AMR develops in microorganisms in response to exposure to antimicrobial drugs such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics. Resistance tends to increase over time, usually through genetic changes; these changes are accelerated by the misuse and overuse of antimicrobials, and poor quality (substandard or falsified) medicines.
Low- and middle-income countries (LMICs) shoulder the bulk of the global burden of infectious diseases and drug resistance. Whilst AMR threatens the health of us all, it has been predicted that the largest numbers of lives that will be lost as a result of AMR will be in LMICs*. However, LMICs tend to have weaker systems of surveillance for AMR and fewer resources to tackle the problem.
For HIV, TB and malaria, monitoring drug resistance in LMICs usually relies on active surveillance efforts such as cross-sectional surveys or observational studies at sentinel sites. The new Global Antimicrobial resistance Surveillance System (GLASS) for antibacterial drug resistance aims to integrate passive surveillance of antibacterial resistance with routine case-management of patients.
Antimicrobial resistant-microbes can spread among people and animals, as well as from person to person, and are also found in the environment, in water, soil and air. Countries are expected to adopt a One Health approach when tackling AMR, and so building up surveillance in the animal sector is also important.
Many networks have been set up to deal with surveillance, monitoring and analysis of AMR and quality management in LMICs. Find out about the challenges and impacts of these networks in Antimicrobial Resistance in Low and Middle Income Countries: An Analysis of Surveillance Networks.
* O'Neill J: Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. In The Review on Antimicrobial Resistance 2014.
Antimicrobial Resistance in Low and Middle Income Countries: An Analysis of Surveillance Networks