Abstract
Antimicrobial drugs are a scarce resource whose misuse, in both industrialized and developing countries, has contributed to an increased economic burden on the health systems of developing countries. The price differential between amoxicillin and the combination of amoxicillin and clavulanic acid, for example, is on the order of a factor of 20; the change in standard therapy for malaria from chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) to artemisinin-containing therapy (ACT) has increased the cost of treating a case of malaria by a factor of 10 or more. Looked at another way, the same malaria drugs budget will now treat only one-tenth the number of patients as before. These cost increases are forcing health staff and policy makers to confront terrible choices, between using a drug which they know to be ineffective in many cases and which may lead to increased morbidity or mortality, or spending ever-increasing amounts on higher cost antibiotics and antimicrobials, often at the expense of buying enough to meet their needs. Improving laboratory capacity to detect and monitor antibiotic resistance can be a cost-effective strategy in many cases, especially as resistance forces us to use more expensive and scarce antimicrobials.
The specter of the permanent loss of many classes of antimicrobials due to resistance – and the failure of the pharmaceutical industry to engage enthusiastically in the search for new ones – means that the developing world, which still bears the vast majority of the world’s infectious disease burden, will soon find itself with fewer and fewer options for treatment. “Resistance without borders” will disproportionately affect the developing world. It is in everyone’s interest to use these scarce and dwindling resources as efficiently and as carefully as possible.
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Notes
- 1.
Dr. T.O’Brien, personal communication, 2007 and author’s calculations.
- 2.
Virtually every child with a fever who is admitted to hospital in Burundi is administered gentamicin and chloramphenicol, regardless of diagnosis. Personal communication of Burundian hospital administrator to S. Foster, July 2006.
- 3.
Global Fund Observer, Issue 81: 29 November 2007.
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Foster, S.D. (2010). The Economic Burden of Antimicrobial Resistance in the Developing World. In: Sosa, A., Byarugaba, D., Amábile-Cuevas, C., Hsueh, PR., Kariuki, S., Okeke, I. (eds) Antimicrobial Resistance in Developing Countries. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89370-9_21
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