**4.3 Emergence of** *E. coli* **resistance e in Africa**

Proper prescription of drugs is not strictly followed in the developing world. A similar case is Africa countries where no such policy is implemented. There are several challenges to implement sustainable and effective AMRs monitoring

programs in the sub-Saharan Africa to encounter the rapid dissemination of AMRs [92]. Around 50–60% of *E. coli* infections reported in patients have a resistance nature to most of the available antibiotics i-e amoxicillin, ciprofloxacin, cefixime [93]. A current study reported the 48% prevalence of AMR *E. coli* in hospitalized patients in Brazzaville, Republic of Congo [94]. Similarly in another study where 65% to ceftazidime, 57% to amoxicillin, 51% to piperacillin, and 11% to ofloxacin resistant respectively in *E. coli* were documented [95]. First reported case of EHEC *E. coli* O157-H7 first case was reported in 1982 in the USA while in South Africa and parts of the world in 1990 cases were reported. Was found in 1982 in the United State while, in 1990 in throughout the world [96, 97]. Besides this, many infrequent cases of EHEC have been reported in different parts of South Africa. A total of 40,912 patients under the age of 5 years was hospitalized in 1992 due to the onset of diarrhea [98]. In South Africa, the most common strains detected are EPEC with detection rates ranging from 14.8% to 41.7%. Several pathotypes of *E. coli* are significant causes of diarrhea in children particularly in sub-Saharan Africa [94]. Most of the AMR genes are encoded in *E. coli* on MGEs that are transmissible among bacteria permitting the rapid spread and maintenance of resistance genes among species [99].
