Box 1 State of Kerala Action Plan for Combating AMR Task Force [46]

1. The Antibiotic prescription guidelines & infection control policy to be available to the public through all official websites of National Health mission, Directorates of Health & Medical Education

2. Formation of a State and district level Task Force with designated State & District Nodal Officers with members from public/ private hospitals and professional bodies. The Task force to ensure the adoption and implementation of the policy at all levels

3. Organizing sensitization workshops across all public/private medical colleges, district/ taluk hospitals and selected private hospitals for sensitizing medical practitioners, pharmacists and other stake holders regarding the short term and long term objectives of antibiotic stewardship

4. Widespread information, education & communication (IEC) among public regarding the bad effects of self-medication & irrational antibiotic consumption

5. Strong Regulatory efforts through Pharmacy Council and Drug control Department to prevent the illegal dispensing of antibiotics without Standard Prescriptions

6. Workshops to be organised with deliberations by experts for all house surgeons who are passing out of Medical Colleges every year regarding the rational antibiotic usage & emerging AMR as a strategy of “catch them young for the better future”

7. Monitoring mechanism through quarterly review, wherein, every stakeholder has to report on the extent of the adoption and implementation of State antibiogram in their respective discipline

8. Review suggestions to be incorporated as the discussion points for the annual CME on state antibiogram and shall be published as a subsequent version

9. Regular CMEs by Government and the professional bodies with credit hours through TCMC to discuss the rational antibiotic usage for the elimination of AMR

10. Formation of Institution level Infection Control Committee for reviewing hospital infection control practices and rational antibiotic prescription patterns

11. The essential Drug List to be optimized as per the state antibiogram and separate antibiotic template for PHS, CHC & FRUs to be prepared and implemented

12. The State core committee to register as a Forum initially and a society later with the Chairman from the industry on a term rotation basis. The society shall chart specific road map for scientific scrutiny and research in the field of AMR

13. In future, State government to provide financial assistance through Plan budget to entertain rational antibiotic usage in public and private facilities & for surveillance & research activities about for microbiological resistance patterns

14. Upscale existing research under leadership of technical advisor

15. Annual national symposium each year to disseminate the findings of Good Antibiotic Prescription Practices

16. Recognition of success through an awards system for better performing professional bodies and institutions. Award criteria to be developed

17. Empirical evidence-based guidelines to be disseminated through a mobile application for smartphones

18. Curriculum on ASP to be developed for undergraduates and post graduates

19. Selected hospitals to develop institutional antibiograms which will serve as a base for the state antibiotic rational usage strategy

20. Establish clinical audits and surveillance