Interventions
EXPERT COMMITTEE FOR DEVELOPMENT OF TRIAGE PROTOCOLS FOR COMMUNITY HEALTHCARE PROVIDERS FOR OPTIMISING ANTIBIOTIC USE
Since January 2021, the project team has held extensive consultations with groups of medical, veterinary, pharmaceutical and high-level government stakeholders. All groups have strongly recommended four clear areas for interventions. These include tierwise guidelines for antibiotic use in human and livestock health starting with para-professionals, continuing training and orientation (ideally digital) about antibiotics for all supply chain actors and communities, prescription audits for professionals and a code of conduct for pharmaceutical industry stakeholders.
Moving forward with these recommendations, we constituted Expert Committees to work with the project team on developing a set of guidelines focusing especially at the primary level of the health care system for human and livestock health.
Please see the Terms of Reference for the Expert Committee Sub-Group on Human Health here.Expert Committee for Human Health
| Name | Designation |
|---|---|
| Chair - Dr. Sangeeta Sharma | Professor, Department of Neuropsychopharmacology, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi. Honorary President, Delhi Society for Promotion of Rational Use of Drugs (DSPRUD) |
| Dr. Arvind Taneja | Senior Consultant - Pediatrics, Madhukar Rainbow Children's Hospital, New Delhi |
| Dr. Yogesh Jain | Public health physician, Jan Swasthya Sahyog (JSS), People's health support group, Chhattisgarh |
| Dr. Narender Saini | Ex-General Secretary, Indian Medical Association (IMA) |
| Dr. Abdul Ghafur | Consultant in Infectious Diseases, Apollo Hospital, Chennai |
| Dr. Poonam Joon | Consultant, Obstetrics & Gynaecology, Sanjay Gandhi Hospital |
| Dr. AK Nasa | Deputy Drugs Controller, Government of Delhi and President, Indian Association of Pharmacy Graduates (IAPG) |
Expert Committee for Animal Health
| Name | Designation |
|---|---|
| Chair - Dr. Jyoti Misri | Principal Scientist (Animal Health), Indian Council of Agricultural Research, New Delhi |
| Dr. Rajesh Kumar Vaid | Principal Scientist, Veterinary Type Culture Collection, National Research Center on Equines, Sirsa Road, Hisar, Haryana |
| Dr. Susim Mukul Ray | Head – Technical & Promotion, Zenex Animal Health India Private Ltd, Zydus Corporate Park, Ahmedabad, Gujarat |
| Dr. Arnab Sen | Principal Scientist and Head, Animal Health Division, ICAR Research Complex for NEH region, Umiam, Meghalaya |
| Dr. Prejit Nambiar | Assistant Professor, Veterinary Public Health, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Pookode, Wayanad, Kerala |
| Dr. Shubhamitra Chowdhury | Assistant Professor (Veterinary Medicine), Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Kolkata |
| Dr. Tapas Kumar Sar | Associate Professor (Veterinary Pharmacology), West Bengal University of Animal and Fishery Sciences, Kolkata |
A key recommendation that emerged across all stakeholder groups was to collaboratively develop a pragmatic set of guidelines to optimise antibiotic use among frontline providers at the primary care level for human and livestock health. The Expert Committee (see tab Expert Committee members) constituted through the OASIS project worked closely over several virtual meetings from December 2021 through March 2022 to develop guidelines (see tab Guidelines of Expert Committee) that aim to:
- Assist frontline providers in identifying symptoms and red flag signs of conditions presented at primary care level,
- Encourage referrals to a higher care centre when appropriate, and
- Determine when and how to optimise use of antibiotics
Provisional drafts of guidelines for the following clinical syndromes have now been prepared by our medical and veterinary experts:
- Acute unidentified fever
- Community acquired respiratory infections
- Urinary tract infections
- Acute watery diarrhea
- Skin soft tissue infections
For animal health:
- Foot and mouth disease (FMD)
- Peste des Petits Ruminants (PPR)
- Mastitis
- Fever
- Diarrhoea
- Anorexia
- Swelling of head in poultry
- Retention of placenta
- Respiratory tract infection
- Black quarter
To gain a deeper understanding of the usability/practicality and acceptability of the guidelines, the OASIS team is working closely with partners at the All India Institute of Medical Sciences (AIIMS), Kalyani and State level partners from Nadia District, West Bengal to conduct a phased feasibility assessment with frontline providers.
On May 23 2022, the first orientation session was conducted with frontline providers at the Sreenagar PHC, Chakdaah Block, Nadia District, 35 kms away from AIIMS Kalyani. In this session, led by the Block Medical Officer of Health, frontline providers received an orientation and training on how to use the guidelines with a) background information on disease spread, germ theory, antibiotics and AMR and b) a presentation on Bengali versions of guidelines for diarrhea and fever. Following a Q and A session, frontline providers were requested to use the guidelines for 7-10 days.
Between May 31-June 3, the research team conducted in-depth interviews (IDIs) and a feedback workshop to understand frontline providers' experience with the guidelines. The guidelines were positively received and frontline providers offered valuable suggestions that will be incorporated into updated versions of the guidelines.
Two more orientation sessions have been planned for the remaining guidelines for respiratory tract infections, urinary tract infections and skin and soft tissue infections. IDIs and feedback workshops will be conducted with the same practitioners who participated in the first session.
A phased orientation assessment has begun for the veterinary guidelines as well. The first orientation session was conducted on June 6, 2022. Subsequent sessions have been planned for the remaining guidelines. These will be followed by IDIs and a feedback workshop.