Table 1 Factors and stakeholders contributing to the problem of antimicrobial resistance
From: The threat of antimicrobial resistance in developing countries: causes and control strategies
Factors | Contribution | Example |
|---|---|---|
Poor drug quality | Sales of counterfeit, adulterated and poor quality antibiotics | These poor quality antibiotics can produce sub-inhibitory concentration in vivo, which increases the selection of resistant strains |
Regulators | While most developed countries have developed AMR action plans, this is still lacking in many developing countries especially in Africa | Most countries lack the resources to enforce policies regarding the manufacture and distribution of sub-standard drugs |
Prescribers | Excessive clinical use and misuse is partially responsible for increase rate of resistance | Variation in prescription practice among health care provider. Sometimes there is prescription of a wrong drug, wrong doses, or antimicrobial not necessary at all |
Dispensers | Drug vendors usually have little or no knowledge of the required dosage regimen, indication, or contraindications | Medications are usually purchased in small aliquots from roadside stall and storage and distribution is usually done under inadequate conditions |
Users (patients) | High rate of self- medication and lack of treatment compliance | Patients fail to adhere to dosage regimens and discontinue treatment when symptoms subside before pathogen is eliminated |
Animal industry | The use of antimicrobial drugs in agriculture or industrial settings, exerts a selection pressure which can favor the survival of resistant strains (or genes) over susceptible ones, leading to a relative increase in resistant bacteria within microbial communities | Resistant bacteria in animals can be transferred to humans through the consumption of food or through direct contact with food-producing animals or through environmental spread |