background in social sciences, technology innovation, and experts in different community settings, are coming together to jointly address this issue.

They are studying current practices, user behaviours, social and economic reasons behind antibiotic consumption in India.

Diagnostics specifications

Based on a user mapping study, they plan to formulate target product profiles i.e., specification of the diagnostic test for three communities setting.

• urinary tract infections in human health
• mastitis (infection of cows' udder) in dairy sector
• antibiotic residue detection in water from the environment.

Development of new technologies

Currently, due to lack of appropriate diagnostic technologies, doctors are prescribing broad spectrum antibiotics empirically (i.e. in a trial and error fashion) and farmers are using huge quantities of antibiotics in agriculture and fish farming without appropriate guidance and monitoring. 

Development of these diagnostic methods will help to reduce the unnecessary consumption, blind prescription and release of antibiotics.

DOSA Project team

The project is led by Till Bachmann in the Division of Infection and Pathway Medicine at the University of Edinburgh, alongside Edinburgh colleagues Alice Street (School of Social and Political Science) and and Dominic Moran (Global Academy of Agriculture and Food Security), and UK collaborators at the Universities of Bradford, Southampton and University of the Arts London.

Indian partners include the Indian Institute of Technology Delhi; the Centre for Cellular and Molecular Platforms Bangalore; ICAR-Central Institute of Fisheries Technology, Cochin, Kerala; ICAR-National Dairy Research Institute, Karnal, Haryana; Silchar Medical College and Assam University, Silchar, Assam.

DOSA project

Till Bachmann

Alice Street

Dominic Moran

David Dockrell has nearly 30 years experience as an Infection Medicine clinician scientist.

He has been involved in antimicrobial stewardship throughout this period and is involved with local infection control and antimicrobial policies along with colleagues in NHS Lothian. He also works with colleagues in pharmacy to implement efficient and cost-effective antimicrobial usage, including in antivirals.

He has previously contributed to regional antimicrobial policies in NHS England. His current national roles include as a Member of the Commission on Human Medicines Anti-infectives committee since 2009.

He has authored or edited national guidelines for antimicrobial therapy for the British HIV Association and the British Infection Association and has served as editor for national guidelines on Opportunistic Infections in HIV for the last ten years.

He is an original applicant and has served on the management committee for the national training programme in AMR funded by the Medical Research Foundation, is an advisor on projects for CarbX/Wellcome Trust, and contributor to the UKRI Cross Council Initiative on AMR.

Carb-X – Combatting Antibiotic Resistant Bacteria

Commission on Human Medicines Anti-Infectives Committee

Evolving controversies and challenges in the management of opportunistic infections in HIV-seropositive individuals, J. Infection 2011, Dockrell et al.

Medical Research Foundation AMR PhD Programme

UKRI Cross Council initiative on AMR