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We recently launched the Global Antibiotic Resistance Partnership (GARP) to extend the work of Extending the Cure to five developing countries - China, India, Kenya, South Africa and Vietnam.  Although these countries do not use antibiotics at nearly the intensity that one sees in the United States, they already face high levels of resistance, particularly in hospital-acquired infections. 

Multi-drug resistance among gram negative bacteria in Vietnam exceeds eighty percent according to their national surveillance data.  One explanation for this might be that hospitals in these countries (like their counterparts in the west) have been highly reliant on antibiotics rather than on hospital infection control to deal with infections. 

One often forgets that the great majority of deaths from infectious diseases in western countries were averted well before antibiotics were ever used (see figure). The reason was improved hygiene and sanitation, both in the community and in hospitals.  Somehow in the antibiotics era, the availability of these easy means to treat infections has led to possibly more lax hygiene (although the fact that patients in hospitals are older and sicker is also a contributing factor).  We rely on these drugs to clean up the mess rather than not making the mess in the first place.  

So what might a post-cheap-antibiotics era in developing countries look like?  Would we see better infection control than we do now?

1 Comment

I always say that "common sense" is the best practice in medicine. As such, I am strong believer that motivated and disciplined use of alcohol-based solutions in long term care facilities (nursing homes) and hospitals, should reduce the incidence of infectious diseases in vulnerable populations (elderly, immunosuppressed patients, patients with HIV, TB, diabetes and children in day care centers, -just to name a few). Efforts and resources should be geared toward this simple measure of common sense.

--Anibal Sosa