Antimicrobial Resistance in Developing Countries

Aug 1, 2005 | Ramanan Laxminarayan
In a two-part review in The Lancet Infectious Diseases, Senior Fellow Ramanan Laxminarayan and colleagues describe recent trends and the current status of resistance to antimicrobial drugs in developing countries and address measures to counter this problem.

Abstracts of the two articles appear below, with links to the articles on the The Lancet website (registration required).


Antimicrobial resistance in developing countries
Part I: recent trends and current status

The global problem of antimicrobial resistance is particularly pressing in developing countries, where the infectious disease burden is high and cost constraints prevent the widespread application of newer, more expensive agents. Gastrointestinal, respiratory, sexually transmitted, and nosocomial infections are leading causes of disease and death in the developing world, and management of all these conditions has been critically compromised by the appearance and rapid spread of resistance. 

In this first part of the review, the authors summarise the present state of resistance in these infections from the available data. Even though surveillance of resistance in many developing countries is suboptimal, the general picture is one of accelerating rates of resistance spurred by antimicrobial misuse and shortfalls in infection control and public health.

Reservoirs for resistance may be present in healthy human and animal populations. Considerable economic and health burdens emanate from bacterial resistance, and research is needed to accurately quantify the problem and propose and evaluate practicable solutions.

In part II, to be published next month (abstract below), the authors review potential containment strategies that could address this burgeoning problem.


Link to Lancet Article
Antimicrobial resistance in developing countries
Part I: recent trends and current status

The Lancet
Infectious Diseases

August 2005
(Registration required)


Antimicrobial resistance in developing countries
Part II: strategies for containment

The growing threat from resistant organisms calls for concerted action to prevent the emergence of new resistant strains and the spread of existing ones. Developing countries have experienced unfavourable trends in resistance--as detailed in part I--and implementation of many of the containment strategies recommended by WHO is complicated by universal, as well as developing country-specific factors.

The control of selective pressure for resistance could potentially be addressed through educational and other interventions for orthodox and unorthodox prescribers, distributors, and consumers of antimicrobials. At national levels, the implementation of drug use strategies--eg, combination therapy or cycling--may prove useful to lengthen the lifespan of existing and future agents. 

Programmes such as the Integrated Management of Childhood Illnesses (IMCI) and directly observed shortcourse therapy (DOTS) for tuberculosis are prescriber-focused and patient-focused, respectively, and have both been shown to positively influence factors that contribute to the selective pressure that affects resistance.

The institution of interventions to prevent the transmission of infectious diseases could also lead to beneficial effects on the prevalence of resistance, as has vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae. There has been an upsurge in the number of organisations and programmes that directly address issues of resistance, and collaboration could be one way to stem the dire trend.

Additional factors such as unregulated drug availability, inadequate antimicrobial drug quality assurance, inadequate surveillance, and cultures of antimicrobial abuse must be addressed to permit a holistic strategy for resistance control.


Link to Lancet ArticleAntimicrobial resistance in developing countries Part II: strategies for containment
The Lancet Infectious Diseases
September 2005
(Registration required)