The Introduction of Antimicrobial Agents in Resource-Constrained Countries: Impact on the Emergence of Resistance

Abstract

A potential undesirable effect of the introduction of a new class or type of antimicrobial drug is the selection and spread of resistant strains of microbial agents. As a result of this biological adaptation, antimicrobial agents become ineffective, leading to poor clinical outcomes at the individual level. At the community level, the spread of these resistant strains may lead to significant morbidity and mortality with potentially devastating economic and social consequences. In this chapter, we describe two case studies that demonstrate the occurrence of antimicrobial resistance after the introduction of antimicrobial drugs into developing settings. The first case describes the emergence of antiretroviral resistance after their recent introduction to control HIV/AIDS in resource-poor settings, particularly in Sub-Saharan Africa. The second case illustrates the negative consequences of the overuse of fluoroquinolones to treat enteric gram-negative bacteria in Southeast Asia. These events have rendered many of these bacterial pathogens resistant to this class of drugs and have caused a significant setback to control programs for diseases such as dysentery, typhoid fever, and gastroenteritis. We therefore suggest that after the introduction of a new antimicrobial agent into developing-country settings, the emergence and subsequent spread of antimicrobial resistance can be ameliorated by the concomitant implementation of programs targeting prudent use of these drugs. This could be achieved through the development of clinical guidelines and prospective surveillance activities to detect the early occurrence of resistance that may provide the opportunity to implement preventive strategies to impede further the spread of resistant microbial strains at the community and hospital levels.