TY - JOUR
T1 - Antimicrobial resistance in developing countries. Part II
T2 - Strategies for containment
AU - Okeke, Iruka N.
AU - Klugman, Keith P.
AU - Bhutta, Zulfiqar A.
AU - Duse, Adriano G.
AU - Jenkins, Philip
AU - O'Brien, Thomas F.
AU - Pablos-Mendez, Ariel
AU - Laxminarayan, Ramanan
PY - 2005/9
Y1 - 2005/9
N2 - The growing threat from resistant organisms calls for concerted action to prevent the emergence of new resistant strains and the spread of existing ones. Developing countries have experienced unfavourable trends in resistance - as detailed in part I, published last month - and implementation of many of the containment strategies recommended by WHO is complicated by universal, as well as developing country-specific, factors. The control of selective pressure for resistance could potentially be addressed through educational and other interventions for orthodox and unorthodox prescribers, distributors, and consumers of antimicrobials. At national levels, the implementation of drug use strategies - eg, combination therapy or cycling - may prove useful to lengthen the lifespan of existing and future agents. Programmes such as the Integrated Management of Childhood Illnesses (IMCI) and directly observed short-course therapy (DOTS) for tuberculosis are prescriber-focused and patient-focused, respectively, and have both been shown to positively influence factors that contribute to the selective pressure that affects resistance. The institution of interventions to prevent the transmission of infectious diseases could also lead to beneficial effects on the prevalence of resistance, as has vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae. There has been an upsurge in the number of organisations and programmes that directly address issues of resistance, and collaboration could be one way to stem the dire trend. Additional factors such as unregulated drug availability, inadequate antimicrobial drug quality assurance, inadequate surveillance, and cultures of antimicrobial abuse must be addressed to permit a holistic strategy for resistance control.
AB - The growing threat from resistant organisms calls for concerted action to prevent the emergence of new resistant strains and the spread of existing ones. Developing countries have experienced unfavourable trends in resistance - as detailed in part I, published last month - and implementation of many of the containment strategies recommended by WHO is complicated by universal, as well as developing country-specific, factors. The control of selective pressure for resistance could potentially be addressed through educational and other interventions for orthodox and unorthodox prescribers, distributors, and consumers of antimicrobials. At national levels, the implementation of drug use strategies - eg, combination therapy or cycling - may prove useful to lengthen the lifespan of existing and future agents. Programmes such as the Integrated Management of Childhood Illnesses (IMCI) and directly observed short-course therapy (DOTS) for tuberculosis are prescriber-focused and patient-focused, respectively, and have both been shown to positively influence factors that contribute to the selective pressure that affects resistance. The institution of interventions to prevent the transmission of infectious diseases could also lead to beneficial effects on the prevalence of resistance, as has vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae. There has been an upsurge in the number of organisations and programmes that directly address issues of resistance, and collaboration could be one way to stem the dire trend. Additional factors such as unregulated drug availability, inadequate antimicrobial drug quality assurance, inadequate surveillance, and cultures of antimicrobial abuse must be addressed to permit a holistic strategy for resistance control.
UR - http://www.scopus.com/inward/record.url?scp=23944500827&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=23944500827&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(05)70217-6
DO - 10.1016/S1473-3099(05)70217-6
M3 - Review article
C2 - 16122680
AN - SCOPUS:23944500827
SN - 1473-3099
VL - 5
SP - 568
EP - 580
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 9
ER -