Antimicrobial resistance in developing countries. Part II: strategies for containment

被引:182
作者
Okeke, IN
Klugman, KP
Bhutta, ZA
Duse, AG
Jenkins, P
O'Brien, TF
Pablos-Mendez, A
Laxminarayan, R
机构
[1] Emory Univ, Sch Med, Rollins Sch Publ Hlth, Dept Global Hlth, Atlanta, GA 30322 USA
[2] Emory Univ, Sch Med, Div Infect Dis, Atlanta, GA 30322 USA
[3] Haverford Coll, Dept Biol, Haverford, PA 19041 USA
[4] Univ Witwatersrand, Natl Res Inst Communicable Dis, MRC, Resp & Meningeal Pathogens Res Unit, Johannesburg, South Africa
[5] Aga Khan Univ, Dept Paediat & Child Hlth, Karachi 74800, Pakistan
[6] Natl Hlth Lab Serv, Dept Clin Microbiol & Infect Dis, Houghton, Gauteng, South Africa
[7] Wits Sch Pathol, Houghton, Gauteng, South Africa
[8] WHO, Dept Communicable Dis Surveillance & Response, CH-1211 Geneva, Switzerland
[9] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA
[10] Brigham & Womens Hosp, WHO, Collaborating Ctr Surveillance Antimicrobial Resi, Boston, MA 02115 USA
[11] Harvard Univ, Sch Med, Boston, MA 02115 USA
[12] Rockefeller Fdn, New York, NY USA
[13] Resources Future Inc, Energy & Nat Resources Div, Washington, DC 20036 USA
关键词
D O I
10.1016/S1473-3099(05)70217-6
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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 1, 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.
引用
收藏
页码:568 / 580
页数:13
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