Antimicrobial resistance in low- and middle-income countries: current status and future directions

ABSTRACT

Introduction

Rising rates of antimicrobial resistance (AMR) globally continue to pose agrave threat to human health. Low- and middle-income countries (LMICs) are disproportionately affected, partly due to the high burden of communicable diseases.

Areas covered

We reviewed current trends in AMR in LMICs and examined the forces driving AMR in those regions. The state of interventions being undertaken to curb AMR across the developing world are discussed, and the impact of the current COVID-19 pandemic on those efforts is explored.

Expert opinion

The dynamics that drive AMR in LMICs are inseparable from the political, economic, socio-cultural, and environmental forces that shape these nations. The COVID-19 pandemic has further exacerbated underlying factors that increase AMR. Some progress is being made in implementing surveillance measures in LMICs, but implementation of concrete measures to meaningfully impact AMR rates must address the underlying structural issues that generate and promote AMR. This, in turn, will require large infrastructural investments and significant political will.

KEYWORDS:

• Antimicrobial resistance (AMR)
• Low- and middle-income countries (LMICs)
• Antibiotic use
• Antimicrobial stewardship
• Review

Article highlights

• Antimicrobial resistance (AMR) is a major public health concern globally, with particularly serious consequences in low- and middle-income countries (LMICs).

• The magnitude of the AMR problem is hard to estimate in LMICs, due to the unavailability of proper surveillance programs, although some progress has been made over the past few years following the launch of the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) project in 2015.

• The widespread and often inappropriate use of antibiotics in humans, animals, and crops, along with the inadequate management of pharmaceutical wastes at the sites of production, are among the key drivers of AMR selection across LMICs and need to be urgently addressed.

• A combination of factors related to poor hygiene and sanitation, limited access to adequate healthcare infrastructures, and lack of regulations make the spread of AMR easier and faster in LMICs.

• The ongoing COVID-19 pandemic is bringing additional challenges in an already complex scenario, favoring the overuse of antibiotics in LMICs, and reducing public attention on the serious threat of AMR.

Author contributions

All authors have substantially contributed to the conception, design and development of the review article. GS and SS prepared the first draft of the article, and all authors were subsequently involved in revising its contents until finalization.

Declaration of interest

G. Sulis is a former recipient of the David G. Guthrie and the Richard H. Tomlinson Doctoral Fellowships from McGill University. Dr. Sayood is a recipient of the NIH Training Grant n. T32AI007172; the content of this work is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. The authors have no other 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

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.