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  • Challenges to Tackling Antimicrobial Resistance
  • Economic and Policy Responses
  • Online publication date: March 2020
  • pp 241-250

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        • Index
        • Edited by Michael Anderson, London School of Economics and Political Science, Michele Cecchini, Elias Mossialos, London School of Economics and Political Science
        • Assisted by Jonathan North
        • Book: Challenges to Tackling Antimicrobial Resistance
        • Online publication: 21 March 2020
        • Chapter DOI: https://doi.org/10.1017/9781108864121.011
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        • Index
        • Edited by Michael Anderson, London School of Economics and Political Science, Michele Cecchini, Elias Mossialos, London School of Economics and Political Science
        • Assisted by Jonathan North
        • Book: Challenges to Tackling Antimicrobial Resistance
        • Online publication: 21 March 2020
        • Chapter DOI: https://doi.org/10.1017/9781108864121.011
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        • Index
        • Edited by Michael Anderson, London School of Economics and Political Science, Michele Cecchini, Elias Mossialos, London School of Economics and Political Science
        • Assisted by Jonathan North
        • Book: Challenges to Tackling Antimicrobial Resistance
        • Online publication: 21 March 2020
        • Chapter DOI: https://doi.org/10.1017/9781108864121.011
        Available formats
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Index

Index note: page numbers in italics denote figures or illustrations
ABSsee antibiotic stewardship (ABS)
Achaogen, company, 191
Acinetobacter, 28
A. baumannii, 74, 126, 166, 192
Action on Antibiotic Resistance (ReAct), 209, 210, 214, 215, 217, 230
advertising, 207, 212
Africa CDC AMR Surveillance network (AMRSNET), 169
Africa Centres for Disease Control and Prevention (Africa CDC), 169
AGP (antimicrobial growth promoters), 101, 103, 106, 111, 224
agricultural sector, 37, 101, 223 see also animal husbandry; farming; livestock production
Alliance for Prudent Use of Antibiotics (APUA), 208
aminoglycosides, 27
amoxicillin, 61, 190
ampicillin, 190
animal feed, 108, 116, 117, 227
animal husbandry, 102, 103, 107 see also farming; livestock production
animal products raised without routine use of antibiotics, 15, 222, 225
animal to human transmission of resistant bacteria, 104, 111, 185
Antibiotic Guardian Campaign, 60
Antibiotic Resistance Coalition (ARC), 15, 209, 228
antibiotic stewardship (ABS), 8, 30, 31, 212, 221 see also interventions to tackle antimicrobial resistance
best practice, 87
cost-effectiveness, 89, 92
evidence of effectiveness, 83
guidelines, 86, 208
in hospitals, 81
methodology used in studies, 85, 92
antibiotic use, in humans
effect of culture, 62
nonprescription, 4
not targeted, 156
reduced, due to vaccination, 182, 186, 195
economic benefits, 196, 198, 200
antibiotic use, in livestock production, 101, 210, 212, 223
in animal feed, 108, 227
decrease in, 103, 105, 107
growth promoters, 101, 103, 106, 111, 224
interventions to reduce use, 114, 208, 209
measuring, 107
risk assessment, 110
antibiotics
access to, 6, 219
alternative therapies, 129
broad spectrum, 23
commercialization of new, 132, 144
ionophore, 102
last-line, 2, 162, 168, 221
market approval of, 131, 143
pipeline for new, 4, 125, 126, 141, 215
post-antibiotic era, 2, 4, 209
promotion and marketing of, 208, 212
prophylaxis, 25, 101, 103
research and development, 10, 125, 214
delinkage, 11, 132, 145, 216, 217
funding, 129, 215
incentives for, 11, 132, 212, 217 see also market entry rewards (MERs); prizes
sales of, 132, 144
second-line, 33
sustainability and systems thinking, 228
used in both humans and animals, 111, 222
wastewater contamination with, 228
antibodies, 129, 191
antigens, 186
antimicrobial growth promoters (AGP), 101, 103, 106, 111, 224
Antimicrobial Resistance Diagnostic Challenge, 139
APUA (Alliance for Prudent Use of Antibiotics), 208
aquaculture, 103, 108, 186
ARC (Antibiotic Resistance Coalition), 15, 209, 228
artemisinin, 6
artists, 230
ASP (antibiotic stewardship programme)see antibiotic stewardship (ABS)
authorisation of new antimicrobials, 140
autoimmune diseases, 191
avilamycin, 111
avoparcin, 111
awareness campaigns, 54
Antibiotic Guardian, 60
public health, 8, 47
azithromycin, 168
bacteria
eradication of, 187
Gram-negative, 2, 126, 128, 131
bacterial infections
bacteraemia, 24
secondary, 195
bacteriophages, 129
BARDA (Biomedical Advanced Research and Development Authority), 138
Bergström, Richard, 215
beta-lactams, 27
Bezlotoxumab, 191
Bill and Melinda Gates Foundation, 139, 146, 191
biomarkers, 157, 159, 218
Biomedical Advanced Research and Development Authority (BARDA), 138
biosecurity measures, 103, 107, 110, 114, 116
biosurveillancesee surveillance programmes
bloodstream infections (BSIs), 30, 71, 73, 74, 89
booklets, for patients, 58, 59
broad spectrum antibiotics, 23
budgets, health care, 32
Burden of Resistance and Disease in European Nations (BURDEN), 71
bystander effects, 182, 195, 196
campaigns, 54
Antibiotic Guardian, 60
public health, 8, 47
Campylobacter, 28, 127
cancer treatments, 25, 191
Candida, 28
carbapenems, 2, 27, 31, 192
resistance, 28, 126
CARB-X (Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), 136
ceftriaxone, 162, 168
cephalosporins, 5, 31, 72, 72
Chan, Margaret, 209
chemotherapy, 25
chicken farming, 102, 116, 117
children, 59, 195, 222
chloroquine, 6
cholera, 190
ciprofloxacin, 162, 193, 194
civil society, 15, 207
cleaning, in hospitals, 74
clinical trials, 11, 131, 136, 142, 170
Clostridium difficile, 191
Clostridium perfringens, 102
coccidiosis, 102
colistin, 2, 111, 192
colony-forming units, 77
Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), 136
commercialization of new antibiotics, 132, 144
communication, with patients, 53, 58, 59, 63
community, prescriptions for antibiotics, 7
companion animals, 113
cooperation, global, 15, 16, 146
cost
of diagnostic research and development, 171
of interventions, 61
of market entry rewards, 145
societal, of antimicrobial resistance, 34
of vaccinations, 198
cost-effectiveness
of antibiotic stewardship in hospitals, 89, 92
of biosecurity in livestock production, 115, 116
of infection control measures in hospitals, 74
of preventative strategies in the community, 38, 61
cough, 58, 59 see also lower respiratory tract infections
C-reactive protein (CRP) 57, 58, 61, 157
cross transmission of infection, 77
Cross-Research Council AMR Initiative, 139
cross-species resistance, 210
culture, and antibiotic use, 62
deaths, due to antimicrobial resistance, 24, 25, 35, 222
decolonization, 74
delayed prescribing (DP), 54, 57
delinkage, 11, 132, 145, 216, 217
dentists, 46
development pipeline for new antibiotics, 4, 125, 126, 141, 215 see also research and development into new antibiotics
diagnostic tests, 12, 89, 218
for antimicrobial resistance surveillance, 164
barriers to innovation, 162
business case for, 174
cost, 61, 171
decrease cost of clinical trials, 170
efficient implementation, 173
funding for, 171, 172
for malaria, 6
pathogen detection, 160
point-of-care, 52, 57, 58, 144, 156
policies, 172
to reduce misuse of antibiotics, 164
regulatory approval, 171
susceptibility testing, 160
using host biomarkers, 157
diarrhoea
in children, 193, 222
in piglets, 102, 116
vaccines, 196
Directorate-General for Research and Innovation (DG-RTD), 137
disability affected life years (DALYs), 25
disease prevention, 105, 107, 110
role of diagnostic tests, 174
doctors (GPs), 46, 58
Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB), 81, 219
Drugs for Neglected Diseases Initiative (DNDi), 218
ear infections, 34
EARS-Net (European Antimicrobial Resistance Surveillance Network), 71, 78, 79, 168
ECDC (European Centre for Disease Prevention and Control), 71, 87, 109, 110
economics
of antibiotic research, 132, 133
benefits of antibiotic stewardship, 92
benefits of vaccines, 196, 198, 200
of biosecurity, 116
burden of antimicrobial resistance, 6, 31, 35, 38
health, 92
EDCTP (European and Developing Countries Clinical Trial Partnership), 136
education
of clinicians, 51, 58
of patients, 53, 58, 173
of undergraduates, 91
Effective Practice and Organisation of Care Group (EPOC), 81
EFPIA (European Federation of Pharmaceutical Industries and Associations), 137
EFSA (European Food Safety Authority), 109
EMA (European Medicines Agency), 140, 144
empirical treatment, 23
enteritis, necrotic, in poultry, 102, 117
Enter-net, 168
Enterobacteriaceae, 24, 31, 72, 74, 192
ESBL (extended spectrum beta-lactamase), 113
Enterococcus faecium, 127
environmentsee also One Health issues
antibiotics entering, 210, 228
transmission of resistant bacteria, 104, 111
environmental cleaning, in hospitals, 74
EPOC (Effective Practice and Organisation of Care Group), 81
EQUIP project, 59
eradication, of bacteria, 187
ESAC-Net (European Surveillance of Antimicrobial Consumption Network), 71
ESBL (extended spectrum beta-lactamase), 113, 115
Escherichia coli, 2, 31, 33, 165
cephalosporin resistant, 5, 36, 72
colistin-resistant, 111
enterotoxigenic E. coli (ETEC), 193
extended spectrum beta-lactamase (ESBL), 115
uropathogenic E. coli (UPEC), 194
vaccines against, 186, 193
Verocytotoxin-producing (VTEC), 168
Essential Medicines List, 207
essential oils, 116
ESVAC (European Surveillance of Veterinary Antimicrobial Consumption), 108, 109
ETVAX, vaccine, 193
EU (European Union), 137
One Health Action Plan ix
European and Developing Countries Clinical Trial Partnership (EDCTP), 136
European Antimicrobial Resistance Surveillance Network (EARS-Net), 71, 78, 79, 168
European Awareness Day, 54
European Centre for Disease Prevention and Control (ECDC), 71, 87, 109, 110
European Federation of Pharmaceutical Industries and Associations (EFPIA), 137
European Food Safety Authority (EFSA), 109
European Medicines Agency (EMA), 140, 144
European Surveillance of Antimicrobial Consumption Network (ESAC-Net), 71
European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), 108, 109
European Unionsee EU
extended spectrum beta-lactamase (ESBL), 113, 115
extrinsic resistance, 27
farmers, 113, 116
farmingsee also agricultural sector; animal husbandry; livestock production
chicken, 102, 116, 117
intensive, 10, 102, 112, 223
pig, 102, 114, 116
salmon, 186
fatality rates, 24, 25, 35, 222
FDA (US Food and Drug Administration), 140, 144
feed, animal, 108, 116, 117, 227
feedback, 51
financial incentives, 52
FIND (Foundation for Innovative New Diagnostics), 157, 218
flavomycin, 111
Fleming, Sir Alexander, 2
fluoroquinolones, 27, 195
food
animal feed, 108, 116, 117, 227
foodborne infections, 185
hygiene, 113
transmission of resistance, 113, 185
Food and Drug Administration (FDA) (US), 140, 144
food animal productionsee also livestock production
use of antibiotics in, 9, 223
without routine use of antibiotics, 15, 222, 225
Foodborne Diseases Active Surveillance Network (FoodNet), 169
Foundation for Innovative New Diagnostics (FIND), 157, 218
funding
for antibiotic research and development, 129, 215
for diagnostic tests, 171, 172
furunculosis, 186
G3REC (E. coli resistant to 3rd generation cephalosporins), 72
G20 summit, Hamburg 2017, 146
GAMRIF (Global Antimicrobial Resistance Innovation Fund), 136
GARDP (Global Antibiotic Research and Development Partnership), 135, 218
GARP (Global Antibiotic Resistance Partnership), 6
GASP (Global Gonococcal Antimicrobial Surveillance Programme), 168
Gavi Vaccine Alliance, 172, 194, 198
GDP (gross domestic product), 37
general practitioners (GPs), 46, 58
GLASS (Global Antimicrobial Resistance Surveillance System), 165
Global Action Plan on Antimicrobial Resistance (WHO) 3, 15, 105, 155, 164, 212, 213, 221
Global Antibiotic Research and Development Partnership (GARDP), 135, 218
Global Antibiotic Resistance Partnership (GARP), 6
Global Antimicrobial Resistance Collaboration Hub, 12, 16, 146
Global Antimicrobial Resistance Innovation Fund (GAMRIF), 136
Global Antimicrobial Resistance Surveillance System (GLASS), 165
Global Challenge Research Fund, 139
global cooperation, 15, 16, 146
Global Gonococcal Antimicrobial Surveillance Programme (GASP) (WHO), 168
Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (GLOBAL-PPS), 169
Global Strategy for Containment of Antimicrobial Resistance, 208
gonococcal resistance, 160, 168
gonorrhoea, 160, 161, 168
governing body, global, 146, 2
GPs (general practitioners), 46, 58
GRACE INTRO project, 58
Gram-negative bacteria, 2, 126, 128, 131
grants, research, 132, 142
gross domestic product (GDP), 37
growth promoters, antimicrobial, 101, 103, 106, 111, 224
guidelines, 51, 86, 88
Haemophilus influenzae, 127, 187
vaccines, 190
hand hygiene, 73, 77
health
campaigns, 8, 47
economics, 92
One Health issues ix, 15, 111, 209, 223, 228
Health Action International (HAI), 207, 209, 212
health burden, of antimicrobial resistance, 24, 27
health care budgets, 32
health care-associated infections (HAIs), 8, 71, 72
outbreak control, 79
surveillance programmes, 71, 78, 90, 91
health technology assessment (HTA), 13, 172
Healthcare without Harm, 222, 226, 229
Helicobacter pylori, 127
Heymann, Dr. David, 209
HNL (human neutrophil lipocalin), 159
Horizon 2020 Better Use of Antibiotics Prize, 137, 159
hospitalssee also health care-associated infections (HAIs)
antimicrobial resistance in, 8, 113
blocked beds, 76
environmental cleaning, 74
overcrowding, 77
vaccines and immunotherapies for resistant bacteria, 191
waste management, 229
host biomarkers, 157, 159, 218
host-microbe relationship, 230
HTA (health technology assessment), 13, 172, 172
human neutrophil lipocalin (HNL), 159
human to animal transmission of resistant bacteria, 104, 111, 185
husbandry, animal, 102, 103, 107 see also farming; livestock production
hygiene
cleaning, in hospitals, 74
food, 113
hand, 73, 77
IMI (Innovative Medicine’s Initiative), 137
immune stimulation, 129
immunocompromized patients, 25
immunotherapies, 191 see also monoclonal antibodies (mAbs); vaccines
incentives for antibiotic research and development, 11, 132, 212, 217 see also market entry rewards (MERs)
incidence of antimicrobial resistance, 29
infection prevention and control (IPC), 8, 25, 30, 72
cost-effectiveness, 74
infection control measures, 73
prevention of cross transmission, 77
by vaccines, 182
infections
bacterial, 24, 195
bloodstream (BSIs), 30, 71, 73, 74, 89
ear, 34, 1
health care-associated infections (HAIs), 8, 71, 72
outbreak control, 79
surveillance programmes, 71, 78, 90, 91
incidence of, 26
lower respiratory tract (LRTIs), 58
reduced severity of, 182
respiratory tract infections (RTIs), 14, 46, 52, 59
urinary tract (UTIs), 61, 194
viral, 46, 52, 54, 57, 195
influenza, 182
vaccines, 195
Innovative Medicine’s Initiative (IMI), 137
InnovFin ID (Infectious Diseases Facility), 138
intensive animal production, 10, 102, 112, 223
international response to antimicrobial resistance, 15, 16, 146
international standards, for diagnostic tests, 172
interspecific effects, 184
interventions to tackle antimicrobial resistancesee also antibiotic stewardship (ABS)
clinician and patient focused, 53
clinician focused, 51
evidence of effectiveness, 83
in hospitals, 81
long-term impact, 63
methodology used in studies, 85, 92
projects, 58, 59
public focused, 54
intrinsic resistance, 27
ionophore antibiotics, 102
IPCsee infection prevention and control (IPC)
isolation, 73
Italy, University hospital Modena, 87
Japanese Pharmaceuticals and Medical Devices Agency (PMDA), 141, 144
Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), 135
KFC, restaurant chain, 225
Klebsiella pneumoniae, 2, 27, 31, 166, 192
cephalosporin resistant, 5, 36
potential vaccine, 199
Korea, Republic of, 227
Krankenhaus-Infektions-Surveillance-System (KISS), 78
last-line antibiotics, 2, 162, 168, 221
legal framework, international, 16
Limited Population Antibacterial Drug (LPAD), 140
livestock production, 9, 37 see also agricultural sector; animal husbandry; farming
animals raised without routine use of antibiotics, 15, 222, 225
antibiotic use in, 101, 210, 212, 223
decrease, 103, 105, 107
measuring, 107
risk assessment, 110
growth promoters, antimicrobial, 101, 103, 106, 111, 224
intensive, 10, 102, 112, 223
interventions to reduce antimicrobial use, 114, 208, 209
productivity, 105
transmission of resistant bacteria to humans and the environment, 104, 111, 185
livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), 113
Longitude Prize, 159
low and middle-income countries (LMICs), 4, 8, 9, 139
lower respiratory tract infections (LRTIs), 58
LPAD (Limited Population Antibacterial Drug), 140
lysins, 129
malaria, 6, 36, 182
manufacturing plants, 228
market approval of antibiotics, 131, 143
market entry rewards (MERs), 11, 144, 217 see also prizes
marketing, of antibiotics, 208, 212
McDonald’s, restaurant chain, 226
meat, produced without antibiotics, 15, 222, 223
Médecins sans Frontièrs (MSF), 209, 217, 218
medicines
ban on advertising, 207
Essential Medicines List, 207
meningitis, 190
metaphylactic antimicrobial use, 99, 101, 102
methicillin-resistant Staphylococcus aureus (MRSA), 26, 28, 36, 72
assays for, 167
livestock-associated (LA-MRSA), 113
microbe-host relationship, 230
Modena, University hospital, 87
monoclonal antibodies (mAbs), 191 see also immunotherapies
mortality, major causes of, 192
mortality rates, 24, 25, 35, 222
MRSA, 26, 28, 36, 72
assays for, 167
livestock-associated (LA-MRSA), 113
MSF (Médecins sans Frontièrs), 209, 217, 218
National Institute for Health Research (NIHR), 139
National Institute of Allergy and Infectious Diseases (NIAID), 138
ND4BB (New Drugs for Bad Bugs), 137
necrotic enteritis, in poultry, 102, 117
Neisseria gonorrhoeae, 28, 127, 166, 168
Neisseria meningitidis, 187, 190
Netherlands, 88
neutrophil biomarkers, 159
New Drugs for Bad Bugs (ND4BB), 137
Newton Fund, 139
NIAID (National Institute of Allergy and Infectious Diseases), 138
NIHR (National Institute for Health Research), 139
norovirus, 196
nosocomial bacterial pathogens, 191
Nunan, Cóilín, 224
nurses, 46
OIE (World Organisation for Animal Health), 99, 108, 185, 214
One Health issues ix, 15, 111, 209, 223, 228
online guidelines, 88
opportunity cost, 38
outbreaks of health care-associated infections, 79
overcrowding, in hospitals, 77
parents, 59
patients, 47, 92, 212
educational materials for, 53, 58, 59
peptides, 129
pets, 113
pharmaceutical industry, 207, 210
Pharmaceuticals and Medical Devices Agency (PMDA), Japan, 141, 144
pharmacists, 46
pig farming, 102, 114, 116
pipeline for new antibiotics, 4, 125, 126, 141, 215 see also research and development into new antibiotics
Plasmodium falciparum, 182
pledges, to reduce antimicrobial resistance, 60
PMDA (Pharmaceuticals and Medical Devices Agency), Japan, 141, 144
pneumonia, 218, 222
pneumococcal conjugate vaccine, 14, 218
point prevalence studies, 167, 169
point-of-care diagnostic tests (POCTs), 52, 58, 144, 156
for antimicrobial resistance surveillance, 164
barriers to innovation, 162
business case for, 174
cost, 61, 171
decrease cost of clinical trials, 170
efficient implementation, 173
funding for, 172
pathogen detection, 160
policies, 172
to reduce misuse of antibiotics, 57, 164
regulatory approval, 171
susceptibility testing, 160
using host biomarkers, 157
pollution, antibiotic, 228
polymyxins, 31
post-antibiotic era, 2, 4, 209
poultry, necrotic enteritis, 102, 117 see also chicken farming
prebiotics, 116
preclinical trials, 131, 142
prescribing, delayed, 54, 57
prescription medicines, ban on advertising, 207
prescriptions, for antibiotics, 7, 46, 61, 108
audit and feedback, 51
preventative strategies, 39
priority pathogens list (PPL), 126
prizes, 137, 159 see also market entry rewards (MERs)
probiotics, 116, 129
procalcitonin, 52, 57, 157
productivity, in livestock sector, 105
profits, from antibiotic sales, 144
projects to tackle antimicrobial resistance
EQUIP, 59
GRACE INTRO, 58
prophylactic antimicrobial use, 25, 100, 101, 103
Pseudomonas aeruginosa, 28, 74, 126, 128, 192
monoclonal antibodies, 191
vaccine, 191
public health campaigns, 8, 47
Qualified Infectious Diseases Products (QIDP), 140
ReAct (Action on Antibiotic Resistance), 209, 210, 214, 215, 217, 230
regulatory approval for diagnostic tests, 171
regulatory initiatives for new antimicrobials, 140, 143, 220
reminders, 51, 58
Republic of Korea, 227
research and development into new antibiotics 10. 125, 214
delinkage, 11, 132, 145, 216, 217
funding, 129, 215
incentives for, 11, 132, 212, 217 see also market entry rewards (MERs)
pipeline, 4, 125, 126, 141, 215
research grants, 132, 142
resistance
extrinsic, 27
genes, transfer of, 185
intrinsic, 27
respiratory syncytial virus (RSV), 195
respiratory tract infections (RTIs), 14, 46, 52, 59
lower respiratory tract (LRTIs), 58
restaurant chains, 15, 225
rotavirus vaccines, 196
safety, patient, 92, 212
sales, of antibiotics, 132, 144
salmon farming, 186
Salmonella, 116, 168
Salmonella spp., 127, 166
S. typhi, vaccines for, 194
Schippers, Edith, 227
screening, 74
secondary bacterial infections, 195
second-line antibiotics, 33
self-care, 53
self-limiting symptoms, 54
shared decision-making (SDM), 53, 55
Shigella spp., 127, 166
smallpox, 187
societal costs of antimicrobial resistance, 34
society, civil, 15, 207
specificity, of vaccines, 186
standards
for diagnostic tests, 172
for licensed drugs, 143
Staphylococcus aureus, 33, 127, 128, 166
methicillin-resistant (MRSA), 26, 28, 36, 72, 113, 167
monoclonal antibodies, 191
vaccine, 191
stewardshipsee antibiotic stewardship (ABS)
Streptococcus pneumoniae, 28, 127, 166
vaccine, 187
Subway, restaurant chain, 225
surgical procedures, 25
surveillance programmes
antibiotic consumption, in agriculture, 109
antibiotic resistance, 71, 78, 90, 91, 109, 212
in developing countries, 167
diagnostic tests, 164
Africa CDC AMR Surveillance network (AMRSNET), 169
Enter-net, 168
European Antimicrobial Resistance Surveillance Network (EARS-Net), 71, 78, 79, 168
Foodborne Diseases Active Surveillance Network (FoodNet), 169
Global Gonococcal Antimicrobial Surveillance Programme (GASP), 168
Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (GLOBAL-PPS), 169
surveys, 91
sustainability and systems thinking, 228
symptoms, self-limiting, 54
therapeutic antimicrobial use, 99, 101, 102, 106, 224
toxicity, 111, 187
Transatlantic Task Force on Antimicrobial Resistance (TATFAR), 141, 144, 215
transmission
of antimicrobial resistance by water, 113, 185, 228
of infection in hospitals, 77
of resistant bacteria between animals, humans and the environment, 104, 111, 185
treatment, empirical, 23
trends in antimicrobial resistance rates, 31
tuberculosis, 34, 36
Ty21a, vaccine, 194
UK Research and Innovation, 139
understaffing, of hospitals, 77
United Kingdom (UK), 139
United Nations (UN), 3, 214
United States (US), 138
antibiotics in food animal production, 224
Food and Drug Administration (FDA), 140, 144
University hospital Modena
Italy, 87
urinary tract infections (UTIs), 61, 194
Vaccine Alliance, GAVI, 172, 194, 198
vaccines, 14, 102, 103, 116, 129, 218 see also immunotherapies
advantages, 186
in animal production, 185
cost, 198
difficulties in developing, 193
economic benefits, 196, 198, 200
impact on antimicrobial prescriptions, 199
reducing antibiotic use, 182, 186, 195
reducing antimicrobial resistance, 182, 199
specificity of, 186
value of, 198
for Clostridium difficile, 191
for Escherichia coli, 186, 193
for Haemophilus influenzae, 190
for Pseudomonas aeruginosa, 191
for rotavirus, 196
for Salmonella typhi, 194
for Staphylococcus aureus, 191
for Streptococcus pneumoniae, 187
for urinary tract infections, 194
for Vibrio cholerae, 190
for viruses, 195
ETVAX, 193
pneumococcal conjugate, 218
Ty21a, 194
Vi-polysaccharide, 194
WC-rBS, 193
vancomycin resistance, 111
vancomycin-resistant Enterococci (VRE), 28
Verocytotoxin-producing E. coli (VTEC), 168
veterinary prescriptions, 108
Vibrio cholerae, vaccines, 190
Vi-polysaccharide, vaccine, 194
viral infections, 46, 54
diagnostics, 52, 57
vaccines for, 195
waste
in environment, 113
management practices of hospitals, 229
wastewater contamination with antibiotics, 228
water, as a means of transmission of antimicrobial resistance, 113, 185, 228
WC-rBS, vaccine, 193
websites, 60
Wellcome Trust, 140, 147
white blood cell count, 157
World Health Organization (WHO), 2, 155, 207, 208, 218, 221
World Organisation for Animal Health (OIE), 99, 108, 185, 214