This Personal View discusses the challenges faced, especially by low-income and middle-income countries (LMICs), in responding to the growing burden of bacterial antimicrobial resistance. Many patients in LMICs lack access to effective and affordable treatments needed to successfully treat patients. Meanwhile, traditional antimicrobial stewardship models face implementation challenges due to financial, health system, and human resource constraints. These constraints call for a paradigm shift from traditional high-income country-style antimicrobial stewardship, which is often resource intensive and aimed at cost containment, to a broader concept of sustainable access. We suggest a model of context-adapted stewardship that continues to emphasise providing the right antibiotic, at the right time, for the right duration, and at an affordable price. Taking lessons from other disease areas, including tuberculosis, we identify interventions such as task shifting to various health-care workers and the implementation of a hub-and-spoke model to support appropriate use of antibiotics, to enable optimal access and maximisation of scarce resources.

中文翻译：

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加速抗生素的获取和管理：保障公众健康的新模式

本个人观点讨论了在应对日益严重的细菌抗菌素耐药性负担方面所面临的挑战，特别是低收入和中等收入国家 (LMIC)。中低收入国家的许多患者无法获得成功治疗患者所需的有效且负担得起的治疗方法。与此同时，由于财政、卫生系统和人力资源的限制，传统的抗菌药物管理模式面临实施挑战。这些限制要求进行范式转变，从传统的高收入国家式抗菌药物管理（通常是资源密集型且旨在控制成本）转向更广泛的可持续获取概念。我们建议采用一种因地制宜的管理模式，继续强调在正确的时间、正确的期限内以可承受的价格提供正确的抗生素。借鉴包括结核病在内的其他疾病领域的经验教训，我们确定了一些干预措施，例如将任务转移给不同的卫生保健工作者，以及实施中心辐射模式来支持抗生素的适当使用，从而实现稀缺资源的最佳获取和最大化。