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Tackling Antibiotic Resistance Through Education

Antimicrobial resistance is, first and foremost, an evolutionary process that reduces the effectiveness of antibiotics as microbes become resistant to the effects of medication previously used to treat them; it is the expected collateral damage caused by their mere use.

The 21 September 2016 was a landmark day for the global healthcare community. 193 member states of the United Nations (UN) simultaneously agreed to sign a declaration to fight antimicrobial resistance. It was only the fourth time in the 70 year history of the UN that a health topic had been debated, placing antimicrobial resistance alongside HIV and Ebola for the gravity of the threat it poses to human health. Antibiotics are the mainstay of modern medicine; they are lifesaving, life extending and life enhancing medicines that underpin the treatment of cancers, joint and organ replacement therapies and many common infections.

Antimicrobial resistance is, first and foremost, an evolutionary process that reduces the effectiveness of antibiotics as microbes become resistant to the effects of medication previously used to treat them; it is the expected collateral damage caused by their mere use. But antimicrobial resistance is accelerated by misuse, inappropriate and overuse of antibiotics. We have, since their discovery by Alexander Fleming in 1928, squandered their use in human and animal medicine, and in recent decades more widely across agriculture and the environment. This squandering has contributed in no small part to the emergence of multi-drug resistant infections for which there are increasingly few, and now sometimes, no cures. It is a health crisis that will, if not addressed, lead to the most unimaginable consequences. The UK government commissioned The Review on Antimicrobial Resistance led by Lord O'Neill reports that antimicrobial resistance will be directly responsible for over 10 million deaths by 2050, more than deaths from cancer or deaths from diabetes, road traffic accidents and cholera combined. Without effective antibiotics much of global healthcare provision as we know it will cease to exist.

The final report by Lord O'Neill's group has been instrumental, in one document, in capturing the key global issues and potential solutions to fighting antimicrobial resistance, and placed education of healthcare professionals to become responsible prescribers of antibiotics at the forefront of solutions. Whilst this and likewise reports have been in preparation, and whilst the landmark UN declaration on antimicrobial resistance was being agreed significant activity in the UK aimed at addressing the global problem through education was already taking place.

With a consolidated aim of providing education to all healthcare professionals, regardless of location, economy or infrastructure the University of Dundee and British Society for Antimicrobial Chemotherapy [BSAC] developed and delivered the first open access global educational course on antimicrobial stewardship (Massive Open Online Course on Antimicrobial Stewardship Hosted by FutureLearn, the e-learning arm of the Open University, the MOOC offers free education on prescribing of antibiotics to all health economies internationally. Antimicrobial stewardship comprises a series of pragmatic, low-cost, achievable actions and interventions that when, consistently employed and applied lead to the effective use of antibiotics by practitioners and consequent improvements in patient outcomes and containment or reduction in antimicrobial resistance rates.

The six week course offers approximately 20 hours tuition delivered in an interactive, multi-media format in addition to traditional learning materials. Learners learn at their own pace, can choose to participate in facilitated discussions and share their views, experiences and expertise online. The MOOC provides a truly global learning space and furnishes learners with a range of evidence, skills and expertise that are pragmatic and can be easily adapted and applied for local use.

This low-cost and free at the point of access, high impact education tool has seen significant success, attracting almost 33,000 registered learners since its launch in September 2015. Already translations are underway to enable provision of the MOOC in Chinese and Spanish in early 2017. Interestingly, whilst aimed primarily at hospital based healthcare practitioners working in infection management the course has attracted interest from a wide range of individuals working in the community and also members of the public.

One would consider development of education on this scale to be costly and time consuming, but this joint venture has proved otherwise. The course was developed over 9 months and cost less than £120,000 to launch using educational grants gifted by a consortium of academic and commercial sponsors. Central to its success was the dedication, enthusiasm and commitment of a team of international authors that wished to work towards the common goal of global education to reduce antimicrobial resistance. The model is, and should be, transformational to the way communities can rise to meet global challenges that require the simultaneous education of many. It has, and will continue, to demonstrate how much can be achieved from within limited resources. The MOOC has provided a valuable beginning for extending education on antimicrobial stewardship and the broader agenda of prevention, diagnosis and treatment of infectious disease. FutureLearn and BSAC have agreed to work in partnership to deliver shorter courses that will address in detail areas of the MOOC that learners are seeking more information and instruction about. To create a sustainable model that is engaging but also less resource intensive and one that addresses the needs of all health care communities is being developed through an e-book. We feel such innovative measures are a blueprint for successful educational impact on antimicrobial resistance. We owe it to future generations to do all we can to secure a future for these vital treatments.

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