Antimicrobials in Primary Care: Advances, Failures and Prospects

Dear Colleagues,

The main challenge in the fight against antibiotic resistance (AMR) is the successful implementation of national action plans, which include policies and strategies for proper antibiotic use and infection control. Although these national AMR action plans have been implemented for decades, the volume of antibiotic prescriptions remains very high in most countries. Up to 90% of antibiotic prescriptions are initiated in primary care.

Reducing the overall volume of antibiotic use and improving the appropriateness of antibiotics prescribed would help prevent the spread of AMR. To this end, numerous interventions have been implemented worldwide, some formally evaluated. The effectiveness of population-based information campaigns in reducing antibiotic use has been low in Europe. Multimodal approaches combining the enablement and restriction of prescribing as well as auditing and feedback of antibiotic prescribing quality indicators to prescribers have been associated with improved compliance with guidelines. Patient involvement through shared decision-making with clinicians for antibiotic prescribing has also been shown to be effective in the short term, but robust endpoints such as infection-related mortality or reinfection are lacking. New technologies such as computerized decision support systems (CDSS) or artificial intelligence programs for antimicrobial prescribing could be effective and have a prolonged impact on practice. This has been demonstrated primarily in the hospital setting, where the implementation of antimicrobial stewardship programs (ASPs) is common compared with primary care. However, these programs may encounter low adherence to the advice they generate, leading to mixed effects on the volume and quality of antibiotic therapy prescribed. It is therefore essential that innovative antimicrobial prescribing interventions be tailored and integrated into the daily workflow of clinical practice, with a minimal impact on the consultation time and on the patient–practitioner relationship.

However, the very definition of primary care and the parameters to be used to evaluate interventions vary within and between high-income and low- and middle-income countries. In addition, while it is important to identify effective interventions in order to implement them through national action plans, it is essential to know which ones are not and to understand the determinants of their success/failure in order to avoid their deployment and diffusion. It is also essential to gather information on populations or settings that are typically overlooked in studies: children, pharmacists, nursing homes, and dental care.

In this Special Issue, we will consider any high-quality qualitative or quantitative research dealing with antimicrobial use in primary care, including general practice and the above subpopulations, with a focus on interventions to prevent AMR:

• What interventions have worked in primary care, or not, and why?
• What is the next intervention to implement in primary care? In what subpopulation?
• What metrics and models should be used to evaluate primary care interventions?
• What are the benefits/challenges of involving parents, pharmacists, dental surgeons, nurses, and the communities at large in the fight against AMR?

Dr. Tristan Delory
Guest Editor

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• antimicrobial prescribing
• antimicrobial stewardship
• primary care
• general practitioner
• paediatrics
• pharmacists
• dental care
• nursing homes
• intervention
• metrics