Poverty and inequity are major drivers of antimicrobial resistance. In developing countries they are linked to inadequate access to effective drugs, unregulated dispensing by unqualified staff and truncated therapy for reasons of cost. The widespread and frequently unnecessary use of antibiotics is also related to health system weaknesses, with poorly trained care providers and lack of suitable laboratory facilities frequently resulting in inappropriate treatment.
For example, because of limited capacity to obtain a bacteriological diagnosis of typhoid fever, treatment is often initiated with ineffective antibiotics and changed to second line therapy following clinical treatment failure. In other instances, physicians may choose to initiate treatment unnecessarily with second line antibiotics. Sometimes alternative antibiotics may not be available at all.
Resistant bacteria are often more virulent, leading to more severe illness. Multidrug-resistant (MDR) typhoid, for example, is associated with greater clinical severity of illness and more complications than the non-resistant form of the disease. So increasing antibiotic resistance is associated with higher economic burden on health systems from the combination of higher rates of complications and enhanced health care costs.
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