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Towards controlling antimicrobial use and resistance in low-income countries-an intervention study in latinamerica

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Antimicrobial resistance on the rise

The problem of antimicrobial resistance is escalating. The project EU funded project ANTRES researched into the extent and possible causes of resistance in Peru and Bolivia.

Health

It seems that one of the main reasons for antimicrobial resistance is indiscriminate and overuse of antibiotics. In many countries, antibiotics are sold over the counter in pharmacies and self-medication is therefore an option, particularly where medical help is either unavailable or expensive. Project partners from the University of Florence followed two lines of research in urban and rural areas of Peru and Bolivia. First, they determined the incidence of resistance to a full range of antibiotics by the bacterium Escherichia coli (E. coli) in four urban areas. As a comparison, they also studied the extent of resistance in a very small remote area in Peru inhabited by 93 Amazon people with very limited access to antimicrobials. The four urban areas contained a high number of healthy carriers of E.coli resistant to antibiotics that had been in general use for over 50 years. These included ampicillin and tetracycline. There was a lower resistance level but still relatively high in other less commonly used antibiotics like gentamicin, nalidixic acid and ciprofloxacin. By contrast, less than one percent showed resistance to expanded spectrum antibiotics, cephalosporins and amikacin. The remote community in Peru showed some surprising results. There was an unexpectedly high resistance rate that could not be explained by antimicrobial consumption alone due to the remoteness of the situation. However, the results overall are evidence of a very steep rise in resistance to many of the antimicrobials in the screening tests. The underlying trends were the same in all four urban areas under study leaving no doubt that resistance generally is on the increase. These results can form the basis for a continuing collection and analysis of data so that the trends in antimicrobial resistance can be identified and explained.

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