Country data on AMR in Saudi Arabia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BACKGROUND: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES: To review AMR in Saudi Arabia and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize a further rise in AMR within Saudi Arabia and improve patient outcomes. METHODS: National AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from a clinician in Saudi Arabia were sought to contextualize this information. CONCLUSIONS: Various initiatives are underway in Saudi Arabia, including a National Action Plan for AMR, which was published in 2017. However, AMR is rising and knowledge about appropriate antibiotic use seems to be lacking among physicians and the general public. Various international guidelines are utilized by clinicians in Saudi Arabia, but a more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Saudi Arabia could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

Singapore’s Responses to the COVID-19 Outbreak: A Critical Assessment

This article reviews how Singapore has responded to the COVID-19 pandemic, from late-January to early May, 2020, through the three-phase approach to ?learning?: in-between learning, trial-and-error learning, and contingency learning. Given its unique political system dominated by the People?s Action Party (PAP) and bureaucratic culture, the Singapore government has progressively implemented numerous control measures including strict travel bans, contact tracing, ?Circuit Breaker,? compulsory mask-wearing, and social distancing policies, along with financial relief to businesses and workers, in a very top-down fashion. Although the health and treatment issues of foreign migrant workers in dormitories continue to be the subject of ongoing debate among many scholars, it should be noted that the mortality rate in Singapore still remains very low compared to that of many other countries. Singapore?s case points to an important lesson that learning-driven coordinated strategic approaches matter for effective crisis management in the long term.