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Antimicrobial resistance: a threat to human and animal health 435

12.2 What can be done about of antibiotics (such as requiring an infectious
antimicrobial resistance? diseases consult, or pre-approval prior to use),
and computer assisted decision support tools.
taking a one Health approach Population-level interventions include pro-
motion of vaccinations, to reduce the risk of
The concept of One Health recognizes that the bacterial infections.
health of humans, animals and the environment
are interconnected (Figure 12.2). Application of World Health Organization Global
the concept to AMR requires interdisciplinary Action Plan
collaboration and communication between phy-
sicians and veterinarians and the engagement The World Health Organization (WHO) has
of a wide range of expertise including micro- recognized the urgency and importance of
biologists, environmental and wildlife experts, addressing the rapid rise of antimicrobial resis-
farm advisers and social scientists. Owing to tance. They have published a Global Action
the complexity of antimicrobial resistance it is Plan, with five key objectives (World Health
paramount that the issue is addressed by both Organization, 2014).
human health and veterinary authorities in a
harmonious and collaborative way. 1 To improve understanding of AMR, through
education and training.
2 To strengthen the knowledge base surround-
ing AMR through the development and
maintenance of surveillance and research.
Examples of knowledge gaps include the
need to understand how resistance circulates
among humans, animals and the environment,
and the need to identify non-antimicrobial
alternatives for use in agriculture.
3 To reduce infection rates through effective
infection prevention strategies.
Figure 12.2 The One Health approach considers 4 To optimize antimicrobial use in human and
the interactions in health among humans, animals, animal populations.
and the environment. 5 To make an economic case for sustainable
investment, and increasing investment in
new medicines, technologies and vaccina-
antibiotics and human health
tions.
Interventions targeting use of antibiotics
in humans In addition to the WHO guidelines on the use of
antimicrobials important for human medicine,
There has been a lot of work done to limit exces- the World Organisation for Animal Health (OIE)
sive use of antibiotics in human medicine, to has developed a list of antimicrobial agents of
slow the rise of AMR. These interventions are veterinary importance (most recently updated
often aimed to change prescriber behaviour in 2018) (OIE, 2018c), which should be consid-
through education, audit and feedback, promo- ered when contemplating antimicrobial therapy
tion of the use of clinical guidelines, restriction in animals (Figure 12.3). Antimicrobials of

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