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.
Antimicrobial Resistance Informal Sector Clavulanic Acid Public Health Importance Syndromic Management
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Aswapokee, N., S. Vaithayapichet, et al. (1990). “Pattern of antibiotic use in medical wards of a university hospital, Bangkok, Thailand.” Rev Infect Dis12(1): 136–41.PubMedGoogle Scholar
Attaran, A., K. I. Barnes, et al. (2004). “WHO, the Global Fund, and medical malpractice in malaria treatment.” Lancet363(9404): 237–40.CrossRefPubMedGoogle Scholar
Becker, J., E. Drucker, et al. (2002). “Availability of injectable antibiotics in a town market in southwest Cameroon.” Lancet Infect Dis2(6): 325–6.CrossRefPubMedGoogle Scholar
Bejon, P., I. Mwangi, et al. (2005). “Invasive Gram-negative bacilli are frequently resistant to standard antibiotics for children admitted to hospital in Kilifi, Kenya.” J Antimicrob Chemother56(1): 232–5.CrossRefPubMedGoogle Scholar
Bosu, W. K. and D. Mabey (1998). “The availability and cost of antibiotics for treating PID in the Central Region of Ghana and implications for compliance with national treatment guidelines.” Int J STD AIDS9(9): 551–3.CrossRefPubMedGoogle Scholar
Daneman, N., D. E. Low, et al. (2008). “At the threshold: defining clinically meaningful resistance thresholds for antibiotic choice in community-acquired pneumonia.” Clin Infect Dis46(8): 1131–8.CrossRefPubMedGoogle Scholar
Duke, T., A. Michael, et al. (2003). “Chloramphenicol or ceftriaxone, or both, as treatment for meningitis in developing countries?” Arch Dis Child88(6): 536–9.CrossRefPubMedGoogle Scholar
Elliott, A. M. and S. D. Foster (1996). “Thiacetazone: time to call a halt? Considerations on the use of thiacetazone in African populations with a high prevalence of human immunodeficiency virus infection.” Tuber Lung Dis77(1): 27–9.CrossRefPubMedGoogle Scholar
Foster, S. (1991). “Supply and use of essential drugs in sub-Saharan Africa: some issues and possible solutions.” Soc Sci Med32(11): 1201–18.CrossRefPubMedGoogle Scholar
Gandhi, N. R., A. Moll, et al. (2006). “Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa.” Lancet368(9547): 1575–80.CrossRefPubMedGoogle Scholar
Gill, C. J., L. L. Sabin, et al. (2004). “Reconsidering empirical cotrimoxazole prophylaxis for infants exposed to HIV infection.” Bull World Health Organ82(4): 290–7.PubMedGoogle Scholar
Grosskurth, H., F. Mosha, et al. (1995). “Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial.” Lancet346(8974): 530–6.CrossRefPubMedGoogle Scholar
Hastings, I. M., E. L. Korenromp, et al. (2007). “The anatomy of a malaria disaster: drug policy choice and mortality in African children.” Lancet Infect Dis7(11): 739–48.CrossRefPubMedGoogle Scholar
Hawkes, S., L. Morison, et al. (1999). “Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh.” Lancet354(9192): 1776–81.CrossRefPubMedGoogle Scholar
Kallander, K., J. Nsungwa-Sabiiti, et al. (2004). “Symptom overlap for malaria and pneumonia – policy implications for home management strategies.” Acta Trop90(2): 211–4.CrossRefPubMedGoogle Scholar
Kelesidis, T., I. Kelesidis, et al. (2007). “Counterfeit or substandard antimicrobial drugs: a review of the scientific evidence.” J Antimicrob Chemother60(2): 214–36.CrossRefPubMedGoogle Scholar
Kelly, P., A. Buve, et al. (1994). “Cutaneous reactions to thiacetazone in Zambia – implications for tuberculosis treatment strategies.” Trans R Soc Trop Med Hyg88(1): 113–115.CrossRefPubMedGoogle Scholar
Kouyate, B., A. Sie, et al. (2007). “The great failure of malaria control in Africa: a district perspective from Burkina Faso.” PLoS Med4(6): e127.CrossRefPubMedGoogle Scholar
Larsson, D. G. J., C. de Pedro, et al. (2007). “Effluent from drug manufactures contains extremely high levels of pharmaceuticals.” J Hazard Mater148(3): 751–5.CrossRefPubMedGoogle Scholar
Levy, S. B. (2002). The antibiotic paradox : how the misuse of antibiotics destroys their curative power. Cambridge, MA, Perseus Pub.Google Scholar
Lubell, Y., H. Reyburn, et al. (2008). “The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis.” BMJ336(7637): 202–5.CrossRefPubMedGoogle Scholar
Phillips, M. and P. A. Phillips-Howard (1996). “Economic implications of resistance to antimalarial drugs.” Pharmacoeconomics10(3): 225–38.CrossRefPubMedGoogle Scholar
Pillay, M. and A. W. Sturm (2007). “Evolution of the extensively drug-resistant F15/LAM4/KZN strain of Mycobacterium tuberculosis in KwaZulu-Natal, South Africa.” Clin Infect Dis45(11): 1409–14.CrossRefPubMedGoogle Scholar
Quick, J. D., J. R. Rankin, et al. (1997). “Managing drug supply.” Management Sciences for Health in collaboration with the World Health Organization. West Hartford, CT: Kumarian Press.Google Scholar