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Tackling antimicrobial resistance in low-income and middle-income countries
  1. Sunil Pokharel1,
  2. Shristi Raut2,
  3. Bipin Adhikari1
  1. 1 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, UK
  2. 2 Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
  1. Correspondence to Dr Bipin Adhikari; biopion{at}

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Antimicrobial resistance (AMR) is a global threat that claims 700 000 lives every year. If no urgent actions are taken, by 2050, AMR will cause an estimated loss of 10 million lives and $US100 trillion.1 Over the years, commonly identified infectious agents have developed resistance to antimicrobials. Since the discovery of penicillin in 1928, 20 000 potential resistant genes of nearly 400 different types have been identified.2 Methicillin-resistant Staphylococcus aureus alone causes more than 80 000 severe infections and claims more than 11 000 lives each year.3 The World Bank estimates a reduction in global domestic product per annum of 1.1%–3.8% by 2050 if AMR remains unchecked, and that an investment of US$9 billion per year will be required to counteract the problem.4

AMR affects all countries, but the burden is disproportionately higher in low-income and middle-income countries.1 To halt the spread of AMR, it is important to understand what contributes to its emergence. While the overuse of antimicrobials in both humans and animals is broadly implicated and strategies are developed to counteract such an overuse, the broader factors that contribute to AMR are often overlooked. In addition, national action plans on AMR are often constrained by lack of comprehensive multisectoral and multipronged approaches (eg, too focused on the health sector), and their findings are only relevant for a limited period of time as AMR continues to evolve at a fast pace.5 A recent assessment of country situational analyses against the political, economic, sociological, technological, ecological, legislative, and industry (PESTELI) framework identified important gaps in addressing AMR.6

Indeed, collaborative efforts are necessary to delineate global, regional and local contingency plans for AMR. A multitude of factors contribute to the development of AMR. Many of these factors transcend discipline and sectors. Efforts to counteract AMR through a traditional biomedical approach …

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