Antibiotic Use and Emerging Resistance: How Can Resource-Limited Countries Turn the Tide?

Abstract

Antibiotic resistance is a global crisis driven by appropriate and inappropriate antibiotic use to treat human illness and promote animal growth. The antimicrobial resistance epidemic continues to spread due to the triple threat of unfettered access, minimal product regulation and oversight of antibiotic prescription, and lack of clinical diagnostic tools to support antibiotic de-escalation in low-resource settings. In high-resource settings, evidence-based strategies have improved appropriateness of antibiotic use, limiting the spread of drug-resistant organisms and reducing hospital-associated infections, which may also be effective to stop the spread of resistance in resource-poor countries. Current research and surveillance efforts on antimicrobial resistance and hospital-associated infections in low-resource settings are extremely limited, largely focused intensive care units. Many challenges exist to improving antibiotic use and infection control in resource-limited settings, and turning the tide requires intensifying research and surveillance, antimicrobial stewardship, and developing new bedside diagnostic tools for bacterial infections and antimicrobial susceptibility.

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

“…18 Prescribing practices are not well documented or regulated in regions with little healthcare infrastructure and with relatively unrestricted access to antimicrobials. [18][19][20][21][22][23][24] Similarly, monitoring and surveillance of antimicrobial resistance is not conducted in most lower and middle income countries, but available data do show clinically relevant resistance in many common bacterial pathogens. [25][26][27][28][29][30][31][32][33][34][35] The ACT Consortium (www.actconsortium.org) included several studies that evaluated the potential of rapid diagnostic tests for malaria to improve case management for patients with undifferentiated fever in malaria endemic areas.…”

“…[58][59][60] Even when treatment with antibiotics is warranted, patients might not receive the most appropriate antibiotic for their illness, particularly in settings with inadequate healthcare infrastructure. 20 In the studies we analysed, choice of antibacterial was inevitably untargeted as health workers in these settings do not have access to facilities to confirm diagnoses and identify pathogens nor to epidemiological data to help guide antibiotic choices-a health system weakness that is unfortunately typical across most malaria endemic areas. In the ACT Consortium studies, nearly all antibiotic prescriptions were for penicillins, trimethoprim-sulfamethoxazole, tetracyclines, and, in several sites, metronidazole.…”

“…This awareness is important in the design of programmes for provider training and community education in Africa and Asia, where antibiotic use is already relatively unregulated and unrestricted. 20 24 65 Without thoughtful intervention in the near term, as the burden of malaria declines and negative malaria test results become more common, the trend toward compensatory prescription of antibiotics can only contribute to increasing levels of antibiotic resistance.…”

Influência da vida séssil e planctônica no perfil de resistência antimicrobiana de Campylobacter jejuni isoladas de carcaças de frangos comercializadas no Brasil

“…Nos últimos anos têm se observado um aumento significativo da resistência aos antibióticos, particularmente entre as bactérias zoonóticas, que é provavelmente, consequente do uso indiscriminado das drogas (BEBELL et al, 2014;LEE et al, 2015). Também há correlação entre a resistência aos antimicrobianos e a utilização das drogas na produção animal, já que de acordo com estudos na União Europeia, 70% dos antibióticos produzidos no mundo são utilizados em fazendas (BEEF WORLD, 2015;ABC, 2016).…”

“…O aumento significativo da resistência aos antibióticos em bactérias zoonóticas (BEBELL et al, 2014;LEE et al, 2015) levou a Organização Mundial da Saúde (OMS) a realizar um alerta em (OMS e PAHO, 2017ONU, 2017). Em C. jejuni a situação foi considerada como alarmante por ser observada resistência às mesmas drogas em cepas isoladas de animais, alimentos e humanos infectados (EFSA, 2016;OMS e PAHO, 2017;ONU, 2017).…”