On the global problem of antibiotic resistance – who is stepping forward?

Most of us are probably alive and kicking thanks to the discovery and subsequent introduction of antibiotics in the early 20th century. They notably improved the clinical management of infectious diseases, which were previously untreatable or even fatal, winning them a reputation for being “miracle drugs”. Unfortunately, their ability to solve wide-ranging health problems has fueled their misuse in medical and agricultural applications, especially in developing countries, which contributed to the reversal of some of the therapeutic effects over the last few decades evident in the explosive growth of antibiotic resistance worldwide [1].

Antibiotic resistance is no joke, and the “quick fix” we have been opting for has witnessed a notable decline in efficacy. Today, less and less patients are responding to antibiotics, making common diseases difficult to treat and potentially fatal. In America alone, the bacterial strain MRSA (Methicillin-resistant Staphylococcus aureus), also known as the “hospital superbug”, kills more than 11,000 people each year due to resistance to a wide range of commonly used antibiotics [2]. This number exceeds the US annual death toll of HIV/AIDS, Parkinson’s disease, emphysema and homicide collectively [3].

In developed countries, there are various contributors to the problem, but interestingly, despite the apparent adequate education there is still a considerable lack of awareness among patients themselves. This has been manifested in several cases, for instance in a 2015 study performed in England and published by the British Journal of General Practice, which concluded that the fewer antibiotics a general practitioner (GP) prescribes, the lower the patient satisfaction [4]. Also in the United States, pressure on primary care physicians to satisfy patients frequently led to inappropriate prescription of antibiotics [5].

Aside from misuse, there are other factors participating in the exacerbation of antibiotic resistance. These extend from the particularity of the bacterial machinery to the frequently corrupt and intricate connections between governments, pharmaceutical companies and –in the medical framework- physicians [6]. Even though comparative antibiotic resistance data across populations is scarce, regional variations have been documented and which are triggered by distinct combinations of causes. Overall, poor-resource countries show greater rates of resistance, with a higher pace at which resistance is occurring [7, 8].

One of the causes for this phenomenon is poor immunity that makes patients more prone to sickness and hence more likely to need medicine.  Add to this, dysfunctional health systems with inefficient therapies and technologies and the wide-ranging misconception that cheap, broad-spectrum antibiotics form an adequate solution to health problems [9, 10]. Also, below-standard and counterfeit drugs acquired via less secure supply chains compose an additional reason [11].

One question that is particularly intriguing is why governments, especially those of developed countries, fail to control the misuse of antimicrobials and ignore the irreversibility of the crisis in the global context. In some cases government actions even seem inconsistent, for example in the UK, the National Institute for Health and Care Excellence recommended the monitoring of GPs’ prescription practices at least once a year. Those doctors, who persistently fail to rationally prescribe antibiotics, may face sanctions. But at the same time, with patient satisfaction under increasing scrutiny, GPs will likely prioritize recommendation and would possibly seek comforting their patients, even if this involves misusing antimicrobials.

If these governments fail to control the situation efficiently on a local level, how can they fulfill their responsibility towards developing countries, taking today’s intensive migration streams into account?


[1]  Okeke I, Laxminarayan R, Bhutta Z, et al. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis 2005;5:481–493.
[2] Gross M. Antibiotics in crisis. Curr Biol. 2013;23(24):R1063–R1065.
[3] Ventola CL. The Antibiotic Resistance Crisis. P T. 2015 Apr; 40(4): 277–283.
[4] Ashworth M, White P, Jongsma H, Schofield P and Armstrong D. Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data RCGP 2015
[5] Sanchez, G. V., et al. (2014). “Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States.” Emerg Infect Dis 20(12): 2041-2047.
[6] Sosa, A Byarugaba, DK, Amabile-Cuevas, C, Hsueh, P- R, Kariuki, S, and Okeke IN (Editors, 2010) Antimicrobial resistance in develop ing countries. US Springer Science and Business Media, New York, XXIV, 556 p. 35 illus ., Hardcover October 2009.
[7] Okeke, I. N., Fayinka, S. T., and Lamikanra, A. 2000. Antibiotic resistance in Escherichia coli from Nigerian students, 1986 1998. Emerg. Infect. Dis. 6:393–396.
[8] Zhang, R., Eggleston, K., Rotimi, V., and Zeckhauser, R. J. 2006. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health 2:6.
[9] Okeke, I. N. 2006. Diagnostic insufficiency in Africa. Clin. Infect. Dis. 42:1501–1503.
[10] Petti, C. A., Polage, C. R., Quinn, T. C., Ronald, A. R., and Sande, M. A. 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin. Infect. Dis. 42:377–382.
[11] Newton, P., Proux, S., Green, M., Smithuis, F., Rozendaal, J., Prakongpan, S., Chotivanich, K., Mayxay, M., Looareesuwan, S., Farrar, J., Nosten, F., and White, N. J. 2001. Fake artesunate in Southeast Asia. Lancet 357:1948–1950.