E-Book, Englisch, 554 Seiten
Sosa / Byarugaba / Amábile-Cuevas Antimicrobial Resistance in Developing Countries
1. Auflage 2009
ISBN: 978-0-387-89370-9
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, 554 Seiten
ISBN: 978-0-387-89370-9
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark
Avoiding infection has always been expensive. Some human populations escaped tropical infections by migrating into cold climates but then had to procure fuel, warm clothing, durable housing, and crops from a short growing season. Waterborne infections were averted by owning your own well or supporting a community reservoir. Everyone got vaccines in rich countries, while people in others got them later if at all. Antimicrobial agents seemed at first to be an exception. They did not need to be delivered through a cold chain and to everyone, as vaccines did. They had to be given only to infected patients and often then as relatively cheap injectables or pills off a shelf for only a few days to get astonishing cures. Antimicrobials not only were better than most other innovations but also reached more of the world's people sooner. The problem appeared later. After each new antimicrobial became widely used, genes expressing resistance to it began to emerge and spread through bacterial populations. Patients infected with bacteria expressing such resistance genes then failed treatment and remained infected or died. Growing resistance to antimicrobial agents began to take away more and more of the cures that the agents had brought.
Autoren/Hrsg.
Weitere Infos & Material
1;Foreword;5
2;Introduction;8
3;Preface;10
4;Acknowledgment;12
5;Contents;13
6;Contributors;17
7;Part 1: General Issues in Antimicrobial Resistance;22
7.1;1 Global Perspectives of Antibiotic Resistance;23
7.1.1;1.1 Introduction;23
7.1.2;1.2 The Biological Side of Resistance;24
7.1.3;1.3 The Pharmacological Side of Resistance;26
7.1.4;1.4 The Educational Side of Resistance;27
7.1.5;1.5 The Regulatory Side of Resistance;28
7.1.6;1.6 The Financial Side of Resistance;29
7.1.7;1.7 The Biological Consequences of Resistance;30
7.1.8;1.8 The Clinical Consequences of Resistance;31
7.1.9;1.9 Final Considerations;31
7.1.10;References;32
7.2;2 Mechanisms of Antimicrobial Resistance;34
7.2.1;2.1 Introduction;34
7.2.2;2.2 Mechanisms of Action of Antimicrobial Agents;36
7.2.3;2.3 Mechanisms of Antimicrobial Resistance;37
7.2.3.1;2.3.1 Resistance to beta-Lactam Antibiotics;38
7.2.3.2;2.3.2 Tetracycline Resistance;39
7.2.3.3;2.3.3 Chloramphenicol Resistance;40
7.2.3.4;2.3.4 Aminoglycoside Resistance;41
7.2.3.5;2.3.5 Quinolone Resistance;41
7.2.3.6;2.3.6 Macrolide, Lincosamide, and Streptogramin (MLS) Resistance;42
7.2.3.7;2.3.7 Glycopeptide Resistance;42
7.2.3.8;2.3.8 Sulfonamides and Trimethoprim Resistance;43
7.2.3.9;2.3.9 Multidrug Resistance;43
7.2.4;References;44
7.3;3 Poverty and Root Causes of Resistance in Developing Countries;46
7.3.1;3.1 Susceptibility to Infection;48
7.3.2;3.2 Access to Appropriate Care and Antimicrobials;49
7.3.3;3.3 The Challenge of Antimicrobial Quality Assurance in Low-Income Countries;50
7.3.4;3.4 Resistance Containment;51
7.3.5;References;52
7.4;4 What the Future Holds for Resistance in Developing Countries;55
7.4.1;4.1 Introduction;56
7.4.2;4.2 Improving the Knowledge Base;57
7.4.2.1;4.2.1 Improving the Knowledge Base in the Care of Individual Patients;57
7.4.2.2;4.2.2 Improving the Public Health Knowledge Base;58
7.4.3;4.3 Improving Information Flow;59
7.4.3.1;4.3.1 Improving Information Flow to Health Providers;59
7.4.3.2;4.3.2 Improving Information Flow to Consumers;60
7.4.4;4.4 Regulatory Environment;61
7.4.4.1;4.4.1 Regulating the Private Sector;61
7.4.4.2;4.4.2 Regulating the Public Sector;63
7.4.5;4.5 Management Capacity and Systems;64
7.4.6;4.6 Reducing Infectious Disease Burden;66
7.4.7;4.7 Improving Social and Economic Conditions;66
7.4.8;4.8 Alternatives to Standard Antimicrobial Therapy;67
7.4.9;4.9 Summary;67
7.4.10;References;73
7.5;5 The Introduction of Antimicrobial Agents in Resource-Constrained Countries: Impact on the Emergence of Resistance;76
7.5.1;5.1 Antimicrobial Resistance in Resource-Constrained Settings;77
7.5.2;5.2 Risk Factors for the Development of Antimicrobial Resistance After the Introduction of Antimicrobial Agents into Resource-Constrained Settings;77
7.5.2.1;5.2.1 Social Determinants;78
7.5.2.2;5.2.2 Health-Care Provider Factors;79
7.5.2.3;5.2.3 Patient-Related Determinants;80
7.5.2.4;5.2.4 Health-Care Institutional Factors;80
7.5.2.5;5.2.5 Governmental and Regulatory Issues;81
7.5.3;5.3 Antimicrobial Resistance After the Introduction of Antiretroviral Therapy into Developing Countries;82
7.5.4;5.4 Antimicrobial Resistance After the Introduction of Quinolones into Developing Countries;84
7.5.5;5.5 The Way Forward;85
7.5.6;References;86
8;Part 2: The Human Impact of Resistance;89
8.1;6 Human Immunodeficiency Virus: Resistance to Antiretroviral Drugs in Developing Countries;90
8.1.1;6.1 Introduction;90
8.1.1.1;6.1.1 Emergence and Transmission of Resistant HIV;92
8.1.1.2;6.1.2 Antiretroviral Therapy in Developing Countries;93
8.1.2;6.2 Emergence and Transmission of Resistant HIV;94
8.1.2.1;6.2.1 Adherence and Emergence of Resistance;94
8.1.2.2;6.2.2 Treatment Interruption and Emergence of Resistance;95
8.1.2.3;6.2.3 Measurement of Primary Resistance;96
8.1.2.4;6.2.4 Transmissibility of Resistant Viral Strains;97
8.1.3;6.3 ART Delivery Systems in Developing Countries: Implications for Resistance;97
8.1.4;6.4 Insights from Mathematical Modeling;99
8.1.4.1;6.4.1 Operational Questions;99
8.1.4.2;6.4.2 Emergence and Evolution of Resistance within Individuals;100
8.1.4.3;6.4.3 Transmission of Drug Resistance;100
8.1.5;6.5 Empirical Data on HIV Primary Resistance in Developing Countries;101
8.1.5.1;6.5.1 Asia;101
8.1.5.2;6.5.2 Africa;102
8.1.5.3;6.5.3 Latin America;103
8.1.5.4;6.5.4 Russia and Eastern Europe;103
8.1.6;6.6 Implications and Policy Recommendations;104
8.1.7;References;105
8.2;7 Drug Resistance in Malaria in Developing Countries;110
8.2.1;7.1 Introduction;110
8.2.2;7.2 History of Malarial Treatment and the Emergence of Resistance;112
8.2.3;7.3 Current Status of Drug-Resistant Malaria;115
8.2.4;7.4 Determinants of Drug Resistance;116
8.2.4.1;7.4.1 Confounding Factors Responsible for Treatment Failure;116
8.2.4.2;7.4.2 Definitions of Antimalarial Drug Resistance;117
8.2.4.3;7.4.3 Mechanisms of Antimalarial Resistance: The Host;118
8.2.4.4;7.4.4 Mechanisms of Antimalarial Resistance: The Parasite, the Vector and the Environment;119
8.2.4.5;7.4.5 Mechanisms of Antimalarial Resistance: The Drugs;119
8.2.5;7.5 Molecular Markers of Antimalarial Resistance;120
8.2.5.1;7.5.1 Chloroquine;121
8.2.5.2;7.5.2 Sulfadoxine-Pyrimethamine (SP) and Antifolates;121
8.2.5.3;7.5.3 Mefloquine, Quinine and Atovaquone;122
8.2.5.4;7.5.4 Artemisinin;123
8.2.6;7.6 Detection of Drug Resistance;123
8.2.6.1;7.6.1 In Vitro Tests;123
8.2.6.2;7.6.2 In Vivo Tests;124
8.2.6.3;7.6.3 Molecular Markers;125
8.2.7;7.7 Future Prospects;126
8.2.8;7.8 Conclusions;128
8.2.9;References;128
8.3;8 Drug Resistance in Mycobacterium tuberculosis;132
8.3.1;8.1 Introduction and Epidemiology;132
8.3.2;8.2 Terminology - Definitions are based on Aziz MA et al. 2003;134
8.3.2.1;8.2.1 New Case of TB;134
8.3.2.2;8.2.2 Previously Treated TB Patient;134
8.3.2.3;8.2.3 Primary Drug Resistance;134
8.3.2.4;8.2.4 Acquired Drug Resistance;134
8.3.2.4.1;8.2.4.1 Treatment Failure;135
8.3.2.4.2;8.2.4.2 Relapse;135
8.3.2.4.3;8.2.4.3 Return After Default;135
8.3.2.4.4;8.2.4.4 Chronic Case;135
8.3.2.5;8.2.5 Mono Resistance;135
8.3.2.6;8.2.6 Multidrug-Resistant Tuberculosis ;136
8.3.2.7;8.2.7 Extensively Drug-Resistant Tuberculosis;136
8.3.3;8.3 Drugs for Tuberculosis;136
8.3.4;8.4 Development of Drug Resistance in M. tuberculosis;136
8.3.5;8.5 Mechanism of Resistance to Anti-tuberculosis Drugs;139
8.3.6;8.6 Drug Susceptibility Testing of M. tuberculosis;140
8.3.6.1;8.6.1 Conventional Susceptibility Methods;141
8.3.6.1.1;8.6.1.1 Proportion Method;141
8.3.6.1.2;8.6.1.2 The Absolute Concentration Method;143
8.3.6.1.3;8.6.1.3 The Resistance Ratio Method;143
8.3.6.2;8.6.2 New Phenotypic Methods;143
8.3.6.2.1;8.6.2.1 The Mycobacterial Growth Indicator Tube;143
8.3.6.2.2;8.6.2.2 Microscopic Observation Drug Susceptibility Assay;144
8.3.6.2.3;8.6.2.3 Colorimetric Methods;144
8.3.6.2.4;8.6.2.4 Other New Phenotypic Tests;144
8.3.6.3;8.6.3 New Genotypic Methods;145
8.3.6.3.1;8.6.3.1 Solid-Phase Hybridization Techniques;145
8.3.6.3.2;8.6.3.2 DNA Sequencing;145
8.3.6.3.3;8.6.3.3 Other Molecular Tests;146
8.3.6.4;8.6.4 Direct Detection of Drug Resistance;146
8.3.6.5;8.6.5 Implementation Issues in Drug Susceptibility Testing;146
8.3.7;8.7 Treatment of Drug-Resistant Tuberculosis;147
8.3.8;8.8 Control of Drug-Resistant Tuberculosis;148
8.3.9;8.9 Surveillance for Drug-Resistant Tuberculosis;148
8.3.10;References;148
8.4;9 Antifungal Drug Resistance in Developing Countries;151
8.4.1;9.1 Introduction;151
8.4.2;9.2 Antifungal Options;153
8.4.3;9.3 Mechanisms of Resistance;153
8.4.3.1;9.3.1 Azoles;154
8.4.3.2;9.3.2 Polyenes;155
8.4.3.3;9.3.3 Echinocandins;156
8.4.3.4;9.3.4 Flucytosine;156
8.4.3.5;9.3.5 Sulfamethoxazole;156
8.4.4;9.4 Antifungal Resistance;157
8.4.4.1;9.4.1 Candidemia;158
8.4.4.2;9.4.2 Cryptococcosis;160
8.4.4.3;9.4.3 Pneumocystis Pneumonia;161
8.4.4.4;9.4.4 Invasive Mold Infections;162
8.4.5;9.5 Conclusion;163
8.4.6;References;163
8.5;10 Drug Resistance in African Trypanosomiasis;171
8.5.1;10.1 The African Trypanosomiases;171
8.5.2;10.2 Human African Trypanosomiasis Is a Zoonosis;172
8.5.3;10.3 Chemotherapy Is the Mainstay in the Control of Trypanosomiasis;173
8.5.4;10.4 Mechanisms of Drug Action;178
8.5.5;10.5 Mechanisms of Drug Resistance;180
8.5.6;10.6 Facing the Challenge;183
8.5.7;References;185
8.6;11 Antimicrobial Resistance in Enteric Pathogens in Developing Countries;191
8.6.1;11.1 Common Enteric Bacteria for Which Multidrug Resistance Is Documented;191
8.6.1.1;11.1.1 Multidrug-Resistant E. coli from Clinical and Environmental Sources;192
8.6.1.2;11.1.2 Cefotaxime-Hydrolysing and Multidrug-Resistant Klebsiella spp.;195
8.6.1.3;11.1.3 Multidrug-Resistant Non-Typhoidal Salmonella Infections;196
8.6.1.4;11.1.4 Emergence of Multidrug-Resistant S. enterica Serovar Typhi;199
8.6.1.5;11.1.5 Emergence of Antibiotic-Resistant V. cholerae Outbreaks;200
8.6.1.6;11.1.6 Outbreaks of Multidrug-Resistant Shigellosis in Africa and Other Developing Countries;202
8.6.1.7;11.1.7 Campylobacter Species;204
8.6.1.8;11.1.8 Helicobacter Species and Gastritis;204
8.6.2;11.2 Conclusion;205
8.6.3;References;206
8.7;12 Bacterial-Resistant Infections in Resource-Limited Countries;212
8.7.1;12.1 Introduction;212
8.7.2;12.2 Micro-organisms;214
8.7.2.1;12.2.1 Streptococcus pneumoniae;214
8.7.2.2;12.2.2 Staphylococcus aureus;219
8.7.2.3;12.2.3 Salmonella enterica serotype Typhi and Paratyphi;220
8.7.2.4;12.2.4 Shigella spp.;222
8.7.2.5;12.2.5 Vibrio cholerae;224
8.7.2.6;12.2.6 Campylobacter jejuni;226
8.7.2.7;12.2.7 Neisseria gonorrhoeae;228
8.7.3;12.3 Surveillance;230
8.7.3.1;12.3.1 Role of Surveillance Through Commensal Bacteria;231
8.7.4;12.4 Antibiotic Use and Bacterial Resistance;231
8.7.5;12.5 Knowledge Gaps;233
8.7.6;12.6 Conclusion;233
8.7.7;References;234
8.8;13 Prevalence of Resistant Enterococci in Developing Countries;245
8.8.1;13.1 Epidemiology in Developing Countries;245
8.8.1.1;13.1.1 East Asia and Pacific;245
8.8.1.2;13.1.2 Europe and Central Asia;246
8.8.1.3;13.1.3 Latin America and the Caribbean;248
8.8.1.4;13.1.4 Middle East and North Africa;251
8.8.1.5;13.1.5 South Africa;252
8.8.2;13.2 Conclusion;252
8.8.3;References;253
8.9;14 Antimicrobial Resistance in Gram-Negative Bacteria from Developing Countries;260
8.9.1;14.1 Salmonella spp. and Shigella spp.;260
8.9.2;14.2 Enterobacteriaceae;264
8.9.3;14.3 Pseudomonas aeruginosa and Acinetobacter spp.;267
8.9.4;14.4 Neisseria gonorrhoeae;271
8.9.5;14.5 Neisseria meningitidis;272
8.9.6;References;273
8.10;15 Resistance in Reservoirs and Human Commensals;278
8.10.1;15.1 Introduction;278
8.10.2;15.2 Defining Commensals;279
8.10.3;15.3 Commensals as Reservoirs of Antibiotic Resistance: A Conceptual Overview;280
8.10.4;15.4 Survey of Resistance in Commensals;281
8.10.4.1;15.4.1 Resistance in African Commensals;281
8.10.4.2;15.4.2 Resistance in Asian and Middle Eastern Commensals;282
8.10.4.3;15.4.3 Resistance in Latin American Commensals;283
8.10.4.4;15.4.4 Summary of Resistance Patterns in Developing Regions;284
8.10.5;15.5 Molecular Approaches;285
8.10.5.1;15.5.1 DNA Sequencing;285
8.10.5.2;15.5.2 Pulsed Field Gel Electrophoresis;286
8.10.5.3;15.5.3 PCR Methods;286
8.10.6;15.6 Future Directions;287
8.10.7;References;288
9;Part 3: Antimicrobial Use and Misuse;291
9.1;16 Determinants of Antimicrobial Use: Poorly Understood-Poorly Researched;292
9.1.1;16.1 Introduction;292
9.1.2;16.2 Who Decides on Antimicrobial Use?;293
9.1.2.1;16.2.1 Lay Networks;294
9.1.2.2;16.2.2 Pharmacies;294
9.1.2.3;16.2.3 Physicians;295
9.1.2.4;16.2.4 Traditional Medical Practitioners;295
9.1.3;16.3 Determinants of Antimicrobial Prescribing, Dispensing and Consumption;296
9.1.3.1;16.3.1 Antimicrobial Use by Consumers;296
9.1.3.1.1;16.3.1.1 Popularity Antimicrobial Folk Culture;296
9.1.3.1.2;16.3.1.2 Powerful Medicine;297
9.1.3.1.3;16.3.1.3 Antimicrobials as Preventive Agents;297
9.1.3.2;16.3.2 Antimicrobial Dispensing and Sales;297
9.1.3.2.1;16.3.2.1 Knowledge of Correct Dispensing;298
9.1.3.2.2;16.3.2.2 Client Demand;298
9.1.3.2.3;16.3.2.3 Lack of Regulation and Enforcement;298
9.1.3.3;16.3.3 Antimicrobial Prescription by Qualified Prescribers;299
9.1.3.3.1;16.3.3.1 Knowledge of Correct Prescribing;299
9.1.3.3.2;16.3.3.2 Fear of Bad Outcomes;299
9.1.3.3.3;16.3.3.3 Perceived Patient Demand;300
9.1.3.3.4;16.3.3.4 Peer Norms and Local Medical Cultures;300
9.1.3.3.5;16.3.3.5 Availability of Laboratory Services;301
9.1.3.3.6;16.3.3.6 Unstable Antimicrobial Supply;301
9.1.3.3.7;16.3.3.7 Pressure of Pharmaceutical Promotion;301
9.1.3.4;16.3.4 Economic Determinants;302
9.1.3.5;16.3.5 Pharmaceutical Industry Influence;303
9.1.4;16.4 Discussion;303
9.1.4.1;16.4.1 Consumers;304
9.1.4.2;16.4.2 Dispensers;304
9.1.4.3;16.4.3 Prescribers;304
9.1.5;16.5 Conclusion;305
9.1.6;References;306
9.2;17 Antimicrobial Use and Resistance in Africa;310
9.2.1;17.1 Scale and Status of the Antimicrobial Resistance in Africa;310
9.2.1.1;17.1.1 Malaria;311
9.2.1.2;17.1.2 Cholera in the Time of Resistance;312
9.2.1.3;17.1.3 Multidrug-Resistant Salmonella;313
9.2.1.4;17.1.4 Neisseria gonorrhoeae;314
9.2.1.5;17.1.5 Resistance Concerns in Other Pathogens;315
9.2.2;17.2 Antimicrobial Use and Potential Contributions to Resistance;315
9.2.2.1;17.2.1 Curative Antimicrobial Use by Health Professionals;315
9.2.2.2;17.2.2 Prophylactic Use and the Expansion of Indications for Antimicrobials Threatened by Resistance;316
9.2.2.3;17.2.3 Unregulated Antimicrobial Use;317
9.2.2.4;17.2.4 Poor-Quality Antimicrobials;317
9.2.3;17.3 Conclusion: Prospects for Controlling Antimicrobial Resistance by Improving Drug Use;318
9.2.4;References;319
9.3;18 Antimicrobial Drug Resistance in Asia;324
9.3.1;18.1 Drug Resistance in Bacterial Infection;324
9.3.1.1;18.1.1 Community-Acquired Infections;324
9.3.1.1.1;18.1.1.1 Respiratory Tract Infections;324
9.3.1.1.2;18.1.1.2 Diarrheal Diseases and Bacteremia;326
9.3.1.1.3;18.1.1.3 Community-Acquired Methicillin-Resistant Staphylococcus aureus (CAMRSA);328
9.3.1.1.4;18.1.1.4 Sexually Transmitted Diseases;328
9.3.1.2;18.1.2 Nosocomial Infections;329
9.3.1.2.1;18.1.2.1 Gram-Negative Pathogens;329
9.3.1.2.2;18.1.2.2 Gram-Positive Pathogens;331
9.3.2;18.2 Drug Resistance of Mycobacterium tuberculosis (TB);332
9.3.3;18.3 Drug Resistance in Fungi;333
9.3.4;References;333
9.4;19 Antimicrobial Drug Resistance in Latin America and the Caribbean;339
9.4.1;19.1 Introduction;339
9.4.2;19.2 Surveillance of Antimicrobial Resistance, Infection Control in Latin America and the Caribbean;340
9.4.2.1;19.2.1 Antibiotic Resistance Among Gram-Positive Bacteria;340
9.4.2.1.1;19.2.1.1 Penicillin and beta-Lactam-Resistant Pneumococcus;340
9.4.2.1.2;19.2.1.2 Methicillin-Resistant Staphylococcus aureus (MRSA);342
9.4.2.1.3;19.2.1.3 Healthcare-Associated MRSA;342
9.4.2.1.4;19.2.1.4 Community-Associated MRSA (CA-MRSA);343
9.4.2.1.5;19.2.1.5 Enterococcus;344
9.4.2.2;19.2.2 Antibiotic Resistance Among Gram-Negatives Bacteria;344
9.4.2.2.1;19.2.2.1 Extended-Spectrum beta-Lactamase (ESBL)-Producing Bacteria;346
9.4.2.2.2;19.2.2.2 Fluoroquinolone Resistance;348
9.4.2.2.3;19.2.2.3 Carbapenem Resistance;348
9.4.2.2.4;19.2.2.4 Enterobacter;348
9.4.2.2.5;19.2.2.5 Acinetobacter;349
9.4.2.2.6;19.2.2.6 Pseudomonas;349
9.4.3;19.3 Development and Use of New Antimicrobial Drugs in the Region;350
9.4.4;19.4 Summary;350
9.4.5;References;350
9.5;20 Hospital Infections by Antimicrobial-Resistant Organisms in Developing Countries;354
9.5.1;20.1 Introduction;354
9.5.2;20.2 Common Antimicrobial-Resistant Pathogens in Developing Countries;355
9.5.3;20.3 Implications of Antimicrobial Resistance in Developing World Hospitals;357
9.5.4;20.4 Antimicrobial-Resistant Infection Rates in Developing Country Hospitals;358
9.5.5;20.5 Antimicrobial-Resistant Neonatal Infections in Developing Countries;359
9.5.6;20.6 Economic Implications of Antimicrobial Resistance;362
9.5.7;20.7 Antimicrobial Resistance Containment Strategies;362
9.5.8;References;365
10;Part 4: Cost, Policy, and Regulation of Antimicrobials;370
10.1;21 The Economic Burden of Antimicrobial Resistance in the Developing World;371
10.1.1;21.1 Introduction;372
10.1.2;21.2 What is Meant by ‘‘Costs’’?;372
10.1.3;21.3 The Drug Supply System: Identifying Opportunities to Intervene;375
10.1.4;21.4 The Economics of Switching Therapy;378
10.1.5;21.5 The Important Role for Diagnostics: A Case Study of Meningitis;380
10.1.6;21.6 Wider and Unintended Consequences of Antimicrobial Use;384
10.1.7;21.7 Counterfeit of Antimicrobial Drugs;385
10.1.8;21.8 Environmental Cost of Antimicrobial Production and Use;385
10.1.9;21.9 Malaria: Who Pays for the Cost of Resistance?;385
10.1.10;21.10 Conclusion;388
10.1.11;References;388
10.2;22 Strengthening Health Systems to Improve Access to Antimicrobials and the Containment of Resistance;391
10.2.1;22.1 Introduction;391
10.2.2;22.2 Medicines from the Health Systems Perspective;392
10.2.2.1;22.2.1 Pharmaceutical Management;393
10.2.2.2;22.2.2 Human Resources Management;394
10.2.2.3;22.2.3 Information Systems Management;395
10.2.2.4;22.2.4 Finance;396
10.2.2.5;22.2.5 Stewardship and Governance;397
10.2.3;22.3 Measuring Access;398
10.2.3.1;22.3.1 Access Framework;398
10.2.4;22.4 Case Study - Improving Access to and Use of Medicines in Tanzania;400
10.2.5;22.5 Conclusion;404
10.2.6;References;405
10.3;23 The Role of Unregulated Sale and Dispensing of Antimicrobial Agents on the Development of Antimicrobial Resistance in Developing Countries;408
10.3.1;23.1 Introduction;409
10.3.2;23.2 Classes of Antimicrobial Agents;409
10.3.3;23.3 Regulation of Antimicrobial Agents;409
10.3.3.1;23.3.1 Factors Contributing to Unregulated Sale and Dispensing;410
10.3.4;23.4 Prescription Patterns and Effect on Development of Resistance;411
10.3.5;23.5 Some Selected Antibiotics and Impact on Bacterial Resistance Development;412
10.3.5.1;23.5.1 Penicillins;412
10.3.5.2;23.5.2 Tetracycline;412
10.3.5.3;23.5.3 Newer Agents;413
10.3.5.4;23.5.4 Fluoroquinolone;413
10.3.6;23.6 Control of Antimicrobial Agents: Interventions;413
10.3.6.1;23.6.1 Public Education;414
10.3.6.2;23.6.2 Pharmacy Education;414
10.3.6.3;23.6.3 Establishment of Legislative Framework and Law Enforcement;415
10.3.6.4;23.6.4 Regular Surveillance and Monitoring;415
10.3.7;References;415
10.4;24 Counterfeit and Substandard Anti-infectives in Developing Countries;417
10.4.1;24.1 Introduction;417
10.4.2;24.2 The Prevalence of Poor-Quality Anti-Infectives;419
10.4.3;24.3 Strategies for the Laboratory Chemical Analysis of Counterfeit and Substandard Drugs in Developing Countries;427
10.4.4;24.4 How to Identify Poor-Quality Medicines Rapidly and Inexpensively;433
10.4.5;24.5 The Consequences of Counterfeit and Substandard Anti-Infectives for Individual Patients;435
10.4.6;24.6 For the Community;436
10.4.7;24.7 Counterfeit Drugs and Policy;439
10.4.7.1;24.7.1 Conflict of Interest Statement;440
10.4.8;References;440
11;Part 5: Strategies to Contain Antimicrobial Resistance;448
11.1;25 Containment of Antimicrobial Resistance in Developing Countries and Lessons Learned;449
11.1.1;25.1 Introduction;450
11.1.2;25.2 The World Health Organization Global Strategy for Containment of Antimicrobial Resistance;450
11.1.3;25.3 Root Causes of AMR;451
11.1.4;25.4 Detection and Surveillance of Antimicrobial Resistance;451
11.1.5;25.5 Impact on Morbidity and Mortality of Antimicrobial Resistance in Developing Countries;452
11.1.6;25.6 Regional Approaches to Contain AMR: Africa, Asia, and Latin America and the Caribbean;453
11.1.6.1;25.6.1 Africa;453
11.1.6.2;25.6.2 Asia;454
11.1.6.3;25.6.3 Latin American and the Caribbean;455
11.1.7;25.7 The Problem: What Do We Know?;455
11.1.8;25.8 What Have We Learned?;456
11.1.9;25.9 What Has Worked?;457
11.1.10;25.10 What Has Not Worked?;458
11.1.11;25.11 The Solution;459
11.1.12;25.12 Conclusion;460
11.1.13;References;460
11.2;26Surveillance of Antibiotic Resistance in Developing Countries: Needs, Constraints and Realities;464
11.2.1;26.1 Introduction;464
11.2.2;26.2 The Microbiological Gap;465
11.2.2.1;26.2.1 Definitions of Surveillance;466
11.2.2.2;26.2.2 Basic Needs for Improving Surveillance Capability;466
11.2.2.3;26.2.3 WHONET;466
11.2.3;26.3 Problems in Organizing Surveillance;467
11.2.3.1;26.3.1 Planning and Development;467
11.2.3.2;26.3.2 Impact of Funding;467
11.2.3.3;26.3.3 Manpower and Human Resources;468
11.2.4;26.4 Available Data;468
11.2.4.1;26.4.1 Asia;468
11.2.4.2;26.4.2 Africa;469
11.2.5;26.5 Resistance Data on Key Pathogens;470
11.2.5.1;26.5.1 S. aureus;470
11.2.5.2;26.5.2 S. pneumoniae;471
11.2.5.3;26.5.3 Enteric Pathogens;471
11.2.5.3.1;26.5.3.1 Salmonella, Shigella and Vibrio spp.;471
11.2.5.4;26.5.4 E. coli and Other Enterobacteriaceae;472
11.2.6;26.6 Conclusion;473
11.2.7;References;474
11.3;27 Vaccines: A Cost-Effective Strategy to Contain Antimicrobial Resistance;477
11.3.1;27.1 Introduction;478
11.3.2;27.2 Vaccines and Infectious Disease;479
11.3.2.1;27.2.1 Vaccines Against Viral Infections and Their Cost-Effectiveness;479
11.3.2.2;27.2.2 Vaccines Against Bacterial Infections and Their Cost-Effectiveness;480
11.3.3;27.3 Vaccine for the Expanded Programme of Immunization;482
11.3.4;27.4 Newer Vaccines;483
11.3.5;27.5 Vaccine for the Future;483
11.3.6;27.6 Why Choose Vaccines?;485
11.3.7;27.7 Vaccines: The Cost;486
11.3.8;27.8 Vaccines - A Renewed Hope;487
11.3.9;27.9 Conclusion;487
11.3.10;References;488
11.4;28 Teaching Appropriate Antibiotic Use in Developing Countries;491
11.4.1;28.1 Introduction;491
11.4.2;28.2 Inappropriate Antibiotic Use;492
11.4.3;28.3 Intervention Studies;494
11.4.4;28.4 Medical Students and Residents;495
11.4.5;28.5 Community Interventions;498
11.4.6;28.6 Conclusion;501
11.4.7;References;502
11.5;29 Containing Global Antibiotic Resistance: Ethical Drug Promotion in the Developing World;505
11.5.1;29.1 Introduction;506
11.5.2;29.2 Resistance to Antimicrobials: Biology and Inappropriate Drug Use;507
11.5.3;29.3 Drug Promotion and Inappropriate Drug Use in Developing Countries: Ethical Considerations;508
11.5.3.1;29.3.1 Building Ethical Frameworks Based on Resource Availability;508
11.5.3.2;29.3.2 Moving Beyond the Resource Availability Criteria in Defining Ethical Thresholds;510
11.5.4;29.4 Mapping the ‘Control Points’ in Drug Promotion Practices in Health Care: The ‘Drug Representative’ as a Key Mediator;512
11.5.5;29.5 Antimicrobial Use in the Food Industry and Adverse Effects on Human Health;514
11.5.6;29.6 Overcoming the Link Between Promotion of Antimicrobial Agents and Emergence of Antimicrobial Resistance in Pathogens;516
11.5.7;29.7 Essential Medicines Library: An Empirical Resource to Evaluate the Accuracy of Drug Promotional Material in Developing Countries;518
11.5.8;29.8 Conclusions and ‘Points to Consider’;519
11.5.9;References;521
11.6;30 News Media Reporting of Antimicrobial Resistance in Latin America and India;525
11.6.1;30.1 Analysis of the Mass Media in Latin America;525
11.6.1.1;30.1.1 Radio and Television;525
11.6.1.2;30.1.2 The Internet;526
11.6.1.3;30.1.3 Newspapers;527
11.6.2;30.2 Analysis of News Reporting of AMR;527
11.6.3;30.3 Recommendations and Priorities for Improved News Reporting of AMR in Latin America;530
11.6.3.1;30.3.1 Key Recommendations;531
11.6.4;30.4 Analysis of the Mass Media in India;531
11.6.4.1;30.4.1 Newspapers;532
11.6.4.2;30.4.2 Television;533
11.6.4.3;30.4.3 The Internet;534
11.6.4.4;30.4.4 Scientific Reporting;534
11.6.5;30.5 Problems and Issues in Reporting;534
11.6.6;30.6 Misuse or Simplification of Data for Lay Audiences;535
11.6.7;30.7 Indian Media Reporting on Antibiotic and Antimicrobial Resistance;536
11.6.8;30.8 Trends and Future Directions;537
12;Index;538
