Summary of antibiotic resistance scenario of three bacteria in different samples from selected developing countries.
Antibiotic resistance is an emerging global concern. It is an increasing threat to public health sectors throughout the world. This devastating problem has drawn attention to researchers and stakeholders after a substantial economic loss for decades resulting from the ineffectiveness of antibiotics to cure infectious diseases in humans and animals. The spectrum of antibiotic resistance varies between developed and developing countries due to having variations in treatment approaches. Antibiotic therapy in the developed countries is usually rational and targeted to specific bacteria, whereas in the developing countries, most of the cases, the use of antibiotics is indiscriminate to the disease etiology. In developing countries, many people are not aware of using antimicrobials. They usually get suggestions from drug sellers and quacks who do not have the authorization to prescribe a drug. If registered doctors and veterinarians are asked to prescribe, then dose, course, and withdrawal period might be maintained adequately. Antibiotic resistance transmission mechanisms between agricultural production systems, environment, and humans in developing countries are very complex. Recent research makes a window to find out the global situation of antibiotic use and resistance pattern. The antibiotic resistance scenario in selected developing countries has been summarized in this chapter based on published literature (Table 1). This chapter describes the judicial use of antibiotics and discussed maintaining proper antibiotic dose, course, drug withdrawal period, especially on food-producing animals. The book contains a few recommendations, suggested by the national multi-sectoral surveillance committee to avoid antibiotic resistance organisms in livestock and humans in the developing countries.
- Antibiotic resistance pattern
- registered doctors
- developing countries
After discovering the first antibiotic ‘Penicilillin’ by Alexander Fleming in 1928, antibiotics played a notable role in saving millions of lives globally. Nowadays, the resistance of antibiotics has intensified significantly throughout the world . Antibiotic resistance is a global problem in both developed and developing countries. The incidence of resistance has increased at an alarming rate in recent years and is expected to increase at a greater rate in the future as antibiotic agents continue to lose their efficiency , mostly in many developing or low-and middle-income countries (LMIC). Resistance bacteria do not respect national borders; the development of resistance in the most remote locations can impact the world in a concise time . The widespread use of antibiotics for human and veterinary treatment has led to large-scale dissemination of bacteria with resistance ability to antibiotics in the domestic animal-wildlife-environmental niche via food chain to humans in most developing countries, including Bangladesh . Resistance bacteria are found in the stool and as intestinal flora of healthy individuals that are serving as reservoirs for resistance to multiple antimicrobials . Antibiotics are a mainstay in the treatment of bacterial infections, and thus the worldwide increase in antibiotic-resistance bacteria is of major concern. The problem of antibiotic resistance is not restricted to pathogenic bacteria—it also involves the commensal microbiota, which may become a major reservoir of resistance strains of bacteria .
2. Main text
2.1 Practical scenario of antibiotic resistance pattern in developing countries
An organized literature search approach was used to detect all published studies reporting resistance bacteria in human samples and foods of animal origin in some selected developing countries. PubMed, Science Direct, and Google Scholar were searched for relevant studies published until 2019. The search terms have been adopted into outcome, population, descriptive, and area categories. Based on the study objectives, specific Boolean words were developed using “AND” and “OR”. Some modification has been conducted based on the search engine requirements, and advanced search criteria have been used to search Google scholar. The papers were downloaded using the Chattogram Veterinary and Animal Sciences University (CVASU) library network. The Boolean words of each category were combined using “AND”, whereas “OR” was used to join the term within a category. Data was extracted and recorded for study location, citation, first author, title, time of study, year of publication, type of specimen, sample size, number of positive specimens, amount of antibiotics, specific antibiotic sensitivity or resistance level percentages, methods of detection used, culturing techniques and resistance genes. Resistance of
2.2 Tale of AMR in developing countries
Antibiotics are considered to safeguard against infectious diseases caused by pathogenic bacteria, but unfortunately, antimicrobial resistance becomes a burden in humans, animals, and the environmental niche worldwide. It happened due to the indiscriminate, inappropriate, and unregulated use of antibiotics in animal and agricultural production systems and humans. In developing countries, AMR is overburdened by antibiotics as growth promoters by the farmers, feed dealers, drug sellers, and the lack of approved legislation by the respective government authorities . However, some countries have written and approved legislation, but appropriate implementation and systematic monitoring are not noticed. Multi-drug resistance (MDR) bacteria are increasing day by day at every corner of developing countries and escalate treatment costs. In a recent WHO report, it is speculated that about 10 million people will die, and 100 trillion USD from the world economy will be lost for AMR by 2050 if no effective measures are taken . Humans are mostly suffering in developing countries due to the ineffectiveness of antibiotics to microbes.
In highly populated developing countries where there is a shortage of physicians, the people seek to take drugs, including antibiotics, by their own decision or prescription from drug sellers or quacks. Even in the rural area, it is hard to find a licensed doctor or veterinarian to treat people and animals and keep faith in a quack or village doctor. Those quacks, health assistant village doctors, and drug sellers prescribe different antibiotics even for common symptoms such as colds, coughs, and diarrhea, where a simple, supportive treatment course would be enough. Self-medication, both in the human and veterinary sectors, is another major problem for generating antimicrobial resistance. In some cases, licensed doctors and veterinarians are biased to treat antimicrobials due to various pharmaceutical companies . Those unnecessary prescriptions and a broad spectrum of antibiotics in animals and humans have already brought a great disaster in most developing countries . Poor sanitation and hygiene are essential factors for transmitting resistance organisms from animals (mainly food and pet animals) and environment to humans. Countries like Bangladesh, Brazil, India, and Nigeria are mostly suffering from sanitation and hygiene management issues for growing AMR . There is a chance of nosocomial infection in hospital settings, as many hospitals have no facilities for waste disposal and wastewater treatment . There is also a high risk of spreading resistance microbes from patients to their surroundings, especially to caregivers or family members.
Poultry meat is one of the topmost widely accepted food worldwide as a cheap protein source, and more than 90 billion tons of chicken meat produce each year. A large variety of antimicrobials are used in poultry production systems for disease prophylaxis and used as growth promoters to increase growth and productivity , which accelerate the expansion of resistance in pathogens and different commensals. Therefore, human health is a great concern with the emergence of resistance pathogens from poultry and AMR residue from poultry meat and eggs [18, 74]. Food producing animals or livestock has, also affected by AMR due to not maintaining proper dose, treatment interval and duration in therapeutics, metaphylactic and prophylactic treatment, and withdrawal periods of different antimicrobials. Growth promoter is another influential factor-like poultry production system in most developing countries [88, 124, 135]. Human-livestock interaction is another vital factor for transmitting resistance microorganisms from food and pet animals to humans or vice versa.
An agreement should be maintained among the scientific community to stop the excessive use of antimicrobials in food animal production system. Thus, it will help to limit the AMR on human health. Otherwise, AMR in food animal pathogens will unavoidably effect on treatment failure of livestock and poultry diseases. As a result, pathogen transmission on the environment will increase, and production loss will be soared, and the economy of developing countries will be hindered. In developing countries, the environment is also contaminated with high levels of resistance organisms and AM residues derived from human, livestock, and poultry waste . Hospital, both human and veterinary wastewater, is the potential source of AMR.
Water is the mainstream potential reservoir of antimicrobial resistance as wastewater contaminated rivers, ponds, and other water bodies. Medical and veterinary hospital effluents (with different types of resistance organisms) were directly drained to the nearby water bodies and contaminated the fishes ultimately consumed by humans. Poor sanitation and hygiene management bring pathogens close to each other’s species and accelerate the horizontal resistance gene transmission . Ceftazidime, Cefpodoxime-resistance bacteria were isolated in Nigeria. Moreover, Azithromycin, Tetracycline, Gentamicin, Ciprofloxacin, Cefotaxime, Chloramphenicol, Cefoxitin, and Oxacillin resistance
To reduce the AMR in developing countries, proper rules and regulations for antibiotic use in humans and animals should be followed. Only registered physicians will prescribe antibiotics for humans; livestock and poultry farming will be conducted with veterinary supervision. Buying and selling antimicrobials should be restricted without prescription. National surveillance with a multi-sectoral committee in the “One Health” concept would be a useful measure for monitoring antibiotic use in animals and humans.
2.3 Transmissions dynamics of AMR in developing countries
Due to the unregulated use of antibiotics in agricultural production systems in developing countries, bacteria become resistance to single or multiple antimicrobials. These resistance bacteria or genes are transmitted directly from agricultural food products such as meat, milk, egg, fish, and vegetables to humans. Hospital effluents, garbage, livestock effluents contaminated with resistance bacteria drained to the nearby water body where fishes raised, and this water is also used in the crop fields for their productions. It is another way to transmit resistance bacteria from crops and fish to humans. The fate of AMR bacteria in the agricultural production system and environment is still unclear. Could AMR bacteria and mobile genetic elements carrying the resistance genes further evolve after their transfer to the environment? There are knowledge gaps regarding the magnitude and dynamic nature of spread regarding antimicrobial resistance bacteria and antimicrobial resistance genes within and between different ecological niches on farms, which deserve to be considered when assessing antimicrobial resistance bacteria’s transmission the food chain. Moreover, the transmission pathway of resistance bacteria between the agricultural production systems, environment, and humans in developing countries is very complex and given in Figure 1.
|Pakistan||Human||Amoxicillin, Ampicillin, Aztreonam, Cephalosporin, Cefotaxime, Ceftriaxone Ciprofloxacin, Floroquinol, Trimethoprim-sulfamethoxazole||Amoxicillin, Ampicillin, Amikacin, Cefoxitin, Chloramphenicol, Ciprofloxacin, Clindamycin, Co-trimoxazole, Doxycycline, Erythromycin, Fusidic acid, Gentamicin, Penicillin, Teicoplanin, Tigecycline, Levofloxacin, Linezolid, Vancomycin||[16, 17, 18]|
|Poultry and poultry products||Ampicillin, Ciprofloxacin, Colistin, Tetracycline||Pefloxacin||Cefoxitin, Gentamicin, Oxacillin, Penicillin, Levofloxacin, Moxifloxacin||[19, 20, 21, 22]|
|Livestock||Amikacin, Amoxicillin, Cefoxitin, Ampicillin, Oxacillin, Augmentin, Cefotaxime, Chloramphenicol, Ciprofloxacin, Clindamycin, Enrofloxacin, Erythromycin, Fosfomycin, Gentamycin, Kanamycin, Linezolid, Ofloxacin, Penicillin, Rifampicin, Teicoplanin, Trimethoprim, Vancomycin||[23, 24]|
|India||Human||Amikacin, Ampicillin, Ampicillin, Augmentin, Cefepime, Cefoxitin, Cefoperazone, Cefotaxime, Quinolones, Ceftazidime, Ceftriaxone, Colistin, Cefuroxime, Cephalosporins, Ciprofloxacin, Co-trimoxazole, Ertapenem, Meropenem, Gentamycin, Imipenem, Nalidixic acid, Nitrofurantoin, Norfloxacin, Piperacillin, Streptomycin, Sulfamethoxazole, Tetracycline||Ampicillin, Azithromycin, Ceftriaxone, Cephalosporins, Chloramphenicol, Fluoroquinolones, Trimethoprim||Ciprofloxacin, Clindamycin, Co-trimoxazole, Erythromycin, Gentamicin||[25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35]|
|Poultry and poultry products||Amoxicillin, Ampicillin, Cephalexin, Colistin, Cefoxitin, Chloramphenicol, Neomycin, Ciprofloxacin, Co-trimoxazole, Trimethoprim, Amoxicillin, Erythromycin, Rifamycin, Streptomycin, Doxycycline, Sulfamethoxazole, Nalidixic acid, Tetracycline, Gentamicin||Sulphamethizole, Chloramphenicol Amikacin Ceftazidime, Oxytetracycline, Nalidixic acid||Penicillin, Ciprofloxacin, Tetracycline, Erythromycin Ampicillin, Tetracycline Amoxicillin, Erythromycin Polymyxin-B, Cefoxitin Novobiocin, Oxacillin||[36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47]|
|Livestock||Meropenem, Imipenem, Ertapenem||Methicillin, Penicillin, Ampicillin, Kanamycin, Cefotaxime, Sulphadizine Amoxicillin||[48, 49, 50, 51]|
|Pet animals||Amoxicillin, Penicillin G, Methicillin, Cloxacillin, Ampicillin, Cephalothin, Cefuroxime, Ceftriaxone, Clavulanate, Neomycin, Streptomycin, Furazolidone, Nitrofurantoin, Ciprofloxacin, Erythromycin, Oleandomycin, Azithromycin, Doripenem, Lincomycin, Clindamycin, Sulfafurazole, Sulfadiazine, Chloramphenicol, Novobiocin, Vancomycin||[50, 52]|
|Food and food products||Colistin, Cefotaxime, Ceftazidime, Gentamicin, Tetracycline, Amoxicillin||Oxacillin, Cefoxitin, Penicillin G, Cephalexin, Ampicillin, Methicillin, Kanamycin, Gatifloxacin, Ciprofloxacin||[53, 54, 55, 56]|
|Environment||Amoxicillin, Ciprofloxacin, Nalidixic acid, Ceftazidime, Cephalosporin, Penicillin, Cefuroxime, Erythromycin, Tetracycline, Ceftazidime, Cefotaxime, Gentamicin, Trimethoprim||[57, 58, 59, 60]|
|Bangladesh||Human||Colistin, Nalidixic Acid, Cefixime, Co-trimoxazole, Ceftazidime, Gentamicin, Amikacin, Imipenam, Ciprofloxacin, Azithromycin, Cefuroxime, Cefotaxime, Ceftriaxone, Meropenem, Nitrofurantoin, Levofloxacin, Meropenem||Ciprofloxacin, Ceftriaxone, Azithromycin, Clindamycin||Nalidixic Acid, Cefixime, Meropenem, Oxacillin, Gentamicin, Ceftazimid, Tocefoxitin, Etracylcin, Cefoxitin, Ciprofloxacin, Chloramphenicol, Clindamycin, Cefotaxime, Levofloxacin||[13, 14, 61, 62, 63, 64, 65, 66, 67, 68]|
|Poultry||Ampicillin, Tetracycline, Trimethoprim, Nalidixic acid|||
|Food and food products||Erythromycin, penicillin, Vancomycin, Novobiocin, Tetracycline, Ceftriaxone, Ampicillin, Azithromycin, Bacitracin, Kanamycin, Nalidixic acid, Sulfamethoxazole||Ampicillin, Azithromycin, Erythromycin, Doxycycline, Sulphonamide, Azithromycin, Novobiocin, Oxytetracycline, Cephradine, Amoxicillin, Erythromycin, Tetracycline, Erythromycin, Vancomycin, Rifampicin, Sulfamethoxazole, Bacitracin||Ampicillin, Chloramphenicol, Nitrofurantoin, Oxytetracycline, Oxytetracycline, Amikacin, Erythromycin, Oxacillin, Ciprofloxacin, Amoxicillin, Trimethoprim, Gentamicin, Penicillin, Erythromycin||[69, 70, 71, 72, 73, 74]|
|Environment||Ceftazidime, Gentamycin, Tetracycline, Imipenem, Ciprofloxacin, Chloramphenicol, Amoxycillin, Erythromycin, Azithromycin, Streptomycin, Norfloxacin, Cefepime, Cefixime||Ceftazidime, Gentamycin, Imipenem, Ciprofloxacin, Chloramphenicol, Cefoxitin, Tetracycline, Rifampicin, Ampicillin||Ceftazidime, Gentamycin, Azithromycin, Tetracycline, Imipenem, Ciprofloxacin, Chloramphenicol, Methicillin, Vancomycin||[75, 76, 77]|
|Thailand||Human||Trimethoprim/sulfamethoxazole, Colistin, Amoxicillin, Gentamicin, Cefazolin, Cefotaxime, Ceftazidime, Ceftriaxone, Cefixime, Cefalexin, Nalidixic acid, Ciprofloxacin, Norfloxacin, Ofloxacin, Doxycycline, Nitrofurantoin, Ampicillin, Oxacillin, Amikacin, Aztreonam, Cefotaxime, Meropenem, Piperacillin, Chloramphenicol, Amoxycillin, Cotrimoxazole||Trimethoprim-Sulfamethoxazole, Cefotaxime, Ceftazidime, Ceftriaxone, Ceftazidime, Norfloxacin, Nalidixic acid, Tetracycline, Gentamicin, Ampicillin, Ciprofloxacin, Chloramphenicol, Cotrimoxazole||Fosfomycin, Methicillin, Cefoxitin, Penicillin, Oxacillin, Mupirocin, Rifampicin, Cotrimoxazole, Ciprofloxacin, Chloramphenicol, Cefazolin, Clindamycin, Cephalexin, Trimethoprim, Amikacin, Ampicillin, Amoxicillin, Tetracycline, Cloxacillin, Cefotaxime, Meropenem, Piperacillin, Gentamicin, Ofloxacin, Erythromycin||[78, 79, 80, 81, 82, 83, 84, 85, 86, 87]|
|Livestock||Methicillin, Penicillin, Rifampin, Novobiocin, Tetracycline, Clindamycin, Oxacillin, Linezolid, Erythromycin, Cefoxitin, Kanamycin, Gentamicin, Trimethoprim, Ciprofloxacin, Levofloxacin|||
|Food and food products||Ampicillin, Cefotaxime, Cefpodoxime, Aztreonam, Ceftazidime, Imipenem, Gentamicin, Amoxicillin, Ceftriaxone, Nalidixic acid, Amoxicillin, Ampicillin, Cefepime, Amikacin, Doxycycline, Tetracycline, Ciprofloxacin, Co-trimoxazole, Colistin sulfate, Cefoxitin, Enrofloxacin, Erythromycin, Chloramphenicol, Ceftazidime, Trimethoprim||[89, 90]|
|Environment||Penicillin G, Vancomycin, Erythromycin, Ampicillin, Tetracycline, Chloramphenicol, Streptomycin, Neomycin, Kanamycin, Cefazoline, Cefotaxime, Ceftazidime, Gentamicin, Nalidixic acid||Tetracycline, Ampicillin, Streptomycin, Tetracycline, Trimethoprim, Gentamicin, Ciprofloxacin, Nalidixic acid, Penicillin G, Neomycin, Vancomycin, Erythromycin, Kanamycin, Chloramphenicol||Methicillin||[91, 92, 93, 94]|
|Nepal||Human||Amikacin, Ampicillin, Cefotaxime, Levofloxacin, Ciprofloxacin, Gentamicin, Ampicillin, Cefoxitin, Trimethoprim, Nitrofurantoin, Amoxyclav, Piperacillin, Ofloxacin, Cefotaxime, Colistin, Meropenem, Nitrofurantoin, Norfloxacin, Imipenem, Fosfomycin, Cefixime, Piperacillin, Cefoperazone, Nitrofurantoin, Meropenem, Co-trimoxazole, Ceftriaxone, Levofloxacin, Ceftazidime, Chloramphenicol, Nalidixic acid, Piperacillin, Tetracycline||Ciprofloxacin, Ampicillin, Chloramphenicol,|
Co-trimoxazole, Streptomycin, Nalidixic acid, Trimethoprim-Sulfamethoxazole, Ceftriaxone
|Ampicillin, Ceftriaxone, Cefotaxime, Cefixime, Nalidixic acid, Piperacillin, Penicillin, Erythromycin, Clindamycin, Cefoxitin, Chloramphenicol, Ampicillin, Ciprofloxacin, Cotrimoxazole, Cefoxitin, Gentamicin, Tetracycline, Teicoplanin, Cephalexin, Cloxacillin, Erythromycin, Linezolid, Vancomycin, Ampicillin, Azithromycin||[15, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107]|
|Food and food products||Amoxicillin, Tetracycline, Cefotaxime, Nalidixic acid, Cotrimoxazole, Gentamycin||Tetracycline, Chloramphenicol, Nalidixic acid, Amoxicillin||Amoxicillin, Nalidixic acid, Cefotaxime, Tetracycline, Azithromycin, Cotrimoxazole||[109, 110]|
|Nigeria||Human||Cefuroxime, Cefotaxime, Amoxicillin, Imipenem, Ceftriaxone, Cefalexin, Ampicillin, Ciprofloxacin, Nalidixic Acid, Gentamycin, Nitrofurantoin, Kanamycin, Chloramphenicol, Pefloxacin, Ofloxacin, Streptomycin, Ceftazidime, Tetracycline, Amoxicillin, Trimethoprim, Co-trimoxazole||Ampicillin, Cefotaxime, Chloramphenicol, Trimethoprim-sulfamethoxazole, Ofloxacin, Ciprofloxacin, Co-trimoxazole, Tetracycline, Eftazidime, Ceftriaxone||Streptomycin, Gentamycin, Tetracycline, Cotrimoxazole, Erythromycin, Cloxacillin, Chloramphenicol, Augmentin, Imipenem, Ceftriaxone, Cefoxitin, Ciprofloxacin, Erythromycin, Cefalexin Co-trimoxazole, Nalidixic Acid, Ampicillin, Vancomycin, Azithromycin, Cefuroxime, Amoxicillin, Ceftazidime||[111, 112, 113, 114, 115, 116, 117, 118, 119, 120]|
|Poultry||Tetracycline, Ampicillin Nitrofurantoin, Chloramphenicol, Penicillin, Ampicillin, Amoxicillin, Cloxacillin, Augmentin, Tetracycline, Streptomycin, Gentamicin, Erythromycin, Cotrimoxazole, Nalidixic Acid||Penicillin, Ampicillin, Amoxicillin, Cloxacillin, Augmentin, Tetracycline, Streptomycin, Gentamicin Chloramphenicol, Ofloxacin, Erythromycin, Cefuroxime, Cefoxitin, Amoxicillin, Ceftriaxone||[121, 122, 123]|
|Livestock||Cloxacillin, Penicillin, Teicoplanin, Sulphadimidine, Ampicillin, Tetracycline, Nalidixic acid, Trimethoprim||Amoxicillin, Enrofloxacin||Ampicillin||[124, 125]|
|Environment||Ceftazidime, Cephalexin, Ceftriaxone, Cefotaxime, Cephalexin, Tetracycline, Lipocaine, Augmentin, Ceftazidime, Cefuroxime, Ampicillin, Chloramphenicol, Amoxicillin-clavulanic acid, Ciprofloxacin, Ampicillin, Augmentin, Gentamicin||Gentamycin, Ofloxacillin, Amoxycillin, Ciprofloxacin, Tetracycline, Pefloxacin, Lipocaine, Ceftazidime, Ceftriaxone, Cefotaxime, Cefotaxine, Cephalexin, Augmentin, Cefuroxime, Ampicillin, Colistin, Ofloxacin, Cotrimoxazole, Ciprofloxacin, Nitrofurantoin Trimethoprim, Ceftazidime||Ceftazidime, Cephalexin, Ceftriaxone, Cephalexin, Tetracycline, Lipocaine, Amoxicillin||[126, 127, 128, 129, 130, 131, 132]|
|Brazil||Poultry||Amoxicillin, Ceftiofur, Ciprofloxacin, Gentamicin, Chloramphenicol, Tetracycline, Sulfafurazole, Enrofloxacin, Sulfonamide, Spectinomycin, Trimethoprim||[133, 134]|
|Human||Ampicillin, Ampicillin, Ceftriaxone, Ceftiofur, Chloramphenicol, Ciprofloxacin, Enrofloxacin Tetracycline, Trimethoprim|||
|Food and food products||Sulfonamides, Streptomycin, Tetracycline, Gentamicin, Ceftriaxone, Trimethoprim||[136, 137]|
Antimicrobial resistance has shown a profound surge in developing countries as well as around the globe. In developing countries, antibiotic resistance on different microorganisms, especially
I acknowledge the Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Bangladesh, to contribute my research. I also acknowledge Shahneaz, Mazhar, Shaikat, Mahabub, Tanzin, Nayem, and Kaisar for their help in writing and checking the document. Finally, I acknowledge the Bangladesh Bureau of Educational Information and Statistics (BANBEIS) project number: SD 2019967 for funding.
Conflict of interest