abstract: 'Antimicrobial stewardship (AMS) is a set of coordinated strategies to

  improve the use of antimicrobials, to enhance patient outcomes, reduce

  antimicrobial resistance, and decrease unnecessary costs. The pioneer

  years of AMS were restricted to high-income countries (HIC), where

  overconsumption of antibiotics was associated with emergence of

  multidrug-resistant (MDR) bacteria. AMS in low- and middle-income

  countries (LMIC) is also necessary. However, programs effective in HIC

  may not perform as well in LMIC, because (i) While decreased consumption

  of antibiotics may be an appropriate target in overconsuming HIC, this

  may be dangerous in LMIC, where many patients die from the lack of

  access to antibiotics; (ii) although AMS programs in HIC can be designed

  and monitored through laboratory surveillance of resistance,

  surveillance programs are not available in many LMIC; (iii) the

  heterogeneity of health care systems implies that AMS programs must be

  carefully contextualized. Despite the need to individually tailor AMS

  programs in LMIC, international collaborations remain highly valuable,

  through the dissemination of high-quality documents and educational

  material, that may be shared, adapted where needed, and adopted

  worldwide. This process, facilitated by modern communication tools,

  combines many benefits, including: (i) saving time, a precious dimension

  for health care workers, by avoiding the duplication of similar works in

  different settings; (ii) taking advantage of colleagues skills, and

  initiatives, through open access to the work performed in other parts of

  the world; (iii) sharing experiences, so that we all learn from each

  others'' successes and failures.'
affiliation: 'Tattevin, P (Corresponding Author), Pontchaillou Univ, Infect Dis \&
  Intens Care Unit, Ctr Hosp, Rennes, France.

  Tattevin, Pierre, Pontchaillou Univ, Infect Dis \& Intens Care Unit, Ctr Hosp, Rennes,
  France.

  Levy Hara, Gabriel, Hosp Carlos G Durand, Infect Dis Unit, Buenos Aires, DF, Argentina.

  Toumi, Adnene, Monastir Univ Hosp, Dept Infect Dis, Monastir, Tunisia.

  Enani, Mushira, King Fahad Med City, Fac Med, Riyadh, Saudi Arabia.

  Coombs, Geoffrey, Murdoch Univ, Antimicrobial Resistance \& Infect Dis Res Lab,
  Perth, WA, Australia.

  Voss, Andreas, Canisius Wilhelmina Hosp, Dept Med Microbiol \& Infect Dis, Nijmegen,
  Netherlands.

  Voss, Andreas; Wertheim, Heiman, Radboudumc, Dept Med Microbiol, Nijmegen, Netherlands.

  Voss, Andreas; Wertheim, Heiman, Radboud Ctr Infect Dis, Nijmegen, Netherlands.

  Poda, Armel, Souro Sanou Univ Hosp, Dept Infect Dis, Bobo Dioulasso, Burkina Faso.

  Daoud, Ziad, St George Hosp UMC, Clin Microbiol, Beirut, Lebanon.

  Daoud, Ziad, Univ Balamand, Beirut, Lebanon.

  Laxminarayan, Ramanan, Ctr Dis Dynam Econ \& Policy CDDEP, New Delhi, India.

  Nathwani, Dilip, Ninewells Hosp \& Med Sch, Dundee, Scotland.

  Gould, Ian, Aberdeen Royal Infirm, Aberdeen, Scotland.'
article-number: '503'
author: 'Tattevin, Pierre and Levy Hara, Gabriel and Toumi, Adnene and Enani, Mushira
  and Coombs, Geoffrey and Voss, Andreas and Wertheim, Heiman and Poda, Armel and
  Daoud, Ziad and Laxminarayan, Ramanan and Nathwani, Dilip and Gould, Ian and APUA,  and
  ISAC, '
author-email: pierre.tattevin@chu-rennes.fr
author_list:
- family: Tattevin
  given: Pierre
- family: Levy Hara
  given: Gabriel
- family: Toumi
  given: Adnene
- family: Enani
  given: Mushira
- family: Coombs
  given: Geoffrey
- family: Voss
  given: Andreas
- family: Wertheim
  given: Heiman
- family: Poda
  given: Armel
- family: Daoud
  given: Ziad
- family: Laxminarayan
  given: Ramanan
- family: Nathwani
  given: Dilip
- family: Gould
  given: Ian
- family: APUA
  given: ''
- family: ISAC
  given: ''
da: '2023-09-28'
doi: 10.3389/fmed.2020.00503
eissn: 2296-858X
files: []
journal: FRONTIERS IN MEDICINE
keywords: 'antimicrobial stewardship; low; and middle; income countries;

  antibiotics; resistance; education'
keywords-plus: 'ANTIBIOTIC STEWARDSHIP; INTERVENTIONS; IMPACT; MANAGEMENT; PROGRAM;

  DISEASE; ACCESS'
language: English
month: AUG 25
number-of-cited-references: '45'
orcid-numbers: 'Daoud, Ziad/0000-0001-7139-6282

  Coombs, Geoffrey/0000-0003-1635-6506

  Wertheim, Heiman/0000-0002-5003-5565'
papis_id: ebf5767b04f39580fd434bdfb309eefd
ref: Tattevin2020advocacyincreased
researcherid-numbers: 'Laxminarayan, Ramanan/ABD-5050-2021

  Daoud, Ziad/AAW-7121-2021

  Wertheim, Heiman/F-3338-2016'
times-cited: '13'
title: Advocacy for Increased International Efforts for Antimicrobial Stewardship
  Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent
  Use of Antimicrobials (APUA), Under the Auspices of the International Society of
  Antimicrobial Chemotherapy (ISAC)
type: Article
unique-id: WOS:000570407800001
usage-count-last-180-days: '0'
usage-count-since-2013: '5'
volume: '7'
web-of-science-categories: Medicine, General \& Internal
year: '2020'