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J Law Med Ethics. 2015 Summer;43 Suppl 3:17-21. doi: 10.1111/jlme.12269.

Universal Access to Effective Antibiotics is Essential for Tackling Antibiotic Resistance.

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Senior Visiting Scholar on Global Health Security at the Norwegian Institute of Public Health in Oslo, Norway.
Director of SEARCH in Gadchiroli, India.
Senior Professor of International Health Systems Research at the Departments of Learning, Informatics, Management and Ethics and Public Health Sciences at Karolinska Institutet in Stockholm, Sweden.
Associate Professor of Pharmacy at Makerere University College of Health Sciences in Kampala, Uganda.
Senior Professor of Infectious Diseases at the Department of Medical Sciences at Uppsala University, Sweden and Founder of Re-Act: Action in Antibiotic Resistance.


Universal access to effective antimicrobials is essential to the realization of the right to health. At present, 5.7 million people die from treatable infections each year because they lack this access. Yet, community-based diagnosis and appropriate treatment for many of the leading causes of avoidable infectious deaths has been shown to be feasible and effective, demonstrating that strategies to reach the under-served need to receive high priority. This is a necessary part of a broad strategy to assure the long-term benefits of antimicrobials and to combat antimicrobial resistance, both because the lack of systematic and rigorous efforts to assure effective coverage increases the likelihood of antimicrobial resistance, and because global efforts aimed at antimicrobial stewardship and innovation cannot succeed without explicitly addressing the needs of the under-served. Elements of this strategy will include clear evidence-based treatment protocols, a robust international framework and locally tailored regulations, active engagement with communities and local health providers, strong attention to program management and cost considerations, a focus on the end user, and robust surveillance and response to emerging resistance patterns. Only by balancing the needs of universal access with stewardship and innovation, and assuring that they are mutually reinforcing can a global strategy hope to effectively address antimicrobial resistance.

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