Antimicrobial resistance in enteric pathogens in developing countries

Abstract

Bacterial enteric infections exact a heavy toll on human populations, particularly among children and immunosuppressed individuals in developing countries, where malnutrition, HIV/AIDS and poor sanitation abound. Despite the explosion of knowledge on the pathogenesis of enteric diseases during the past two decades, the number of diarrhoeal episodes and human deaths reported especially among the poor populations in developing countries remain of apocalyptic dimensions. With several studies from developing countries showing worrying trends in multiple resistance among key enteric pathogens such as Escherichia coli, Klebsiella, Salmonella spp., Vibrio cholerae and Shigella spp. to nearly all commonly available antibiotics, it is imperative that this trend should be reversed. Many countries in the developing world lack a formal surveillance system for antibiotic resistance and often treatment is given empirically based on clinical diagnosis alone. Availability of antibiotics over the counter without prescription has not helped either. To minimize the negative effect on public health, a concerted effort is required in surveillance, public health education and awareness of dangers of resistance, and a clear policy on procurement and prudent use of antibiotics in these resource-poor settings.