Antimicrobial resistance in countries with limited resources: unique challenges and limited alternatives.

The haphazard use of antimicrobial agents has caused these essential drugs to lose their effectiveness. In the resource-poor parts of the world, the problem is complex, involving inadequate access to antimicrobial agents in the poorest countries along with an excessive variety of drugs in middle-income countries that have inadequate capability to use them well or to control the unnecessary emergence of resistant microbes. Both circumstances may result in the rapid dissemination of antimicrobial resistance. Resistant organisms, which in wealthy countries would result in the increased expense or inconvenience of alternative agents, in poor countries may cause infections that for practical purposes are untreatable. The basic requirements for controlling drug-resistant problems in resource-poor and wealthy countries alike include first-line prevention of infectious diseases, laboratory support for etiologic diagnosis, adequate surveillance and epidemiological information, appropriate drug selection, locally appropriate guidelines for treatment, and proper education about infectious diseases in all levels. These requirements generally are lacking in resource-poor countries. The most important key to success in these countries is a strong central commitment and governmental support for minimizing drug-resistance problems while maintaining the highest effectiveness of health care within the limits of available resources.