Addressing Antibiotic Resistance in Lower-Income Countries

Combating antibiotic resistance in lower- and middle-income countries (LMICs) will require particular attention to emerging One Health challenges, according to an article published January 18, 2018, in the journal Clinical Infectious Diseases.

Although traditional efforts to reduce the spread of antibiotic resistance in these countries have focused on antibiotic use in individuals, LMICs must also address the increasing roles of animal and environmental exposures in this public health crisis, write Maya Nadimpalli, PhD, University of Versailles Saint-Quentin-en-Yvelines, France, and colleagues.

“In particular, current strategies do not prioritize the impacts of increased antibiotic use for terrestrial food-animal and aquaculture production, inadequate food safety, and widespread environmental pollution,” the authors stress.

With this in mind, they highlight integrated One Health strategies that target human, environmental, and animal health challenges. These strategies include:

Reducing antibiotic misuse in food animals and aquaculture

Because little is known about antibiotic use in livestock production and aquaculture in LMICs, Dr. Nadimpalli and colleagues suggest that researchers should conduct surveys to identify specific areas of these production systems where government regulation could reduce animal antibiotic misuse.

Farmers also need better education, the authors note. Education should target best practices in animal agriculture, they explain, including vaccine use and antibiotic withdrawal periods before slaughter.

Also, because about 80% of the antibiotics administered to fish and farm animals are excreted unaltered, the authors stress the need for LMICs to improve waste disposal from fish and livestock farms to protect human health.

For example, fish farms must reduce antibiotic use to help address this problem, and antibiotics such as fluoroquinolones that are important to human health should be banned in aquaculture.

Improving food safety through supply chains

Studies are also needed to determine areas of the food supply chain where the risk for contamination with antibiotic-resistant bacteria is highest, say Dr. Nadimpalli and colleagues. These may include areas such as slaughterhouses and high-contact animal holding pens.

Points of animal transport should also be addressed, especially because poorly monitored food supply chains can cross borders and contribute to the regional or international spread of antibiotic-resistant pathogens.

Treating highly contaminated waste before disposal

The authors also stress the need to set minimum treatment levels for waste from drug manufacturers and hospitals, because these are important point sources of release of antibiotics and antibiotic resistance genes into LMIC environments. “Because antibiotics present in pharmaceutical wastewater have not been metabolized, their concentrations may be many-fold higher than in human waste,” they write.

Improving drinking water and sanitation

Because diarrheal disease is the second-leading cause of mortality among children in LMICs, public health measures are critical to reducing its incidence. Thus, improving access to safe drinking water and sanitation are key priorities in LMICs. To help achieve this, the authors propose that global funding processes to reduce antibiotic resistance should include water and sanitation initiatives.

Combating antibiotic resistance will require the use of such integrated approaches to address the increasing contribution of animal and environmental exposures to this problem, Dr. Nadimpalli and colleagues write. However, “only LMICs can identify which strategies to prioritize and the timelines in which to achieve them based on their own national contexts,” they emphasize.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.