title: A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail.
abstract: In February, 2016, WHO released a report for the development of national action plans to address the threat of antibiotic resistance, the catastrophic consequences of inaction, and the need for antibiotic stewardship. Antibiotic stewardship combined with infection prevention comprises a collaborative, multidisciplinary approach to optimise use of antibiotics. Efforts to mitigate overuse will be unsustainable without learning and coordinating activities globally. In this Personal View, we provide examples of international collaborations to address optimal prescribing, focusing on five countries that have developed different approaches to antibiotic stewardship-the USA, South Africa, Colombia, Australia, and the UK. Although each country's approach differed, when nurtured, individual efforts can positively affect local and national antimicrobial stewardship programmes. Government advocacy, national guidelines, collaborative research, online training programmes, mentoring programmes, and social media in stewardship all played a role. Personal relationships and willingness to learn from each other's successes and failures continues to foster collaboration. We recommend that antibiotic stewardship models need to evolve from infection specialist-based teams to develop and use cadres of health-care professionals, including pharmacists, nurses, and community health workers, to meet the needs of the global population. We also recommend that all health-care providers who prescribe antibiotics take ownership and understand the societal burden of suboptimal antibiotic use, providing examples of how countries can learn, act globally, and share best antibiotic stewardship practices.
authors.affiliation: The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: debbie.goff@osumc.edu.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goff
authors.affiliation: Merck Research Laboratories, Merck & Co, Kenilworth, NJ, USA.
authors.forename: Ravina
authors.initials: R
authors.lastname: Kullar
authors.affiliation: R M Alden Research Laboratory, Los Angeles, CA, USA; UCLA School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Ellie J C
authors.initials: EJC
authors.lastname: Goldstein
authors.affiliation: Department of Infection and Pharmacy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Gilchrist
authors.affiliation: Infection Unit, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC Australia.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Pharmacy Department, Alfred Health, Melbourne, VIC Australia.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Cairns
authors.affiliation: Bacterial Resistance and Hospital Epidemiology Area, International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Escandón-Vargas
authors.affiliation: Bacterial Resistance and Hospital Epidemiology Area, International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
authors.forename: Maria Virginia
authors.initials: MV
authors.lastname: Villegas
authors.affiliation: Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa.
authors.forename: Adrian
authors.initials: A
authors.lastname: Brink
authors.affiliation: Department of Quality Leadership, Netcare Hospitals, Johannesburg, South Africa.
authors.forename: Dena
authors.initials: D
authors.lastname: van den Bergh
authors.affiliation: Division of Infectious Diseases & HIV Medicine, Department of Medicine University of Cape Town, Groote Schuur Hospital Observatory, Cape Town, South Africa.
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003299:Cooperative Behavior; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000592:standards*; D004496:Education, Continuing; D014943:Global Health; D006282:Health Personnel / Q000193:education; D006761:Hospitals; D006801:Humans; D038622:Internationality; D063487:Prescription Drug Misuse / Q000517:prevention & control
chemical_list: D000890:Anti-Infective Agents