SciDev.Net

Researchers looked at global patterns of antibiotic resistance to assess how best to tackle the problem. They looked at three geographically separated, and culturally and economically distinct countries — China, Kuwait and the US: the theory was that if these very different countries had different patterns of resistance, a country-specific approach could still work: if the patterns were similar, a coordinated international response would be needed.

China had the fastest growing rate of increasing resistance, followed by Kuwait and then the US. The authors note that surveillance data are urgently needed to clarify the scope of the problem. Despite the paucity of data, preliminary data show China is doing worst — resistance of SPN (Streptococcus pneumoniae) to erythromycin is 73 per cent, compared with 23 per cent in Kuwait, and its MRSA levels are at 90 per cent

The authors say that although these countries have different trends at the moment, increasing globalisation means this might not last long. Also needed are better methods of data aggregation and analysis of how resistance is transmitted across national boundaries.

The first of this two-part series looks in detail at how antibiotic resistance affects the treatment of different types of illnesses — those that attack the gut (such as salmonella or cholera) and respiratory system (such as the tuberculosis bacterium), and the bacterium that causes gonorrhoea.  Treating these diseases in developing countries is increasingly difficult because the cheap antibiotics that were once effective are growing to be useful against bacteria that have developed resistance. These changes are pushing up treatment costs in developing countries. Drug-resistant tuberculosis, for example, is more expensive to treat than the non-drug-resistant type.

Free registration is required to view this article.

The second half of this series focuses on action needed to contain antimicrobial resistance. It outlines the risk factors that can lead to resistance emerging and spreading, particularly in developing countries: using poor-quality drugs or inadequate infection control in hospitals, for example. The article outlines strategies to stop the problem getting worse but points out that developing countries differ widely in the state of their healthcare systems and their resources, so a one-size-fits-all model is not useful.

The authors emphasise the importance of education of the public and of medical practitioners because otherwise the only information available to most healthcare professionals is from pharmaceutical companies that may not fit government or local priorities. In developing countries, unsanctioned providers are a particular problem because they might give people counterfeit or substandard antibiotics that can fuel resistance.

Free registration is required to view this article.

Good prescribing practices are important in tackling antibiotic resistance, and diagnostics are key to ensuring good practice. Knowing who not to treat is as important as knowing who to treat. The article reports on analyses by the Global Health Diagnostic Forum of the Bill & Melinda Gates Foundation to assess how many lives could be saved by better diagnostics for six major illnesses, including malaria and tuberculosis. The researchers assessed the technical issues associated with implementing the diagnostic tests in developing countries for three classes of laboratory infrastructure — none, minimal, or moderate to advanced.

They found that for acute lower respiratory infections, syphilis, gonorrhoea, chlamydia and TB, outcomes could be much improved if tests were sent to sites with minimal or no laboratory infrastructure. In these types of settings, the practicality of obtaining a specimen is important. For example, obtaining a blood sample correctly to test HIV viral load is almost impossible where there are no laboratory facilities. Using sputum to test for TB has similar issues because of the impracticability of the sample medium. Thus, new biomarkers might be needed to test for diseases with specimens different from those currently used. Combination tests that look for a range of infectious organisms in one sample would be useful in resource-poor settings.

The researchers also highlight the importance of taking into account cultural and social sensitivities when designing interventions – blood sampling is not always accepted in some regions of the world, for example.