Drivers of Antibiotic Resistance Transmission in Low- and Middle-Income Countries from a “One Health” Perspective—A Review

• Main Authors: Katia Iskandar, Laurent Molinier, Souheil Hallit, Massimo Sartelli, Fausto Catena, Federico Coccolini, Timothy Craig Hardcastle, Christine Roques, Pascale Salameh
• Format: Article
• Language: English
• Published: MDPI AG 2020-07-01
• Series: Antibiotics
• Subjects: antibiotic resistance; one health; low- and middle-income countries
• Online Access: https://www.mdpi.com/2079-6382/9/7/372

Antibiotic resistance is an ecosystem problem threatening the interrelated human-animalenvironment<br />health under the “One Health” framework. Resistant bacteria arising in one<br />geographical area can spread via cross-reservoir transmission to other areas worldwide either by<br />direct exposure or through the food chain and the environment. Drivers of antibiotic resistance are<br />complex and multi-sectoral particularly in Lower- and Middle-income countries. These include<br />inappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; food<br />supply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. In<br />order to examine the drivers of antibiotic resistance from a “one health” perspective, a literature<br />review was conducted on three databases including PubMed, Medline and Google Scholar. A total<br />of 485 studies of potential relevance were selected, out of which 182 were included in this review.<br />Results have shown that the aforementioned market failures are the leading cause for the negative<br />externality of antibiotic resistance that extends in scope from the individual to the global ecosystem.<br />Incremental and sustainable global actions can make the change, however, the problem will<br />continue to prevail if governments do not prioritize the “One health” approach and if individual’s<br />accountability is still denied in a world struggling with profound socio-economic problems.