STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
8. STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
The problem of AR is a global one and will require a concerted effort and cooperation among nations. Several suggestions have been made (Burke, 2002; Coast and Smith, 2003; Kettler, 2000; Schwartz et al., 1997; Lees and Shojaee, 2002; Wise, 2002) although there is absence of good published evidence con- cerning cost-effectiveness in reducing emerging resistance (Wilton et al., 2002). Containment will depend on coordinated interventions that simultaneously
638 Denis K. Byarugaba target the behaviour of providers and patients, and change important features of
the environment in which they interact, as well as managerial and policy issues which have been well articulated (Barrett, 2000; Dagan et al., 2001; de Man et al., 2000; Gruson et al., 2000; Hooton and Levy, 2001; Murthy, 2001; Poole, 2001; Samaranayake and Johnson, 1999; Schwartz et al., 1997; Schwarz et al., 2001; Sehgal, 1999; Semjen, 2000; Sirinavin et al., 1998; Slots, 1999; Smith, 1999; Tan et al., 2002; Weinstein, 2001; Wise, 2002).
However, responsible use of the available antimicrobial agents is of para- mount importance despite the challenges DCs face (Byarugaba et al., 2003). Use of antimicrobial agents in food producing animals should follow prudent principles to minimise the selection and spread of resistant zoonotic bacteria like Salmonella spp and Campylobacter spp. Emphasis should be placed on disease preventive measures such as good farm management and hygiene to reduce bacterial load, rather than use of antimicrobials (WHO, 2000). The goal of any programme to monitor the quantities of antimicrobials used in animals is to generate objective quantitative information to evaluate usage patterns by animal species, antimicrobial class, and type of use. These data are essential for risk analysis and planning and can be helpful in interpreting resistance sur- veillance data and evaluating the effectiveness of prudent use efforts and miti- gation strategies. The total consumption of antimicrobials for human usage, food animal, and other uses is a key factor in any consideration of this issue. Data on antimicrobial consumption is scanty and has been reported in only a few countries (Anonymous, 1999; Grave, 1999; Greko, 2000) and less so in DCs (Mitema et al., 2001).
The global coalition against poverty and the concerted efforts to combat AIDS are very important strategies within which AR can be contained. Through massive education, sustained prevention efforts will prevent trans- mission of infections and liberate resources that can be used to combat AR. Pursuance of the millennium development goals and other global partnerships against important development challenges are very critical to containment of AR not only among the DCs but also among the developed nations. Without a bold, concerted action, not only will millions die in Africa, but the entire world will suffer. To allow sub-Saharan Africa to become socially and economically devastated will have a major impact on the economies of every country of the world and impact on AR. The African Comprehensive HIV/AIDS Partnership (ACHAP) is one answer to the problem.
The public–private partnership has provided a new sense of optimism for fighting many devastating pandemics such as AIDS and has given lots of people hope. ACHAP offers all interested parties a multifaceted paradigm that addresses not only the need for ARV medications, but also the other social and medical facets of the HIV/AIDS problem facing sub-Saharan Africa including indirectly the problems of AR.
AR and its Containment in DCs 639
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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