Update from 2019 Winner – Das Pillay Antibiotic Stewardship Award – David Oliver Hamilton, Doctor, Pennine Acute Hospitals NHS Trust

I won the Das Pillay 2019 Antimicrobial Stewardship Award for two antimicrobial stewardship quality improvement projects I coordinated whilst volunteering in Sierra Leone in a rural district general hospital called Masanga: one writing and implementing new antibiotic guidelines[1]; and another creating an innovative transport link to the nearest tertiary centre to improve TB diagnostics and isolation[2].

There are comparatively few antimicrobial stewardship (AMS) programmes in sub-Saharan Africa so it is wonderful that ours gained some recognition so that hopefully, through this international prize, we can encourage others to run similar projects in the area. The award ceremony was a great place to network with others in the field and learn about different methods of tackling stewardship problems.

AMS in low- and middle-income countries (LMICs) faces even more challenges than in high-resource settings given the lack of diagnostic and microbiological facilities, fewer doctors per capita and inadequate control over the production and sale of antibiotics. It is predicted that by 2050, there will be ten million deaths per year worldwide from antibiotic resistance, with four million in Africa alone and a further two-and-a-half million from multi-drug resistant tuberculosis[3]. With a mobile population around the planet and microbes that don’t respect national borders, it is clear that antimicrobial stewardship will fail unless efforts are made to combat drivers of resistance globally rather than in high-income countries alone.

I would like to create a short teaching programme on antimicrobial stewardship which focusses on problems specific to LMICs. With the prize money, I intend to re-visit Masanga and deliver this programme and to also collect data from the new microbiology lab that has recently been installed there. This data will inform us about resistance patterns in Sierra Leone and help us to edit the empirical antibiotic guidelines to provide better patient care now and in the future.

I am contactable at dohamilton@doctors.org.uk and we are always on the lookout for volunteers to work in Masanga!

References:

[1] Hamilton D, Bugg I. Improving antimicrobial stewardship in the outpatient department of a district general hospital in Sierra Leone. BMJ Open Quality 2018;7:e000495.

[2] Hamilton DO, Vas Nunes J, Grobusch MP. Improving the diagnostics of tuberculosis and drug resistance with Xpert MTB/RIF in a district general hospital in Sierra

Leone: a quality improvement project. BMJ Open Quality 2019;8:e000478.

[3] Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Jim O’Neil et al., 2016. http://bsac.org.uk/securing-new-drugs-for-future-generations/, accessed on 12th January 2020.