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Lancet. 2016 Jan 9;387(10014):188-98. doi: 10.1016/S0140-6736(15)00547-4. Epub 2015 Nov 18.

Maximising access to achieve appropriate human antimicrobial use in low-income and middle-income countries.

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Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa. Electronic address:
Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
Zambia Center for Applied Health Research and Development, Lusaka, Zambia; Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam; Nuffield Department of Clinical Medicine, Centre for Tropical Diseases, Oxford, UK.
Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal.
Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
Departments of Learning, Informatics, Management, Ethics and Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
Access Campaign, Médecins Sans Frontières, Geneva, Switzerland.


Access to quality-assured antimicrobials is regarded as part of the human right to health, yet universal access is often undermined in low-income and middle-income countries. Lack of access to the instruments necessary to make the correct diagnosis and prescribe antimicrobials appropriately, in addition to weak health systems, heightens the challenge faced by prescribers. Evidence-based interventions in community and health-care settings can increase access to appropriately prescribed antimicrobials. The key global enablers of sustainable financing, governance, and leadership will be necessary to achieve access while preventing excess antimicrobial use.

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