References

Abdi, Y.A., Rimoy, G., Ericsson, O., Alm, C., and Massele, A.Y. 1995. Quality of chlor-oquine preparations marketed in Dar es Salaam, Tanzania. Lancet 346 1161. Abdo-Rabbo, A., Bassili, A., and Atta, H. 2005. The quality of antimalarials available in Yemen. Malar. J. 4 28. Alabdalla, M.A. 2005. Chemical characterization of counterfeit Captagon tablets seized in Jordan. Forensic Sci. Int. 152 185-8. Ali, S.L. 2000. Counterfeit drugs and analytical tools for their discrimination European...

Introduction

The discovery of antimicrobial drugs in the first part of the nineteenth century is considered as a major milestone in medical history however, the remarkable success of antimicrobial drugs generated a misconception in the late 1960s and early 1970s that infectious diseases had been conquered. This belief has misled generations of physicians and patients causing them to overuse these drugs. One Direcci n General Adjunta. Instituto de Diagnostico y Referencia Epidemiol gicos (InDRE). Secretaria...

Enterobacter

Enterobacter cloacae and E. aerogenes are the most common Enterobacter species in clinical practice and in nosocomial infections. In humans, these micro-organisms cause health-care-related infections because of colonization in these settings, a pre-requisite for infection occurs more often than in the community. Emergence and spread of significant antibiotic resistance has been observed in all Enterobacter spp. The use of third-generation cephalosporins has resulted in the selection of strains...

Classes of Antimicrobial Agents

Developing countries use both branded and generic antimicrobial preparations for the management of bacterial infections, even though generics exceed in usage due to their low costs, which can be afforded by many people. Some of the newer classes of antimicrobial agents like third- and fourth-generation cephalosporins and fluoroquinolones, respectively, are rarely used due to their high costs. Major classes of antibiotics which are used include beta-lactams (penicillin and cephalosporins),...

Common Enteric Bacteria for Which Multidrug Resistance Is Documented

Diarrhoeal illness rarely requires antimicrobial treatment and can be prevented by improving living conditions yet antimicrobials, which are widely available over the counter and through other unregulated outlets in a number of developing countries, remain a mainstay of empirical therapy. This widespread injudicious use diminishes the efficacy of affordable and available drugs, which poses a serious problem when antimicrobial treatment is needed (Wise et al. 1998 WHO 1999). Kenya Medical...

Case Study Improving Access to and Use of Medicines in Tanzania

In 2001, the Strategies for Enhancing Access to Medicines (SEAM) program received funding from the Bull and Melinda Gates Foundation to improve access to medicines important for public health through private sector initiatives. The access to medicines framework described above guided the research to define the nature of the problem. Health systems considerations guided the design of a feasible and viable intervention. The case study outlines how a health systems perspective was applied to...

Mechanisms of Antimicrobial Resistance

Prior to the 1990s, the problem of antimicrobial resistance was never taken to be such a threat to the management of infectious diseases. But gradually treatment failures were increasingly being seen in health care settings against first-line drugs and second-line drugs or more. Microorganisms were increasingly becoming resistant to ensure their survival against the arsenal of antimicrobial agents to which they were being bombarded. They achieved this through different means but primarily based...

Pseudomonas aeruginosa and Acinetobacter spp

Nonfermentative gram-negative bacilli (NFB) are primarily opportunists, mainly causing infections in seriously ill, hospitalized patients, immunocompromised hosts, and patients with cystic fibrosis. NFB can be isolated from the environment and are intrinsically resistant to many commonly used antimicrobial agents. Dramatic increases in the prevalence of multidrug-resistant NFB have influenced the empiric antimicrobial therapy for treatment of serious infections caused by such pathogens. The...

Glycopeptide Resistance

Glycopeptides comprise peptide antibiotics of clinical interest such as vancomycin and teicoplanin. Their antimicrobial activity is due to binding to D-alanyl-D-alanine side chains of peptidoglycan or its precursors, thereby preventing cross-linking of the peptidoglycan chain and thus are largely effective against gram-positive microorganisms which poses a bigger layer of the peptidoglycan although not all gram-positive organisms are susceptible to these agents. High-level resistance to...

Cholera in the Time of Resistance

Cholera is a deadly dehydrating diarrheal disease caused by cholera toxin-producing Vibrio cholerae strains. Although referred to as 'Asiatic' cholera because an endemic focus exists in the Indian sub-continent, cholera has caused at least seven pandemics in recent history and the most recent focus of the on-going pandemic is Africa where over two-thirds of outbreaks in the last decade have occurred (Griffith et al. 2006). This present pandemic has been characterized by appearance of new V....

Chemotherapy Is the Mainstay in the Control of Trypanosomiasis

Concerning the control of trypanosomiasis, there exist three possible areas of intervention, namely the host, the vector, and the parasite itself. Control by targeting the host is possible only in the case of animal trypanosomiasis where some breeds of cattle, e.g., N'dama and Muturu breeds, are known to be trypanotolerant (Molyneux and Ashford 1983). Thus, to increase production in trypanosomiasis-endemic areas, it is logical to rear such trypanotolerant breeds. In the past, the wild animal...

Development of Drug Resistance in M tuberculosis

Drug resistance among previously treated patients usually results from exposure to a single drug that suppresses the growth of bacilli susceptible to that drug but permits the multiplication of pre-existing drug-resistant mutants. It is the most common type of resistance to the first-line drugs and can emerge against any anti-tuberculosis agent during chemotherapy (Cohn et al. 1997). Subsequent transmission of resistant bacilli to other persons leads to disease that is drug resistant from the...

Streptococcus pneumoniae

Streptococcus pneumoniae colonizes the upper respiratory tract commonly in individuals, especially children, without causing disease, and is easily transmitted from person to person. The rapid pneumococcal acquisition observed in RLCs is associated with a high risk of serious infections early in infancy (Saha et al. 2003 Granat et al. 2007). Streptococcus pneumoniae is the most frequently isolated respiratory pathogen in community-acquired pneumonia and also a major cause of meningitis, otitis...

Newer Vaccines

Approximately 2.0 of the 10.6 million deaths that occur in young children each year are due to pneumonia (Wardlaw et al. 2006). About half of these deaths occur among children in sub-Saharan Africa and another 30 occur in the countries of south Asia (Bryce et al. 2005). In developing countries 11-20 million children with severe pneumonia are known to require hospital admission (Rudan et al. 2004). Streptococcus pneumoniae has been identified as a main bacterial cause of pneumonia (Shann 1986)...

Mechanisms of Drug Action

Although its mode of action is not well known, the primary target of melarso-prol was suggested to be the inhibition of trypanothione reductase, a key enzyme in detoxification processes in the trypanosomes (Walsh et al. 1991). However, Wang (1995) proposed inhibition of phosphofructokinase, a key enzyme in the glycolytic pathway. Despite melarsoprol having been the drug of choice for late-stage HAT for a long time, its application was until recently based on empirical rather than rationally...

Europe and Central Asia

The first report of a case in Turkey came in 2001, caused by E. faecium, isolated by hemoculture (Basustaoglu et al. 2001). In 2002, the first outbreak of 20 clonally disseminated strains of VRE was reported in Turkey (Colak et al. 2002). Of 23 enterococci isolated in the Bayindir-Ankara hospital, 34.8 were of high-level and 60.9 of low-level glycopeptide resistance, indicating an increase in the rate of resistance in that hospital (Coleri et al. 2004). In that same year, another study was done...

Community Acquired Methicillin Resistant Staphylococcus aureus CAMRSA

Community-acquired MRSA infection (CAMRSA) emerged during the last decade and causes considerable morbidity and mortality. Like nosocomial MRSA infection, clonal spreading of CAMRSA between community and hospital has been noted (Boucher and Corey 2008). The isolates of sequence type (ST59) identified by the multilocus sequence typing (MLST) method appeared to be the major clone of CAMRSA in northern Taiwan, accounting for more than 90 of CAMRSA (Boyle-Vavra et al. 2005). In Hong Kong, three...

Cefotaxime Hydrolysing and Multidrug Resistant Klebsiella spp

Extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae have caused major therapeutic problems worldwide since the majority are resistant to various antibiotics commonly used for treatment of most bacterial infections. In sub-Saharan Africa nosocomial infections caused by multi-drug-resistant K. pneumoniae are becoming increasingly common. For instance, in a Kenyan referral hospital, all K. pneumoniae isolates obtained from sporadic infections in neonatal wards over a...

Inappropriate Antibiotic

Despite the association between the increased use of antibiotics and the spreading of resistant organisms in the community, the use of these drugs continues to grow worldwide. Unfortunately, most of the information regarding antimicrobial resistance and intervention strategies comes from developing countries. One of the reasons for this is that most reports from developing countries do not get published in peer-reviewed journals and end up in non-indexed publications (Keiser et al. 2004). In...

Enterobacteriaceae

Enterobacteriaceae is a large family of bacteria that causes both nosocomial and community-acquired infections. This family includes many more familiar pathogens, such as Salmonella spp. and Escherichia coli, as well as Citrobacter spp., Enterobacter spp., Klebsiella spp., Morganella spp., Proteus spp., Providencia spp., Serratia spp., and others. The resistance mechanisms mostly related to b-lactam resistance among these pathogens are the overexpression of AmpC b-lactamases and or the...

Resistance in Reservoirs and Human Commensals

Abstract The role of commensal bacteria in the spread of antibiotic resistance is recognized as a vital component in understanding how to preserve the power of antibiotics. Excepting tuberculosis, the majority of bacterially caused illness results from infection by commensal organisms, such as Escherichia coli, streptococci, and staphylococci. Thus, better knowledge of the biology of antibiotic resistance in commensal bacteria is a crucial component to treating these life-threatening diseases....

Neisseria gonorrhoeae

Neisseria gonorrhoeae can cause cervicitis, urethritis, proctitis and pelvic inflammatory disease. It can lead to long-term sequelae like infertility and ectopic pregnancy and it can be implicated in chronic pelvic pain. Remarkably it can cause increased susceptibility to transmission of HIV infection (Fleming and Wasserheit 1999). Among the aetiological agents of treatable STIs, N. gonorrhoeae stands out because of the extent to which antibiotic resistance compromises the effectiveness of...

Antimicrobial Use in the Food Industry and Adverse Effects on Human Health

Tremendous amounts of antimicrobials are used annually in food production (e.g. chicken, cattle, pigs) unfortunately, no unbiased estimates of their use are available and the published data differ markedly and unlike the case of drug promotion for human medicines, there appear to be only limited discussions in the veterinary and agricultural sciences literature of the impact of drug promotion on veterinary prescribing practices and farmer utilization. The WHO has estimated that half of the...

Neisseria meningitidis

Neisseria meningitidis is the etiologic agent of meningococcal disease, most commonly meningococcal bacteremia and meningitis, in industrialized countries and in the developing world. These two clinically overlapping syndromes may occur simultaneously, but meningitis alone occurs most frequently see CDC 2003 . Meningococcal disease differs from the other leading causes of bacterial meningitis because of its potential to cause large-scale epidemics. Historically, these epidemics have been...

Antimicrobial Resistance Containment Strategies

A true state of public hospitals in the developing world can be garnered by an audit conducted by Baqi et al. 2007, Infection Control at a Public Sector Hospital in Karachi, Pakistan, unpublished in 13 units of a large public sector hospital in Karachi. Factors promoting infection ranged from individual omissions like poor hand washing, minimal occupational safety practices, suboptimal disinfection of instruments between patients, and improper device care to more institutional lapses like...

Common Antimicrobial Resistant Pathogens in Developing Countries

Hospitals especially intensive care areas tend to become colonized by highly resistant organisms capable of causing seriously untreatable infections. Antimicrobial-resistant organisms in hospital settings differ from those in the community. Agents causing nosocomial infections in developing world hospitals more or less follow developed world trends. Methicillin-resistant S. aureus MRSA , a strain of S. aureus resistant to penicillinase-resistant penicillins like methicillin and nafcillin, is of...

News Media Reporting of Antimicrobial Resistance in Latin America and India

Marisabel Sanchez and Satya Sivaraman Abstract To provide an insight into current media environments, types of coverage, reasons for such coverage, and potential improvements in news media coverage of antimicrobial resistance AMR in Latin America and India. To better understand the potential influences of news reporting of antimicrobial resistance it is important to gain an insight into the current trends in mass media in Latin America and India. As elsewhere, the mass media permeates daily...

Containment of Antimicrobial Resistance in Developing Countries and Lessons Learned

Abstract Developing countries are not an exemption when we describe the gravity of antimicrobial resistance AMR and its impact in morbidity and mortality. Emergence of AMR in poor-resource countries is a complex issue that transcends all ethnic groups, races, classes, etc. however, human beliefs, practices, and behavior are very similar and AMR has lot to do with its growing risk in treatment failures. This situation is not indicative that resistance is a health-care problem until data mining...

Prescribers

Physicians' knowledge of correct prescribing is a fascinating subject. A number of papers have shown that prescribers may demonstrate correct knowledge, but that they may still practice differently. This suggests that other determinants are stronger. Some of these determinants have been explored in the literature, but much remains to be explored. The often heard assumption that lack of quality diagnostic services drives poor antimicrobial use remains to be proven, as even when laboratory...

Counterfeit Drugs and Policy

There is an urgent need to assess the prevalence of poor-quality anti-infective in the developing world, to examine their impact, both on the outcome of individual patients and in the emergence and spread of antimicrobial drug resistance and to investigate the most cost-effective solutions. The recent 'Declaration of Rome' has led to the formation of an International Medical Products Anti-Counterfeiting Taskforce by WHO. Increased political and financial support for police action, close...

Healthcare Associated MRSA

Most nosocomial MRSA is multidrug resistant. They tend to colonize and infect patients during hospitalization or stays in long-term care facilities, after surgery or after contact with persons who had an MRSA infection or used illicit drugs. In the 1970s, periodic outbreaks were described in various parts of the world, in association with high levels of oxacillin or methicillin use and in intensive care environments, but since the 1980s, MRSA became a significant worldwide problem, first in...

Surveillance of Antimicrobial Resistance Infection Control in Latin America and the Caribbean

The emergence and spread of antimicrobial drug resistance in Latin American and Caribbean countries contribute to the worldwide threat to undermine the fight against the spread of bacterial infectious diseases. In these countries, ADR may have several distinct contributing causes, including inappropriate use of available antibiotics, environmental changes and rapid population growth, and in the area, the problem of ADR may be exacerbated by malnutrition, poor sanitation and overcrowding....