By Sharon Atieno
A new study reveals that inadequate access to appropriate treatment is resulting in increased cases of antimicrobial resistance (AMR) in low—and middle-income countries (LMICs).
The study, published in the Lancet Infectious Diseases journal, looked at which antibiotics were available to treat nearly 1.5 million cases of carbapenem-resistant Gram-negative (CRGN) infections across eight geographically diverse and populous LMICs. These include Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan and South Africa.
The research carried out by the Global Antibiotic Research & Development Partnership (GARDP), a not-for-profit global health organization, found that in nearly seven percent of the cases were the appropriate antibiotics potentially available, ranging from as little as 0.2% to 14.9%.
In Kenya, just 0.25% received suitable antibiotics, compared to 0.7% in South Africa, 7.8% in India, and 14.9% in Egypt. The total number of Kenyan infections included in the study was 15,830, with only 39 of them receiving appropriate treatment.
According to the researchers, such extreme gaps in access to antibiotic treatments can result in increases in AMR-related morbidity and mortality, which in LMICs is already the highest in the world. It can also contribute to the under or inappropriate treatment of these
infections, which can further fuel poor patient outcomes and make infections more difficult to treat in the long run.
“For years, the dominant narrative has been that antibiotics are being overused, but the stark reality is that many people with highly drug-resistant infections in low- and middle-income countries are not getting access to the antibiotics they need,” said Dr Jennifer Cohn, GARDP’s Global Access Director and senior author of the study.
“Some strong innovative government programmes do already exist and are attempting
to address this, but we need more of them and they need more resources.”
AMR is already one of the world’s biggest killers, accounting for 4.71 million associated deaths each year. This work draws from and builds on the recent findings of the Global Burden of Antimicrobial Resistance (GRAM) study, which suggests that AMR has now reached an alarming tipping point.
While AMR-related mortality has remained relatively stable in recent decades, a sharp rise is now expected, with the number of AMR-related deaths likely to increase by more than 70% by 2050. The primary reasons behind this sudden surge are the rise and spread of difficult-to-treat Gram-negative infections and a lack of access to effective antibiotics across the globe. According to the GRAM study, more than 50 million deaths could be prevented through improvements to access.
The study’s authors point out that there are likely many gaps that hinder access, from a lack of access to health facilities and the absence of diagnostics, to a lack of access to appropriate treatment, and they call for more research to be done to identify and address specific gaps in care.
“This research casts the spotlight on a much overlooked and increasingly dominant aspect of AMR, that there is now a massive treatment gap and people are dying because of it,” said Dr. Manica Balasegaram, Executive Director of GARDP.
“This data shows a radical shift in focus is needed towards R&D and access efforts that are aimed at ensuring people get the antibiotics they need. Ultimately, the priority should be
saving people’s lives.”
The authors stress that this is a first estimation and that more data is needed to tell the detailed story. The research was conducted and funded by GARDP in collaboration with colleagues at the Perelman School of Medicine (University of Pennsylvania) and the Center for Innovation in Diagnosis (University of Maryland School of Medicine).
