Challenges of drug resistance in the developing world

Resistance to anti-infective drugs, particularly bacterial resistance to antibiotics, is a global phenomenon. Resistant infections increase morbidity and mortality and prolong the time of infectiousness, putting others at risk. In high income countries, where the burden of infectious diseases is modest, the decreasing effectiveness of first line antibiotics is overcome by more expensive second and third line antibiotics. The challenge is greater in developing countries, where the burden of infectious diseases is high and patients with a resistant infection may be unable to obtain or afford any antibiotic, let alone expensive second line treatments. Poor hygiene, unreliable water supplies, civil conflicts, and increasing numbers of immunocompromised people with HIV infection, facilitate both the evolution of resistant pathogens and their rapid spread.1 2

The most complete data on resistance in developing countries come from tertiary care facilities, typically located in large cities. Very little information exists on resistance in other settings and almost none in rural areas. Recent data from community settings in Indian and South African urban and peri-urban areas indicate that levels of resistance are high. In urine specimens collected from November 2003 to December 2004, more than 70% of Escherichia coli isolated from healthy women were resistant to ampicillin and nalidixic acid, and more than 50% of isolates were resistant to fluoroquinolones (fig 1⇓). 3