Agenda-setting analysis for antimicrobial restriction policy in Islamic Republic of Iran

Abstract

Background: Antimicrobial resistance is a serious threat to healthcare globally and antimicrobial stewardship is fundamental in combating it. Aim: To analyse the agenda-setting process for the development of an antimicrobial restriction policy in Islamic Republic of Iran using Kingdon's Multiple Streams Framework. Methods: We conducted key informant interviews with 21 experts who were involved in agenda-setting for an antimicrobial restriction policy in Islamic Republic of Iran and reviewed relevant documents relating to the development of the policy. We analysed the data using Kingdon's Multiple Streams Framework. Results: In 2019, Islamic Republic of Iran officially announced its antimicrobial restriction policy. Although national surveillance data were limited, multiple proxy indicators showed excessive use of antimicrobials and an increase in antimicrobial resistance in Islamic Republic of Iran. Based on available data, stakeholders made a compelling case for urgent policy actions to minimize irrational prescription and use of antimicrobials in the country. To balance antimicrobial stewardship with clinical needs, the antimicrobial restriction policy mandates infectious disease specialists to conduct laboratory and clinical assessment of patients, after taking the first antimicrobial dose, prior to treatment continuation. Conclusion: In addition to evidence, demonstrating the clinical, economic and public health benefits can help improve system responsiveness to antimicrobial stewardship policy and programme development.