Antimicrobial resistance in developing countries

In 1990, an estimated 78% of the world's total population lived in the developing world. Of the 39.5 million deaths in the developing world, 9.2 million were estimated to have been caused by infectious and parasitic diseases. 98% of child mortality occurs in the developing world, due mainly to infections. Based upon information gathered through searches of the Medline and Bath Information and Data Services computerized databases, discussions with colleagues, and personal experiences, the authors consider the progress and impact of bacterial resistance to antimicrobial drugs in the developing world. While antibiotics are important in developing countries, they are often scarce commodities which are affordable and therefore available to only the comparatively wealthy. Because the use of antibiotics is unregulated in many developing countries, antibiotics are often misused and overused. Such use has provoked the development of infectious agents which are resistant to antimicrobial drugs, such as strains of pneumococcal meningitis, tuberculosis, and typhoid fever. Levels of morbidity and mortality are increasing as a result. Better access to diagnostic laboratories is needed, as well as improved surveillance of the emergence of resistance, better regulation of antibiotics' use, and better education of the public, physicians, and veterinarians in the appropriate use of drugs.