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Initial Comments
A. Themes and Approaches
B. General Recommendations
C. Structure and Process
D. Specific Recommendations by Item
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Themes
and Approaches
In general, the goals and action items are impressively comprehensive and in large part complete. We suggest, however, that the following overarching themes and approaches receive greater emphasis in each section of the Action Plan.
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The Interdependence of National and International Interests in Addressing the Problem of Antimicrobial Resistance
The solutions for antimicrobial resistance require a coherent global and national strategy, because resistant bacteria and their resistance genes cross country borders. We urge that Part I (Domestic Issues) of the Action Plan stress this interrelationship upfront. In acknowledging this broader picture, the Action Plan can lay out the extensive nature of the global problem and the international resources dedicated to it, as well as prepare the reader for the second phase of this effort, the International Action Plan.
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The Local Feature of Global Resistance
Despite its global appearance, antibiotic resistance is a local phenomenon with cumulative global presence and consequences. Bringing awareness to this critical feature of the problem will encourage local groups to organize and find local solutions. It will offer a way to focus some of the action items and identify the groups to take action.
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The Ecological Effects of Antibiotic Use
Little, if any, attention is being given to research on the residues in the environment after treatment effects of antibiotic use. Antibiotics have a potential effect far beyond the course of treatment for which they are prescribed. They are disseminated in animal and human excrement, waste products, and municipal sewer systems. We recommend that the Action Plan include this unknown, but probably large, factor in its focus and include ways to fund research and education in this area. The residues from the use of antibiotics in animals, plants and humans need to be considered.
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