Antibiotic resistance in low- and middle-income countries: current practices and its global implications

ABSTRACT

Introduction

Antibiotic consumption rates are high in both high and low-income countries, but addressing antibiotic practices in low- and middle-income countries (LMICs) is crucial to combatting antibiotic resistance (AR).

Area covered

This editorial examines the current landscape of antibiotic practices in LMICs, investigate the factors driving such trends including lack of resource equity and shared global responsibility, and explore (AR) global implications, with particular emphasis placed on swift measures to combat its spread.

Expert opinion

LMICs face three key obstacles that exacerbate AR: inadequate WASH services, climate factors, and misuse of antibiotics. A lack of sanitation and clean water promotes infections, while poor hygiene exacerbates resistant pathogen spread. Global strategies should go beyond simply educating LMICs about antibiotic misuse; they must also understand its repercussions, such as prolonged illnesses and drug-resistant bacteria like MRSA. Addressing this challenge requires multifaceted strategies, including improving WASH services, acknowledging climate impacts, and tightening regulations. Prioritizing WASH requires significant funding, community participation, technology solutions, and partnerships with NGOs. Utilizing social media influencers can boost AR awareness. Antibiotic regulation reforms, manufacturing quality, and seeking antibiotic alternatives are vital. Antimicrobial Stewardship Programs and AI’s potential in managing resistant infections are notable.

KEYWORDS:

• Antibiotic resistance (AR)
• WASH services
• low and middle-income countries (LMICs)
• antimicrobial stewardship programs
• Health equity

Article highlights

• Antibiotic use rates have increased by 65-75% between 2000 and 2015 in LMICs due to unsupervised consumption – leading to an unsupervised increase of 65-75% between these countries and other LMICs.

• Lack of healthcare infrastructure and weak regulations contributes to misuse and resultant resistance.

• Poor drug quality and international pharmaceutical policies contribute to antibiotic resistance in LMICs.

• Environmental factors, such as climate, and individual practices like traditional healing or self-medication may contribute to misuse of antibiotics in LMICs.

• Solving antibiotic resistance requires global collaboration on several fronts;WASH services, education programs, regulatory reform and technological innovations like AI.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed receiving research grants from Abbott Diagn. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author (AZM).

Additional information

Funding

The paper was not funded.