Antibiotics have become an indispensable part of modern medicine, both at primary care and intensive care level. However, our most important weapon in the fight against bacterial infections is gradually losing its effectiveness. Any use of antibiotics promotes the development of bacterial resistance. Published on 19th May 2016, shortly before the start of the 96th WHO World Health Assembly, the Final Report of the Review on AMR calls for an awareness campaign to educate the public about the problem of antibiotic resistance. In an effort to address this issue in Germany, a team made up of Charité – Universitätsmedizin Berlin and six other partners started the pilot project "Rational use of antibiotics through information and communication (RAI)" in 2015.
Charité's RAI efforts are led by Prof. Dr. Petra Gastmeier, Head of the Institute of Hygiene and Environmental Medicine, who believes that the irresponsible use of antibiotics results in serious consequences – an opinion shared by other experts in the field. Current AMR Review estimates suggest that approximately 50,000 patients a year die as a result of antibiotic-resistant infections in Europe and the USA, and that numbers are on the increase. Information and communication are central to the RAI project’s purpose. According to Prof. Petra Gastmeier, the issue is as follows: “Knowledge is crucial if antibiotics are to be used correctly. However, there are still some considerable gaps in people's knowledge, which need to be plugged.” The RAI group project breaks new ground in the sense that, for the first time ever, specialists from human and veterinary medicine have been joined by experts in design and communication, with the aim of developing innovative information and communication strategies on the responsible use of antibiotics. Prof. Dr. Lothar H. Wieler, President of the Robert Koch Institute and one of the project partners, explains that the project's approach is also very much cross-sectoral in nature: “One of the biggest failures of the past was to limit initiatives to a particular target group. The shortcomings this has resulted in will now need to be addressed as a matter of urgency.”
As a result of this, the project is modeled on the holistic One Health approach, which is underpinned by the concept of interdisciplinary collaboration and acknowledges the complex connections that exist between humans, animals, the environment and health. As this integrative approach is now seen as key to a more sustainable way of managing health care, RAI targets its efforts at all prescribers of antibiotics, i.e. general practitioners, as well as surgeons and intensive care specialists, but also veterinarians and farmers, and even patients visiting their family practice.
Phase I of the project, which set out to establish a baseline for the chosen target group, was also used to develop appropriate intervention tools for testing during phase II. According to results from phase I of the study, 58% out of a total of 1,000 respondents stated they did not believe that behavioral factors associated with antibiotic use have an impact on the development of bacterial resistance. In reality, failure to follow advice on how to take antibiotics is directly responsible for promoting bacterial resistance. Nearly one in two veterinary surgeons stated that they did not believe their own prescribing behavior had any impact on bacterial resistance in their area. Data analysis also revealed practical barriers as well as uncertainties in relation to what constitutes proper antibiotics usage, including lack of time and ineffective information transfer between prescribing physicians and patients.
Targeted intervention tools were developed as part of the project with the aim of supporting prescribers in the future. These include the 'Infozept-Generator', which allows general practitioners to offer personalized patient packs containing information on the patient's condition, as well as information on antibiotics-based treatment. They also include a podcast, which was developed for veterinary surgeons and is accessible on-the-go, offering a time-efficient way of gathering information on antibiotics and bacterial resistance. The aim is to offer alternatives to antibiotics-based treatments. All RAI partners will be involved in testing the new measures in clinical practice. All new measures will be phased in from August 2016, with first results expected in 2018.
*AMR stands for antimicrobial resistance
The RAI pilot project
The pilot project 'Rational use of antibiotics through information and communication (RAI)' is one of the fundamental research endeavors of the infection control consortium 'InfectControl 2020', and forms part of the 'Zwanzig20 – Partnerschaft für Innovation' funding program of the Federal Ministry of Education and Research (BMBF). The aim of 'InfectControl 2020' is to develop, validate and implement new strategies aimed at helping in the fight against infections (www.infectcontrol.de). RAI is unique in that it is the first group project dealing with antibiotics use and antibiotics resistance that is truly cross-sectoral in nature, and combines specialists from human and veterinary medicine with experts from design and communication. The following partners are involved in the project: Charité as project coordinator (Institute of Hygiene and Environmental Medicine), Freie Universität Berlin (Institute of Microbiology and Epizootics; Institute for Media and Communciation Studies), the Robert Koch Institute, Jena University Hospital (Zentrum für Infektionsmedizin und Krankenhaushygiene; Institut für Allgemeinmedizin) and strategic design specialists Lindgrün GmbH.
AMR Review – Final Report and Recommendations: The global fight against infections caused by drug-resistant organisms
In July 2014, internationally renowned economist and former Goldman Sachs Chief Economist Jim O'Neill was appointed by the British Prime Minister, David Cameron, to chair an investigation into antimicrobial resistance, and to develop measures to counter this global threat. O'Neill's team of experts has now presented its final report on AMR. The report also contains a concrete Action Plan, whose top recommendations are the need to raise awareness of antibiotic resistance and the need to improve the effectiveness of communication. In view of the fact that RAI implements some of the AMR report's recommendations, it has effectively taken on a pioneering role in this regard.
*AMR steht für Antimikrobielle Resistenzen
Dr. Sandra Schneider
Institut für Hygiene und Umweltmedizin
Charité – Universitätsmedizin Berlin
t: +49 30 450 577 612
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