The Role of Unregulated Sale and Dispensing of Antimicrobial Agents on the Development of Antimicrobial Resistance in Developing Countries



Antimicrobial resistance has become a major medical and public health problem worldwide. This has been brought about by overuse and/or misuse of these drugs especially in developing countries. The role of unregulated sale and dispensing of antimicrobial agents on the development of resistance is presented in this chapter.

Developing countries use both branded and generic antimicrobial agents which include major classes like beta-lactams, tetracyclines, aminoglycosides, fluoroquinolones, sulfonamides, chloramphenicol, macrolides, lincosamides, polymixins, bacitracin, vancomycin, vovobiocin, and rifamycins among others. Despite existing legislative framework to control antibiotics in most developing countries, enforcement of these regulatory processes is still a problem. Some of the factors that have led to unregulated sale and dispensing of antibiotics in developing countries include inadequate legislative framework, lack of financial resources for implementation, inadequate education on the awareness of public health risks of antimicrobial resistance, social–cultural attitudes on antimicrobial agents, easy access to antimicrobial agents due to high prevalence of HIV/AIDS, and lack of surveillance and monitoring programs on antibiotic usage in medical and veterinary use among others. Intervention measures required to contain the upsurge of antimicrobial resistance in developing countries should include the following among others: increased public education and creation of awareness to the public and pharmacists, enactment of laws where none exists and their proper enforcement and regular surveillance, and monitoring of antimicrobial usage and emergence of resistance. Mitigation measures mentioned above will go along way in the containment of antimicrobial resistance and hence protection of public health from emerging antimicrobial resistance.


Antimicrobial Agent Antimicrobial Resistance Typhoid Fever Food Animal Neisseria Gonorrhoeae 


  1. Bhutta T.I. and Balchin C. (1996). Assessing the impact of a regulatory intervention in Pakistan. Soc Sci Med 42: 1195–202.CrossRefPubMedGoogle Scholar
  2. Bhutta T.I. and Vitry A. (1997). Treating dysentery with metronidazole in Pakistan. BMJ 314: 146–147.PubMedGoogle Scholar
  3. Chambers H.F. (2002). Antimicrobial drugs. In: Basic and Clinical Pharmacology 8th ed. By B.G. Katzung, New York: Lange Medical Books/McGraw-Hill.Google Scholar
  4. DANMAP (2005). Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, foods and humans in Denmark. DANMAP 2005-July 2006. ISSN 1600–2032.Google Scholar
  5. De Vries T.P., Henning R.H., Hogerzeil H.V., Bapna J.S., Bero L., Kafle K.K., Mabadeje A., Santos B. and Smith A.J. (1995). Impact of a short course in pharmacotherapy for undergraduate medical students: An international randomized study. Lancet 346: 1454–1457.CrossRefPubMedGoogle Scholar
  6. Gachia P.J. and Holmes K.K. (2003). STD trends and patterns of treatment for STD by physicians in private practice in Peru. Sex Transm Infect 79: 403–407.CrossRefGoogle Scholar
  7. Gwatkin, D.R. and Guillot M. (2000). The burden of disease among global poor. Current trends, future trends and implications for strategy. Washington DC: The World Bank. Health, Nutrition and population series.Google Scholar
  8. Hart C.A. and Kariuki S. (1998). Antimicrobial resistance in developing countries. BMJ 317: 647–650.PubMedGoogle Scholar
  9. Indalo A.A. (1997). Antibiotic sale behavior in Nairobi. A contributing factor to antimicrobial drug resistance. East Afr Med J 74: 171–173.PubMedGoogle Scholar
  10. Isturiz R.E. and Carbon C. (2000). Antibiotic use in developing countries. Infect Control Hosp Epidemiol 21: 394–397.CrossRefPubMedGoogle Scholar
  11. Kahn C.M. and Line S. (2005). Antimicrobial agents. In: The Merk Veterinary Manual, 9th ed., Whitehouse, NJ: Merck and Co 2056–2098.Google Scholar
  12. Kikuvi G.M., Schwarz S., Ombui J.N., Mitema E.S and Krehrenberg K. (2007). Streptomycin and chloramphenicol resistance genes in Escherichia coli from cattle, pigs and chicken form Kenya. Microbial Drug Res 13: 63–69.Google Scholar
  13. Lansang M., Lucas-Aquino R., Tupasi T., Mina V.S., Salazar L.S., Juban N. Limjoco T.T., Nisperos L.E. and Kunin C.M. (1990). Purchase of antibiotics without prescription on Manila, the Philippines. J Clin Epidemiol 43: 61–67.CrossRefPubMedGoogle Scholar
  14. Larsson M., Kronvall G., Chuc N.T., Karlsson I., Lager F., Hanh H.D., Tomson G. and Falkenberg T. (2000). Antibiotic medication and bacterial resistance to antibiotics: A survey of children in a Vietnamese community. Trop Med Int Health 5: 711–721.CrossRefPubMedGoogle Scholar
  15. Laxminarayan R. (2003). Battling resistance to antibiotics and pesticides: An economic approach. Washington DC: Resources for future.Google Scholar
  16. Mitema E.S., Kikuvi G.M., Stohr K. and Wegener H. (2001). An assessment of antimicrobial consumption in food producing animals in Kenya. J Vet Pharmacol Ther 24: 385–390.CrossRefPubMedGoogle Scholar
  17. Mitema E.S. and Kikuvi G. (2004). Surveillance of overall use of antimicrobial drugs in humans over a five-year period (1997–2001) in Kenya. J Antimicob Chemother 54: 966 67.CrossRefGoogle Scholar
  18. Mbori-Ngacha D.N. (1997). Rational approach to limiting emergence of antimicrobial drug resistance. East Afr Med J 74: 187–189.PubMedGoogle Scholar
  19. NORM/NORM-VET (2005). Usage of antimicrobial agents and occurrence of antimicrobial resistance in Norway Tromso, Oslo 2006. ISSN: 1502–2307.Google Scholar
  20. Okeke I.N., Laxminarayan R., Bhutta Z.A., Duse A.G., Jenkins P., O’Brien T.F., Pablos-Mendez A. and Klugman K.P. (2005a). Antimicrobial resistance in developing countries. Part I: Recent trends and current status. Lancet Infect Dis 5: 568–580.Google Scholar
  21. Okeke I.N., Klugman K.P., Bhutta Z.A., Duse A.G., Jenkins, P., O’Brien, T.F., Pablos-Mendez A. and Laxminarayan R. (2005b). Antimicrobial resistance in developing countries. Part II: Recent trends and current status. Lancet Infect Dis 5: 481–493.Google Scholar
  22. Ole-Mapenay I.M. (2007). An assessment of antimicrobial usage and occurrence of antimicrobial resistance in E. coli from food animals in Kenya. PhD Thesis. University of Nairobi, Kenya.Google Scholar
  23. Pakistan Pharmaceutical Index. (2005). Selected Information on Drug Sales (1988–2002): Karachi, Pakistan: Information Medical Statistics. (Accessed June 30, 2005).
  24. Sirinavia S. and Dowell S.F. (2004). Antimicrobial resistance in countries with limited resources. Unique challenges and limited alternatives. Semin Pediatr Infect Dis 15: 94–98.CrossRefGoogle Scholar
  25. SWEDRES/SVARM (2005). A report of Swedish antibiotic utilization and resistance in human medicine. SWEDRES 2005. ISSN 1400–3473.Google Scholar
  26. Tollefson L, Fedorka-Cray P.J. and Angulo F.J. (1999). Public health aspects of antibiotic resistance monitoring in the USA. Acta Vet Scand Suppl 92: 67–75.PubMedGoogle Scholar
  27. Urassa W., Lyamuya E. and Mhalu F. (1997). Recent trends on bacterial resistance to antibiotics. East Afr Med J 74: 129–133.PubMedGoogle Scholar
  28. Vollebbregt J. A., van Oldenriik J., Kox D., van Galen S.R., Sturm B., Metz J.C., Richir M.C., de Haan M., Hugtenburg J.G. and de Vries T. P. (2006). Evaluation of a pharmacotherapy context-learning programme for preclinical medical students. Br J Clin Pharmacol 62: 666–672.CrossRefGoogle Scholar
  29. Wenzel R.P and Edmond M.B. (2000). Managing antibiotic resistance. New Engl J Med. 343: 1961–1963.CrossRefPubMedGoogle Scholar
  30. World Health Organization (2000). Global principles for the containment of antimicrobial resistance due to antimicrobial use in animals intended for food June 5–9, Geneva, Switzerland.Google Scholar
  31. World Health Organization (2001). WHO global strategy for containment of antibiotic resistance. Geneva: 99.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary MedicineUniversity of NairobiNairobiKenya

Personalised recommendations