Antibiotic use in developing countries

Antimicrobials have been used successfully for over 6 decades, but genes ex pressing resistance to them have emerged in strains of bacteria and have di sseminated through the global ecosystem to reach infecting microorganisms, produce disease, and seriously interfere with therapy, allowing infections to progress and kill despite antibiotic administration. The upsurge in prev alence of such resistance genes in the bacterial population that colonize a nd infect humans involves two processes, emergence and dissemination, in bo th of which there have been contributions from the developing world, where resistance is common and increasing. The emergence of pneumococcal isolates noted in Papua New Guinea and later in South Africa that 1 decade later sp read to most of the world and the intercontinental spread between the Unite d States and Venezuela of a new gentamicin resistance gene carried on an ep idemic plasmid are examples of the ability of bacteria to travel freely, wi thout regard to borders. Complex societal issues such as the misuse of anti biotics by physicians, pharmacists, and the public; the suboptimal quality of the drugs (emergence); and conditions such as crowding, lack of hygiene, poor or nonexistent hospital infection control practices, or insufficient surveillance (dissemination) play a largely unmeasured role that requires s tudy and solutions. In the meantime, we may intervene to delay the emergenc e of resistance and to limit its spread by promoting the judicious use of a ntibiotics both at the local level as well as from multinational organized cooperative efforts. Education and improvement of surveillance and socioeco nomic conditions are integral parts of any solution strategy (Infect Contro l Hosp Epidemiol 2000;21:394-397).