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Education And Debate

Antimicrobial resistance in developing countries

BMJ 1998; 317 doi: (Published 05 September 1998) Cite this as: BMJ 1998;317:647
  1. C A Hart (, professora,
  2. S Kariuki, senior research officerb
  1. aDepartment Medical Microbiology and Genitourinary Medicine, University of Liverpool, Liverpool L69 3GA
  2. bCentre for Microbiology Research, Kenya Medical Research Institute, PO Box 54840, Nairobi, Kenya
  1. Correspondence to: Professor Hart

    In 1990 it was estimated that 4123 million of the world's 5267 million population—78%—lived in developing countries. Of the 39.5 million deaths in the developing world, 9.2 million were estimated to have been caused by infectious and parasitic disease; infections of the lower respiratory tract were the third most common cause of death worldwide, and diarrhoeal diseases were the fourth.1 Ninety eight per cent of deaths in children occur in the developing world, mostly as a result of infections.

    Projections of disability adjusted life years (that is, the years of life without disability) for the year 2020 show great improvement in developing regions: people are living longer without disabilities.2 However, even the most pessimistic model analysed did not take into account the possibility that the development of new antimicrobial drugs might slow or cease, and that rates of drug resistance in bacteria such as pneumococci, Mycobacterium tuberculosis, or Staphylococcus aureus might increase. We chart the progress and impact of bacterial resistance to antimicrobial drugs in the developing world. The information in this review has been assembled from searches of the computerised databases Medline and Bath Information and Data Services, discussions with colleagues, and personal knowledge.

    Summary points

    • Antibiotics are an important but often scarce resource in developing countries

    • Resistance to antimicrobial drugs is causing increasing mortality and morbidity from infectious diseases

    • Particular problems of resistance are seen in pneumococcal meningitis, tuberculosis, and typhoid fever

    • To maintain the useful life of antimicrobial drugs in developing countries there needs to be improved access to diagnostic laboratories, improved surveillance of the emergence of resistance, better regulation of the use of antibiotics, and better education of the public, doctors, and veterinarians in the appropriate use of the drugs

    Availability of antimicrobial drugs

    Although even the most potent and recently developed antimicrobial drugs are available throughout the world, …

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