What the future holds for resistance in developing countries

The challenge to controlling antimicrobial resistance in coming years is to put into practice recent policy and programmatic advances. Increasing attention to the problem of antimicrobial resistance, and how resistance in developing countries can affect industrialized countries, has led to increased attention to the problem of resistance in developing countries. Efforts, however, have lagged behind good intentions. Inappropriate use of antimicrobials, thought to be the major driver of resistance, remains the norm rather than the exception in most of the developing world, as well as in many industrialized countries. Enhanced educational outreach to both consumers and health-care providers to change the pattern of antimicrobial use is crucial and methods to do this effectively have been developed. There is an urgent need for greater regulation of antimicrobial distribution and sale so that private shops staffed by untrained owners and employees are no longer a common source of antimicrobials. Greater management capacity is required to ensure adherence to regulations, to audit prescribing in both the public and the private sectors, and to control corrupt practices and the proliferation of counterfeit or sub-standard drugs. Implementing and sustaining resistance surveillance systems that will alert the medical and public health communities to changes in resistance is also crucial. Development and introduction of rapid techniques to determine infecting pathogens and their susceptibility should enhance both surveillance and care. The substantial funding that is now flowing to targeted diseases - HIV and AIDS, tuberculosis, and malaria, all three of which have substantial problems with antimicrobial resistance - can in the coming years be both a boon (if funds are used to enhance infrastructure to manage all diseases of public health concern) and a detriment (if efforts remain narrowly focused on these diseases) to controlling resistance. Efforts to reduce disease burden - through health interventions such as immunizations and improved socioeconomic conditions - have the potential to have profound effects on the burden of resistance. Ultimately, control of resistance will depend on an integrated, multidimensional effort, the components of which can be implemented if the commitment, political will, and resources are made available.