Drug Resistance

Excerpt

The control of infectious diseases is seriously threatened by the steady increase in the number of micro-organisms that are resistant to antimicrobial agents—often to a wide range of these agents. Resistant infections lead to increased morbidity and prolonged hospital stays, as well as to prolonged periods during which individuals are infectious and can spread their infections to other individuals (Holmberg, Solomon, and Blake 1987; Rubin and others 1999). The problem is particularly severe in developing countries, where the burden of infectious diseases is relatively greater and where patients with a resistant infection are less likely to have access to or be able to afford expensive second-line treatments, which typically have more complex regimens than first-line drugs. Furthermore, the presence of exacerbating factors, such as poor hygiene, unreliable water supplies, civil conflicts, and increased numbers of immunocompromised patients attributable to the ongoing HIV epidemic, can further increase the burden of antimicrobial resistance by facilitating the spread of resistant pathogens. In this chapter, we discuss the causes and burden of drug resistance and evaluate interventions that address the resistance problem in developing countries. Although a number of the interventions we discuss are relevant to drug resistance in HIV/AIDS and other forms of antiviral resistance, chapter 18 includes a more in-depth discussion of this subject.