The One Health stewardship of colistin as an antibiotic of last resort for human health in South Africa

Increasing reliance on antibiotics of last resort to treat the rising numbers of multidrug-resistant bacterial infections in people has focused attention on how shared-use antibiotics are managed and regulated across human and animal health. Discussions at international and national levels have inte...

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Published in:	The Lancet infectious diseases Vol. 18; no. 9; pp. e288 - e294
Main Authors:	Mendelson, Marc, Brink, Adrian, Gouws, Joey, Mbelle, Nontombi, Naidoo, Vinny, Pople, Troy, Schellack, Natalie, van Vuuren, Moritz, Rees, Helen, Banoo, Shabir, Bokaba, Khotso, Collins, Marius, Faure, Kim, Herbst, Maryke, Hoek, Beyers, Lancaster, Ruth, Lotter, Jeanette, Modisane, Mike, Mohlala, Mahlodi, Mokantla, Ernest, Molatuli, Adelaide, Molefe, Margaret, Molewa, Griffith, Mompati, Kefiloe, Moshiga, Lesiba, Munbodh, Shyamli, Nkambule, Portia, Patterson, Camilla, Reddy, Darshana, Sigobondhla, Alice, Suliman, Suraiya, Swan, Gerry
Format:	Journal Article
Language:	English
Published:	United States Elsevier Ltd 01-09-2018 Elsevier Limited
Subjects:	Agricultural production Animal health Animals Anti-Bacterial Agents - therapeutic use Antibiotic resistance Antibiotics Antimicrobial agents Bacteria Bacterial diseases Bacterial infections Colistin Colistin - therapeutic use Councils Drug resistance Drug Resistance, Bacterial - drug effects Farm buildings Food Genes Gram-negative bacteria Gram-Negative Bacterial Infections - drug therapy Gram-positive bacteria Hogs Humans Infection Control - legislation & jurisprudence Infection Control - standards Infectious diseases Legislation Multidrug resistance Multidrug resistant organisms Nosocomial infections Organic chemistry Pharmacy Poultry Practice Guidelines as Topic Registration South Africa Surveillance Tariffs Veterinarians Veterinary medicine Working groups South Africa France
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Summary:	Increasing reliance on antibiotics of last resort to treat the rising numbers of multidrug-resistant bacterial infections in people has focused attention on how shared-use antibiotics are managed and regulated across human and animal health. Discussions at international and national levels have intensified since the identification of new plasmid-mediated genes for colistin resistance in 2016, first in China and subsequently in many other countries, removing the last line of defense against multidrug-resistant Gram-negative bacterial infections with carbapenem resistance. South Africa has reacted to this threat by doing a situational analysis and review of the existing legislation concerning colistin use in animals and people, to inform which course of action to take. The experiences shared in this Personal View outline the process, institution of governance with widespread stakeholder engagement, surveillance, and interventions that South Africa has taken towards optimising the shared use of colistin. The instigation of stewardship guided by the principles of the One Health concept for shared-use antibiotics at the country level is a crucial component of any action plan to combat antibiotic resistance, and is as relevant to other existing antibiotics and new chemical entities that will be forthcoming from an invigorated antibiotic pipeline as it is to colistin.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1473-3099 1474-4457
DOI:	10.1016/S1473-3099(18)30119-1