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Tackling drug resistance, one context at a time

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Dr Helen Lambert. Photo credit: Helen Lambert

To tackle growing numbers of drug-resistant infections we can’t apply the same ideas to every situation. Dr Helen Lambert, Reader in Medical Anthropology at the University of Bristol, explains why tailoring our tactics to the local context is vital in the fight against antimicrobial resistance (AMR).

In many parts of the world you can buy antibiotics over the counter without a prescription. It’s a practical way to obtain life-saving drugs where quality medical care is inaccessible.

In Europe we might effectively slow the spread of drug-resistant infections by reducing antibiotic prescribing and stopping access to over-the-counter antibiotics. But that doesn’t mean it’s the best solution everywhere. Particularly in resource-poor settings, where infectious illness is a really big problem and many people don’t have access to a prescriber. In parts of Asia, more young children die from infections that aren’t treated in time with antibiotics, than from drug-resistant infections.

Combining disciplines to tackle drug resistance

How we use antibiotics has a big effect on the way resistant infections move between humans, animals and the environment. Ultimately, why and when people take antibiotics is to do with social, cultural, psychological and economic issues, as well as the political will to tackle them. That means we need to look at those factors as well as microbiological and bacterial aspects.

We’re aiming to bring these perspectives together to explore what drives antibiotic use and how to develop strategies to optimise their use in China. Our project, funded through the Newton Fund AMR-China Partnership Initiative, aims to build on pioneering pilot work conducted by our collaborators at Anhui Medical University.

We have a great group of collaborators on the project. The UK-China team includes microbiologists, infectious disease and primary care physicians, psychologists, anthropologists, epidemiologists and health service researchers.

The unknown

Very little is known about what influences the use of antibiotics in rural environments in China. For example, most rural practitioners don’t have access to microbiology techniques to identify the specific type of pathogen causing infection. So how do they decide when to prescribe or dispense antibiotics? We’ll talk to practitioners and patients in rural clinics to find out.

Our estimates about the number of resistant infections mainly come from large hospital laboratories. But these don’t necessarily represent the whole population, and particularly not rural communities. We plan to take bacterial samples from patients living in rural parts of Anhui Province to try and identify levels of antibiotic resistance. We’ll then assess whether the current drugs are effective.

There are lots of possible reasons why antibiotics might be used in ways that speed up the spread of resistance. But if antibiotics are freely available over-the-counter, without proper medical advice, people may be using them inappropriately. We’ll also study local medicine shops supplying pharmaceuticals and traditional Chinese medicine. This will give us a picture of when, and why, people buy antibiotics rather than seeing a doctor.

Local knowledge

Most countries are developing national action plans to tackle AMR. However, there’s been very little opportunity, until now, to understand how we can tailor interventions to different contexts.

We plan to focus our work on rural areas and district hospitals rather than the big urban centres where most research is undertaken. We hope this will help us identify interventions that have most potential for limiting the spread of resistance in these communities, while ensuring people still have access to antibiotics for essential treatment of bacterial infections.

The project will also benefit UK research as it will help us to understand a wide range of parameters in a very different kind of environment. It’s an opportunity to assess whether approaches developed in the UK to encourage general practitioners to prescribe fewer antibiotics would work in a very different setting. And to work through in practice how we can develop a complex, interdisciplinary solution.

Mutual benefits

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Helen with one of her students in Suzhou, China. Photo credit: Helen Lambert

An important part of our project is training groups of local researchers in our collaborating university. Qualitative research is relatively new in health science institutions in China. So we’ll share our knowledge of talking to patients and practitioners about their perceptions of antibiotic use and their actions.

We’re eager to learn about the Chinese health system from our collaborators. My co-Principal Investigator Debin Wang and his team are keen to develop expertise in new research approaches. I very much hope that this will be the beginning of enhancing local, and international, research capacity in this area, and of building strong UK-China research collaboration.

As told to Isabel Baker

The Newton Fund is managed by the Department for Business, Energy and Industrial Strategy (BEIS). The fund forms part of the UK government’s official development assistance (ODA). The Newton Fund AMR-China Partnership Initiative is supported by the MRC, ESRC, BBSRC and the National Natural Science Foundation of China.

Read about more Newton Fund projects.

Helen is the ESRC’s AMR Research Champion. Read her latest articles on the rhetoric of resistance and why social scientists are needed to address the challenge of drug-resistant infections.

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