Antimicrobial use in developing countries

We conducted a study on agriculture related antimicrobial resistance (AMR) in developing countries. AMRpathogens are commonly found in animals, animal food products and agro-food environments, but the lackof surveillance systems means there are no reliable national data on the level of AMR in animals and theirproducts. While AMR infections in animals and their products contribute to AMR infections in people indeveloping countries the literature is insufficient to draw firm conclusions on the extent of this contribution,which is likely to vary in different contexts. For example, a recent study found high levels of multi-drugresistance in goats kept by pastoralists in remote, isolated areas and never given treatments by veterinariansor farmers. The key driver of agriculture-related AMR is the quantity and quality of use of antimicrobials inlivestock production and aquaculture. In developing countries as much as several hundred thousand tonsmay be used every year, agricultural use probably exceeds medical use, and most use is probably inintensive systems. The underlying driver for antimicrobial use and development of AMR is the livestock andaquaculture revolution that is the rapid growth in intensive production systems in response to increaseddemand for livestock and fish products. Based on livestock intensification patterns, China, Brazil and Indiaare current hotspots, and future hotspots with fastest growth of the intensive livestock sector in Myanmar,Indonesia, Nigeria, Peru and Vietnam. China is a hotspot for aquaculture and Indonesia, Thailand, Vietnam,Bangladesh, India and Chile are other countries where antimicrobial use in fish production may beproblematic. AMR is intrinsically a global problem that can only be managed at supra-national scale and thecurrent strong momentum to take action on AMR provides an opportunity to address the problem globallyand comprehensively, addressing medical and veterinary use. This will require better evidence on the use ofantimicrobials in agriculture, the impacts of this use on human and animal health, the acceptability andfeasibility of stricter control of antibiotic use in agriculture, and the costs and benefits of stricter controltaking into account trades offs between overuse and lack of access to antimicrobial drugs.