TCIH AMR Paper 2023-1

The contribution of Traditional, Complementary,
and Integrative Healthcare (TCIH) to addressing

Antimicrobial Resistance (AMR)
TCIH Coalition position paper on AMR
VISIT OUR WEBSITE TCIH

Introduction
In recent decades, there has been a growing interest in the use of Traditional,
Complementary, and Integrative Healthcare (TCIH)1 in the prevention and treatment
of infectious diseases. As multidrug-resistant bacteria continue to pose a pressing
global challenge, TCIH strategies not only diversify therapeutic solutions but also
contribute to reinforcing preventive actions and enhancing health maintenance
and recovery strategies in response to Antimicrobial Resistance (AMR). While global
policy responses and healthcare initiatives exist, additional efforts are essential
to reinforce preventive actions, as well as to enhance health maintenance and
treatment strategies.2
TCIH approaches to prevention and treatment of infectious disease draws upon

broad historical use in many TCIH professions, already in high demand by millions
of patients across the globe and increasingly integrated in healthcare systems.
These broad TCIH practices, which are supported by a growing body of research,
require a concerted effort to harness their potential and further include them into
healthcare systems worldwide.3 Through its One Health approach4,
TCIH offers a promising avenue to help mitigate AMR, emphasizing prevention and
the holistic concept of human, animal, and environmental health by focusing on
modifiable lifestyle risk factors, and supporting patient awareness, positive lifestyle
choices, including nutrition and psycho-social factors such as stress.
This paper introduces the role of TCIH in addressing AMR, highlighting its potential
to mitigate AMR. Additionally, we propose a set of actionable steps for policymakers,
healthcare professionals, and researchers on how to integrate TCIH effectively into
healthcare systems, contributing to a holistic approach to combat AMR and promote
human health.
1
https://iris.who.int/bitstream/handle/10665/312342/9789241515436-eng.pdf
2
https://www.who.int/publications/i/item/9789240041387
3
https://www.who.int/publications/m/item/who-traditional-medicine-summit-2023-meeting-report--gujarat-declaration
4
https://www.who.int/news-room/questions-and-answers/item/one-health
09/11/2023
The role of TCIH in addressing AMR: Embracing the
One Health perspective
As global efforts to combat AMR prioritize One Health approaches and cross-
sectoral collaboration5, TCIH therapies offer valuable contributions to infection
prevention and management. TCIH promotes holistic health, encompassing
physical, mental, and social well-being. Furthermore, it places significant emphasis
on inclusion, cultural and societal diversity, including Indigenous knowledge and
individual preferences. TCIH provides expertise across the entire health spectrum,
from prevention to recovery. These modalities are already embraced by millions
worldwide, as recognized in the recently published Gujarat Declaration of 20236 and
G20 New Delhi Leaders’ Declaration7.
Prevention: Health promotion and enhancing resilience

Prevention lies at the core of TCIH practices and modalities. These approaches
prioritize health promotion, patient awareness and the enhancement of patients’
health resilience against infectious diseases. By fostering overall health and well-being,
TCIH can reduce the need for antibiotic treatments and prevent the relapse of chronic
infections. These preventive measures include interventions such as dietary guidance,
stress management techniques and prescriptions, and lifestyle adjustments.
Management: A holistic approach to treatment

In cases where healthcare interventions are needed, TCIH offers a comprehensive
and holistic approach to disease management. In addition to conventional antibiotic
treatments, TCIH provides a wide-range of non-antibiotic therapeutic options that have
demonstrated potential in the treatment of simple, acute infections, in addressing
chronic infections and preventing recurrence of infections. TCIH can be help with
infection prevention and control as:
• Non-antibiotic treatment option: Research suggests that TCIH approaches

contribute to lower antibiotic prescription rates, e.g., in instances of infections
such as respiratory, urinary, or skin infections.8 9 10 11 These efforts align with the
broader AMR strategies of promoting innovative non-antibiotic treatments for
infections, which, in turn, help with prudent use of antimicrobials.
• Adjunct therapy in supporting standard treatments: The integration of TCIH
as an adjunct therapy alongside conventional treatments for infectious diseases
is well-supported by historical use and empirical evidence12. Research indicates
that TCIH therapies enhance the overall effectiveness of antibiotic treatment,
reduce relapse, and improve the well-being of patients.13
To maximize the impact of TCIH, policymakers and healthcare stakeholders should

recognize TCIH as a valuable resource to diversify therapeutic solutions and improve
broader health outcomes.14 15 16
5
https://www.who.int/groups/one-health-high-level-expert-panel/meetings-and-working-groups
6
https://www.who.int/publications/m/item/who-traditional-medicine-summit-2023-meeting-report--gujarat-declaration
7
https://www.g20.org/content/dam/gtwenty/gtwenty_new/document/G20-New-Delhi-Leaders-Declaration.pdf
8-11
See e.g., https://doi.org/10.1016/j.eujim.2020.101068 , https://doi.org/10.1089/jicm.2023.0001, https://doi.org/10.1186/
s12906-019-2428-5, https://doi.org/10.1016/j.jaim.2017.10.012
12
See e.g., https://doi.org/10.1016/j.eujim.2020.101191
13
See e.g, https://doi.org/10.3390/antibiotics10020134
14-16
See e.g., https://doi.org/10.1159/000448440 and https://doi.org/10.3390/antibiotics10020134 or https://pubmed.ncbi.
nlm.nih.gov/35860018/ Although a growing body of research suggests the use of such therapies, more research investment and
targeted frameworks are needed.
09/11/2023
Integrating TCIH practices into AMR strategies and antimicrobial stewardship
programs (ASPs) allows for a more holistic and comprehensive approach to
health and well-being.
Education and Empowerment of Patients

Patient education on therapeutic options and promotion of responsible self-care
practices are key in reducing antibiotic use and to preventing resistance spread17.
TCIH practices and practitioners foster collaborative decision-making, to actively
involve patients in healthcare choices18, with studies showing that medical providers
trained in integrative medicine have lower antibiotic prescription rates.19 20 TCIH
practices promote overall well-being, reduce infection risks, and encourage
responsible antibiotic prescription and use.
Policy recommendations
In light of the considerations outlined above, the TCIH Coalition puts forth the
following recommendations to enhance the role of TCIH to combating AMR and
addressing infectious diseases:
• Policy integration: Include TCIH in international and regional policies and work
plans related to AMR, infectious diseases, and One Health initiatives. This includes
alignment with frameworks such as the WHO Global Action Plan on AMR21
and the EU One Health AMR Action Plan22 and their implementation.
• National integration: Promote the incorporation of TCIH within national health
policies, National Action Plans (NAPs), and AMR-related guidelines, with a specific
emphasis on adopting TCIH best practices.
• Healthcare integration: Encourage the integration of TCIH into primary
healthcare delivery systems, fostering collaboration and knowledge exchange
between TCIH practitioners and conventional healthcare providers through the
development of specific guidelines.
• Education and awareness: Integrate TCIH in healthcare education and
continuous AMR education programs to enhance understanding and utilization of
TCIH approaches among healthcare professionals, practitioners, and researchers.
• Research and development23: Allocate funding for research and development
of TCIH therapies and products, focusing on assessing their effectiveness
and safety as non-antibiotic prevention and treatment options.24 25 26
This can be done by:
⸰ Designing specialized and targeted research frameworks that facilitate the
comprehensive evaluation of the efficacy of TCIH methodologies and products
⸰ Encourage local production of TCIH products where appropriate
• One Health embrace: Embrace a multi-sectoral One Health approach
comprehensively across all levels and systems, with particular attention to
preventive antibiotic usage in animal husbandry and waste management.
17
https://doi.org/doi:10.3122/jabfm.2020.06.200210
18
https://doi.org/10.1016/j.eujim.2019.05.003
19-20
See e.g, https://dx.doi.org/10.1136/bmjopen-2017-020488 and https://doi.org/10.1001/jama.2016.0275
21
https://www.who.int/publications-detail-redirect/9789241509763
22
https://health.ec.europa.eu/system/files/2020-01/amr_2017_action-plan_0.pdf
09/11/2023
Conclusion
TCIH approaches offer a valuable perspective in addressing infectious diseases and
the challenge of AMR by reducing the dependency on antibiotics, thereby preserving
the efficacy of these critical antimicrobial drugs. To effect meaningful change, TCIH
approaches must be fully recognized, promoted, and integrated into global AMR
efforts, guided by the aforementioned considerations.
In summary, TCIH’s contributions span prevention, management, and responsible

antibiotic use, in line with the One Health approach. It serves as a non-antibiotic
treatment option, complements conventional therapies, and educates and empowers
patients, while encouraging responsible self-care practices. As we move forward in
the fight against AMR and infectious diseases, it is crucial to recognize that TCIH
is not a standalone solution but an integral part of a comprehensive approach.
The collaboration, research, and integration of TCIH with conventional healthcare
systems are essential for harnessing its full potential.
We, therefore, urge policymakers, healthcare providers, education institutions,

and researchers to promote best practices and implement policies that support
the integration of TCIH into healthcare systems and healthcare education. By
doing so, we can collectively advance AMR prevention, ensure the continued
effectiveness of antibiotics, and promote the holistic well-being of individuals
and communities worldwide.
On behalf of the TCIH Coalition, written by: Christine Liebing-Gabel (ICH),

Dwi Linna Suswardany (IAKMI), Edward de Beukelaer (ECH), Fitsum Lakew (WACI
Health), Gillian Wray (ISH), Janka Szoke (TCIH Secretariat), John Littleton (ACI), Kamil
Mohammad (Lotus Holistic Institute), Ricardo Taixaira (ETCMA), Robert Kempenich
(AREMA), Wolfgang Devine (AMAA), Xiaowen Zhang (BUCM)
23
See e.g, the TCIH AMR research agenda by the GIFTS-AMR (JPIAMR)
https://www.b2match.com/e/research-on-tcih-strategies/components/34631/biYz4tsQRpZA
24-26
See e.g., https://doi.org/10.1155/2019/5365608, https://doi.org/10.1016/j.eujim.2020.101194,
https://doi.org/10.17236/sat00273
09/11/2023

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The contribution of Traditional, Complementary,

and Integrative Healthcare (TCIH) to addressing

VISIT OUR WEBSITE TCIH

TCIH approaches to prevention and treatment of infectious disease draws upon

Prevention: Health promotion and enhancing resilience

Management: A holistic approach to treatment

• Non-antibiotic treatment option: Research suggests that TCIH approaches

To maximize the impact of TCIH, policymakers and healthcare stakeholders should

Education and Empowerment of Patients

In summary, TCIH’s contributions span prevention, management, and responsible

We, therefore, urge policymakers, healthcare providers, education institutions,

On behalf of the TCIH Coalition, written by: Christine Liebing-Gabel (ICH),

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