Guadalajara Declaration to Combat Antimicrobial Resistance in Latin America
May 1, 2001
Guadalajara, Jalisco, Mexico
Sponsored by:
The Alliance for the Prudent Use of Antibiotics (APUA)
The Pan American Health Organization (PAHO)
The Pan American Society for Infectious Diseases (API)
The Mexican Association for Infectious Diseases and Clinical Microbiology (AMIMC)
We recognize that:
- Antibiotics are first line medications for the treatment of numerous infectious diseases caused by bacteria; however, if their inappropriate use is tolerated, they will become increasingly less powerful. Antibiotics are scarce resources and should be managed as non-renewable.
- Antibiotic resistance is a growing problem in Latin America, as in other regions of the world, negatively impacting the treatment of common community-acquired infections as well as hospital-acquired infections. Identification of an antibiotic resistant pathogen in the laboratory clearly correlates with clinical failure.
- Antibiotics are societal agents and it should be considered a public good and, therefore, be managed in consideration of individual and societal benefits, without discrimination.
- Likewise, indiscriminate prescribing on the part of physicians excessive antibiotic use without justification, and the potential for consumers to self-medicate with antibiotics, are factors that promote the development and spread of antimicrobial resistance.
- Use of antibiotics in agriculture and animal husbandry also significantly contribute to the selection for resistant microorganisms in the environment.
The Following Actions Should be Promoted:
- Systematic monitoring and surveillance of bacterial resistance to antibiotics, both in hospitals and in the community.
- Rational use of antibiotics as a key factor in reducing resistance.
- Clearly informing the general public about the risks of self-medication, side effects associated with antibiotic use, and the potentially serious result of promoting the development of antimicrobial resistance.
- Promotion of a permanent continuing medical education system, tailored to the circumstances of each country.
- Passage of strict regulations regarding responsible prescription and dispensing of antibiotics.
- Establishment of Antimicrobial Stewardship Committees within all public and private institutions where these drugs are prescribed, in harmony with governmental regulations on rational use of antimicrobials.
- Ministry of Health guidance in each country to assist private and public hospitals in implementing Standard Treatment Guidelines for the most common infectious diseases, with the participation of relevant medical associations such as infectious disease and microbiology societies.
- The sale of antibiotics only by medical prescription, and with the adequate dose and treatment duration for the intended condition.
- Industry commitment to develop newer antibiotics, promote their prudent use and suspend the manufacture of combination antibiotics, with their higher risk of harmful interactions.
- The prohibition of antibiotics as growth promoters or digestive enhancers in animal husbandry.
- Enforcement of quality control standards in the production of generic antibiotics, under the direction of an independent organism that would guarantee compliance with standards in terms of drug efficacy, absorption, bioavailability, and biosafety.
- Provision of necessary infrastructure and capabilities in microbiology laboratories - including building the capacity of human resources - for the precise identification of pathogens, as well as the expanded use of modern tests for susceptibility and/or resistance.
- Creation of Infection Control Committees in every public and private hospital.
- Unambiguous prohibition of advertising or marketing of antibiotics in the community by industry and pharmaceutical representatives.
We Recommend That:
- Health authorities in each Latin American country endorse the various points in this Declaration to benefit the public in general and the rational use of antibiotics in particular.
- As part of the process for approval of new antibiotics, regulatory agencies should require data on the development and spread of antimicrobial resistance in each country.
- Ongoing revision of the duration of therapy and dosages of antibiotics for each infection based on local resistance and susceptibility patterns.
- Implementation of surveillance studies to determine the most effective antibiotics for particular bacterial pathogens, particularly in the presence of multi-resistant strains.
- Development of potentially biodegradable antibiotics.
- Development of antimicrobials that are specifically targeted to a pathogen or body organ system.
- Promotion of cycling, or rotation, of antibiotics in special critical areas, such as hospital intensive care units.
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