In most developing countries, access to antimicrobial drugs is as easy as a run to the grocery store or nearby pharmacy – with or without a prescription from a medical professional. Even with a prescription, patients may not complete their doses, or they may not fully recover from an infection that then continues after the duration of the medicine. How does this unregulated use of antibiotics and related medications relate to the development and spread of antimicrobial resistance in developing countries and what strategies may help mitigate this increasing health crisis?
Antimicrobial resistance herein referred to as AMR, is a complex issue that the World Health Organization (WHO) and the Centers for Disease Control (CDC) have designated a global threat. AMR occurs when bacteria, viruses, fungi, or other infectious organisms adapt and become able to survive in the presence of a medication previously used to kill them. Organisms like bacteria and viruses can even exchange their genetic materials with other susceptible pathogens, thereby enabling the receiving organisms to become resistant, as well. It is worth noting that many potentially deadly diseases – such as influenza, AIDs, and cancer, and COVID-19—become more deadly when secondary bacterial infections that co-occur with them (such as pneumonia) cannot be treated with antibiotics. In fact, a study of nearly 200 COVID-19 patients in a Wuhan, China hospital showed that 50% of patients who died tested positive for secondary infections compared to only one of the nearly 140 survivors. (Read the original article here.)
Bacteria – including AMR bacteria – are a natural part of our soil, water, and living bodies. Even in pristine environments (where humans have never been present), bacteria exist; even bacteria that are resistant to antibiotics. But that’s not to say that humans have not greatly impacted this issue. Any use of antibiotic drugs for the treatment of humans and animals can lead to the development of AMR. In many countries, including the U.S., people cannot access antibiotics without a prescription issued by a medical professional and a veterinarian must approve antibiotic use for animals. Across Asia and Africa, on-the-spot diagnosis and treatment by non-medical personnel are rampant. This may be the single greatest cause of AMR in these countries.
Mass production of generic antimicrobial drugs in industrialized countries also makes the accessibility to these drugs easier and less costly in developing countries. Amoxicillin, a first-line antimicrobial drug that could once treat multiple diseases, including bacterial pneumonia, chlamydia, and salmonella, is now often ineffective against these bacterial infections. In Kenya, renowned microbiology researcher Sam Kariuki reported to the New York Times that nearly 70% of salmonella infections had stopped responding to the most widely used antibiotic treatments.
The World Health Organization recognized AMR as a global public health threat requiring action across all government sectors and society. At their inaugural meeting during the World Antibiotic Awareness Week, the Ministry of Health in Kenya encouraged the collaboration between different stakeholders from agriculture and livestock production to public health. This effort is intended to identify and implement strategies that will institutionalize surveillance systems and encourage antimicrobial stewardship for both human and animal use of antibiotics. This “one-health” approach recognizes the interconnectedness and mutual dependency of human, animal, and environmental health.
Another driving factor to this crisis is poverty and the often accompanying lack of proper health amenities and basic sanitation practices. These factors lead to unregulated drug supply chains, improper diagnostics, and rampant spread of infectious diseases. Thus, the fight against AMR as a global public health threat must be combated by incorporating economic considerations into the disease mitigation model. Other notable organizations are working on strategies to bring awareness to AMR in the African continent and implementing such strategies through education, encouraging behavioral change, and conducting research.
This article was written by Noelle Atieno Mware, PhD student at the University of Nebraska-Lincoln, as a part of a course on antimicrobial resistance and science communication. This article was reviewed by Drs. Amy Schmidt (firstname.lastname@example.org) and Kari Nixon, both members of the iAMResponsible extension team for antimicrobial resistance.