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Handbook of WMA Policies
World Medical Association ½ S-1996-01-2008
WMA STATEMENT
ON
RESISTANCE TO ANTIMICROBIAL DRUGS
Adopted by the 48th
WMA General Assembly, Somerset West, South Africa, October 1996
and amended by the 59th
WMA General Assembly, Seoul, Korea, October 2008
PREAMBLE
The global increase in resistance to antimicrobial drugs, including the emergence of bac-
terial strains resistant to all available antibacterial agents, has created a multi-faceted public
health problem of crisis proportions with significant economic and human implica-tions.
The development of resistant microorganisms is a problem whenever antimicrobial agents
are used. The increase in high-risk populations who frequently require antimicro-bial
therapy, including immunocompromised patients, those undergoing invasive medical
interventions, those with implanted medical devices and patients with chronic debilitating
diseases, has amplified the problem. The fact that certain infectious diseases have been
linked to the development of chronic disease and cancer adds another dimension to the
problem.
A renewed effort to increase awareness of antimicrobial resistance is needed in order to
contain and slow its development. International cooperation is essential in accomplishing
this objective, including global, national, and local components. In particular, implement-
tation of national and global efforts to contain the development and spread of antimicro-
bial resistance is vital; policy statements without international will to accomplish results
are not enough. Given the dynamics of antimicrobial resistance, the need for continuing
development of new antimicrobials by the pharmaceutical industry can be anticipated.
Substantial misuse and overuse of antimicrobial agents have exacerbated the problem by
adding selection pressures to microbial populations that favor mutation to antibiotic resist-
ance. These include inappropriate prescribing of antibacterial prophylactics and/or treat-
ment of bacterial infections by physicians and poor compliance with antimicrobial regi-
mens by patients. Thus, there is a need for enhanced training and education to improve the
appropriate clinical use of antimicrobials and prevent the development of resistance. There
is a need at every level to educate the public about the appropriate use of antimicrobials
and the problem of antimicrobial resistance.
The availability of antimicrobial agents without a prescription in many developing coun-
tries is escalating antibiotic resistance, and this practice must be discontinued. The in-
creasing prevalence of counterfeit medications is another critical and expanding risk fac-
tor. Successfully addressing this problem will require substantial cooperation among
nations and the development and use of better technologies to verify the authenticity of
pharmaceutical products and assure the security of deployment from point of manufacture
to the point of need. Similarly, the inappropriate use of antibiotics in veterinary medicine
and livestock production in many countries needs to be controlled.
S-1996-01-2008½ Seoul
Antimicrobial Resistance
RECOMMENDATIONS
Global
Individual governments should work to create cross-sectional national task forces to col-
lect national data on the use of antibiotics and antimicrobial resistance and to prioritize
regulation, intervention, and other measures to reduce antimicrobial resistance.
The World Medical Association and its member national medical associations should
advocate for:
• Individual governments to cooperate with the World Health Organization (WHO)
to enhance the effectiveness of the WHO’s global network of antimicrobial resist-
ance surveillance. This will foster the collection, quality and sharing of data; the
monitoring of progress in combating antimicrobial resistance; the establishment of
appropriate formularies; and scientific support for interventions.
• The WHO to examine the role of international travel and trade agreements on the
development of antimicrobial resistance.
• The widespread application of verifiable technology to ensure the authenticity of
pharmaceutical products.
The World Medical Association and its national medical associations should encourage
their governments to:
• Fund more basic and applied research directed toward the development of inno-
vative antimicrobial agents and vaccines, and on the appropriate and safe use of
such therapeutic tools.
• Create incentives for the pharmaceutical industry to pursue research and develop-
ment programs leading to the availability of innovative antimicrobial agents, vac-
cines, and rapid diagnostic methods.
National
National medical associations should:
• urge their governments to require that antimicrobial agents be available only
through a prescription provided by licensed and qualified health care and/or veteri-
nary professionals.
• urge their governments to initiate a national media campaign explaining to the pu-
blic the harmful consequences of overuse and misuse of antibiotics.
• actively pursue the development of a national surveillance system for antimicrobial
resistance that will provide physicians with the information necessary to deliver
timely, evidence-based, high-quality care. Data from this system should be linked
with, or at minimum, fed into, the WHO’s global network of antimicrobial resist-
ance surveillance.
• create guidelines on the appropriate use of antibiotics for common medical con-
ditions, such as respiratory infections, tonsillitis, pneumonia and urinary tract in-
fection; pursue the development of a national surveillance system for sales of anti-
microbials.
Handbook of WMA Policies
World Medical Association ½ S-1996-01-2008
• encourage medical schools and continuing medical education programs to renew
their efforts to educate physicians about the appropriate use of antimicrobial agents
and appropriate infection control practices, including antibiotic use in the out-
patient setting.
• in collaboration with veterinary authorities, encourage their governments to restrict
the use of antimicrobial agents as feed additives for animals strictly to those anti-
microbials that do not have a human public health impact.
Local
Physicians should:
• assume leadership roles in their local hospitals, clinics, and communities regarding
appropriate antiseptic habits, antimicrobial agent usage, and antimicrobial resist-
ance prevention and control programs. This applies especially to those trained in
infectious diseases and clinical microbiology.
• raise awareness amongst their patients about antimicrobial therapy, its risks and
benefits, the importance of compliance with the prescribed regimen, optimal hy-
gienic practices, and the problem of antimicrobial drug resistance.
• herever possible, explore strategies for reducing the use of antibiotics that do not
compromise the quality of patient care, such as “wait-and-see” prescriptions for
the treatment of acute otitis media.