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Access, excess, and ethics—towards a sustainable distribution model for antibiotics
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition/Persson)
2014 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 2, 134-141 p.Article, review/survey (Refereed) Published
Abstract [en]

The increasing antibiotic resistance is a global threat to health care as we know it. Yet there is no model of distribution ready for a new antibiotic that balances access against excessive or inappropriate use in rural settings in low-and middle-income countries (LMICs) where the burden of communicable diseases is high and access to quality health care is low. Departing from a hypothetical scenario of rising antibiotic resistance among pneumococci, 11 stakeholders in the health systems of various LMICs were interviewed one-on-one to give their view on how a new effective antibiotic should be distributed to balance access against the risk of inappropriate use. Transcripts were subjected to qualitative 'framework' analysis. The analysis resulted in four main themes: Barriers to rational access to antibiotics; balancing access and excess; learning from other communicable diseases; and a system-wide intervention. The tension between access to antibiotics and rational use stems from shortcomings found in the health systems of LMICs. Constructing a sustainable yet accessible model of antibiotic distribution for LMICs is a task of health system-wide proportions, which is why we strongly suggest using systems thinking in future research on this issue.

Place, publisher, year, edition, pages
2014. Vol. 119, no 2, 134-141 p.
Keyword [en]
Antibiotic distribution, antibiotic resistance, ethics, rational use, systems thinking
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-223161DOI: 10.3109/03009734.2014.904958ISI: 000336526100011OAI: oai:DiVA.org:uu-223161DiVA: diva2:712779
Available from: 2014-04-16 Created: 2014-04-16 Last updated: 2017-12-05Bibliographically approved

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Cars, OttoBejarano, Maria-TeresaPeterson, Stefan

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