What current policies are in place in low- and middle-income countries regarding antibiotic use and resistance? What related programs are in place in these countries and how effective are they? What are some policy recommendations for the future?
What we found
Awareness of the need to curb antibiotic use is on the rise globally, but policies and actions are more prevalent in high-income countries. As incomes in low- and middle-income countries rise, antibiotic use increases, but there are still significant problems concerning lack of access to antibiotics in such place. At the same time, overuse of antibiotics is occurring in other areas of these same countries.
Many low- and middle-income countries have done studies on antibiotic resistance, but significantly fewer have written or implemented policies regarding the issue. These countries need greater capacity to respond to global directives and enact policies for combating antibiotic resistance. In several countries, non-government programs are providing good models of partnerships and support; the Global Antibiotic Resistance Partnership (GARP) model ReAct-assisted model have had successes on individual country levels. The WHO has intermittently provided effective efforts at combating antibiotic resistance in the last decade.
There are a variety of opportunities for low- and middle-income countries to limit the spread of antimicrobial resistance within their borders, including reducing the need for antibiotics by improving public health, phasing out agricultural antibiotic use, changing prescription incentives, investing in antibiotic resistance surveillance, and ensuring political commitment to combating the threat of resistance.
Why it matters
Despite significant discussion in the last decade of antibiotic resistance in high-income countries, low- and middle-income countries across the world lag behind in focusing on antibiotic resistance as a major public health concern. Antibiotic use is on the rise globally, and the increase is occurring in these areas faster than elsewhere; India is the largest consumer of antibiotics in the world, followed by China. Such countries have issues with policy creation and implementation that differ from high-income countries, and require different policy focuses and solutions.