Advocating for Amoxicillin Amidst AMR

Advocating for Amoxicillin Amidst AMR

The UN high-level meeting on antimicrobial resistance present those fighting child pneumonia with an opportunity to speak out in support of efforts to battle both AMR and child pneumonia.

By Kate O’Brien, Executive Director, International Vaccine Access Center & Amy Sarah Ginsburg, Senior Advisor in International Programs, Save the Children

The issues surrounding antimicrobial resistance (AMR) are gaining considerable attention as policymakers continue to mobilize support for the Global Action Plan on Antimicrobial Resistance. As the September UN high-level meetings on AMR begin, it is worth considering not only how the growing fear of an “antibiotic apocalypse” will generate innovative strategies to tackle this threat, but also how these measures will intersect with and bolster other health priorities.

The global fight against pneumonia will certainly impact, and be impacted by, initiatives to combat AMR. Pneumonia, currently the leading infectious cause of death for children under 5, takes lives in countries where children do not have access to appropriate antibiotic treatment. In fact, a recent article published in the Lancet by Ramanan Laxminarayan and colleagues provides insight into the correlation between access to antibiotics and pneumonia deaths. They estimate that “universal provision of antibiotics could avert a mean of 445,000 community-acquired pneumonia deaths in children aged younger than 5 years, a 75.4% reduction across the 101 countries.”

The unique challenges of low-resource countries are summarized by UK Chief Medical Officer Dame Sally Davies: “We must not forget that at this time more people die because they didn’t get access to the appropriate antibiotic than because of resistance.” She explains that appropriate use of antibiotics does not always mean less, and major hurdles include a lack of care-seeking behavior, a shortage of trained health care professionals, misdiagnosis, and a lack of appropriate, quality antibiotics.

How can policy makers bolster efforts to close the treatment gap while simultaneously curbing the flow of unnecessary antibiotics? The answer, though not without its complexities, may be found by building on shared priorities in the global plan to address pneumonia and diarrhea and the Global Action Plan on Antimicrobial Resistance (GAP-AMR). In fact, overlaps exist in three common goals:

  • To decrease the need for antibiotics by reducing incidence of disease through prevention measures, such as improved vaccine coverage, safe water, hygiene, and sanitation and reduction of household air pollution.
  • To strengthen the evidence base around treatment and antibiotic resistance through surveillance and research. For example, the true burden of decreased antibiotic susceptibility is not currently being assessed or monitored in many low-resource countries. Accurately defining the problem will be an important part of addressing it.
  • To develop the case for and increase investment in new vaccines, medicines, and diagnostics/prognostics.


The final point, the need for innovation, is of the utmost importance. Impediments to judicious antibiotic use include our limited ability to diagnose true pneumonia, and to determine what pathogen(s) are causing the infection.  As a result, in some settings, we are over-treating respiratory illnesses and erring on the side of providing antibiotic treatment, while in other settings children still have limited access to treatment. Better diagnostics and prognostics for true cases of bacterial pneumonia are needed in rich and poor countries alike, and would simultaneously eliminate the need to provide antibiotics “defensively,” provide better care, and reduce unneeded exposure to antibiotics.

The high-level meetings present those of us fighting child pneumonia with an opportunity to speak out in support of efforts to battle both AMR and child pneumonia. Working together, we can ensure that providing children with access to appropriate antibiotic treatment is also on the minds of policymakers.

Kate O’Brien, MD, MPH, is the Executive Director of the International Vaccine Access Center and Professor at the Johns Hopkins Bloomberg School of Public Health. She is a pediatric infectious disease physician, epidemiologist, and vaccinologist.

Amy Sarah Ginsburg, MD, MPH, is Senior Advisor in International Programs at Save the Children, where she leads the Innovative Treatments in Pneumonia clinical trials. She is an infectious diseases physician and epidemiologist.