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CITATION: Antimicrobial resistance: learning lessons from antiparasitic, antibacterial and antimycobacterial drug resistance in low-income settings
Christopher J M Whitty
Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 113, Issue 3, 1 March 2019, Pages 105–107,
Published: 31 January 2019

‘The importance of antimicrobial resistance is widely accepted and has led to a resurgence of political and scientific interest in the subject, although arguably less interest from industry than is needed. Lumping together the different resistance problems between drug–microbial combinations from different infections, classes of drug and health care settings can conflate largely unrelated problems and therefore lead to misleading conclusions. However, relevant lessons that have been learned in one field are often largely unknown in other fields. An example is the extensive literature on the often counterintuitive behavioural impact of introducing rapid diagnostic malaria tests for investigating febrile illness aimed at reducing antimalarial overprescription. This is often unknown to people working on diagnostic tests for bacterial disease to reduce the overprescribing of antibiotics, as they often go to different conferences and read different journals…’

The paper describes five scenarios and I reproduce scenario 4 in full as it is the most common:

‘Group 4 is where an antimicrobial is usually given with no definitive diagnosis and testing is not available either for the infection or drug resistance. This is actually the most common scenario where an antimicrobial may be prescribed by trained professionals. In particular the outpatient management of febrile illness is the most common presentation in many low-income settings. This is not a group of problems that can be solved with new drug classes. Better diagnostic tests for specific diseases can help, but probably only at the margins, since a large number of undiagnosed febrile cases will always remain, even where the most sophisticated testing is available. In many low-income and most middle-income settings the majority of cases will be viral. The only way to reduce prescription of antimicrobials is to provide persuasive evidence that patients (especially children) will come to no harm without them. There is unlikely to be an easy technological fix for this; it is a behaviour-change issue backed up by safety data.’

The full text is freely available here:

Best wishes, Neil

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