Scenario of Antibiotic Resistance in Developing Countries

*Mohammad Mahmudul Hassan*

#### **Abstract**

Antibiotic resistance is an emerging global concern. It is an increasing threat to public health sectors throughout the world. This devastating problem has drawn attention to researchers and stakeholders after a substantial economic loss for decades resulting from the ineffectiveness of antibiotics to cure infectious diseases in humans and animals. The spectrum of antibiotic resistance varies between developed and developing countries due to having variations in treatment approaches. Antibiotic therapy in the developed countries is usually rational and targeted to specific bacteria, whereas in the developing countries, most of the cases, the use of antibiotics is indiscriminate to the disease etiology. In developing countries, many people are not aware of using antimicrobials. They usually get suggestions from drug sellers and quacks who do not have the authorization to prescribe a drug. If registered doctors and veterinarians are asked to prescribe, then dose, course, and withdrawal period might be maintained adequately. Antibiotic resistance transmission mechanisms between agricultural production systems, environment, and humans in developing countries are very complex. Recent research makes a window to find out the global situation of antibiotic use and resistance pattern. The antibiotic resistance scenario in selected developing countries has been summarized in this chapter based on published literature (**Table 1**). This chapter describes the judicial use of antibiotics and discussed maintaining proper antibiotic dose, course, drug withdrawal period, especially on food-producing animals. The book contains a few recommendations, suggested by the national multi-sectoral surveillance committee to avoid antibiotic resistance organisms in livestock and humans in the developing countries.

**Keywords:** Antibiotics, Antibiotic resistance pattern, prescribed, registered doctors, developing countries

#### **1. Introduction**

After discovering the first antibiotic 'Penicilillin' by Alexander Fleming in 1928, antibiotics played a notable role in saving millions of lives globally. Nowadays, the resistance of antibiotics has intensified significantly throughout the world [1]. Antibiotic resistance is a global problem in both developed and developing countries. The incidence of resistance has increased at an alarming rate in recent years and is expected to increase at a greater rate in the future as antibiotic agents continue to lose their efficiency [2], mostly in many developing or low-and middleincome countries (LMIC). Resistance bacteria do not respect national borders; the development of resistance in the most remote locations can impact the world in a concise time [1]. The widespread use of antibiotics for human and veterinary treatment has led to large-scale dissemination of bacteria with resistance ability to

antibiotics in the domestic animal-wildlife-environmental niche via food chain to humans in most developing countries, including Bangladesh [3]. Resistance bacteria are found in the stool and as intestinal flora of healthy individuals that are serving as reservoirs for resistance to multiple antimicrobials [4]. Antibiotics are a mainstay in the treatment of bacterial infections, and thus the worldwide increase in antibioticresistance bacteria is of major concern. The problem of antibiotic resistance is not restricted to pathogenic bacteria—it also involves the commensal microbiota, which may become a major reservoir of resistance strains of bacteria [5]. *Escherichia coli* is commonly found in the intestinal tract of humans and animals and can also be concerned with human and animal infectious diseases. Animal food products are important sources of *E. coli* as fecal contamination of processed animal carcasses at the slaughterhouse is frequently occurred. These resistance microorganisms and their possible resistance determinants may be transmitted to humans if these animal origin foods are improperly washed, cooked, or otherwise mishandled [6]. Although most isolates of *E. coli* are nonpathogenic, they are considered an indicator of fecal contamination in food. About 10 to 15% of intestinal coliforms are opportunistic and pathogenic serotypes and cause a variety of lesions in immunocompromised hosts such as animals and humans [7]. Among the diseases that they cause, some are often severe and sometimes lethal such as- meningitis, endocarditis, urinary tract infection, septicemia, and epidemic diarrhea in human, and yolk sac infection, omphalitis, cellulitis, swollen head syndrome, coligranuloma, and colibacillosis in birds [8]. Furthermore, salmonellosis is one of the most frequent foodborne diseases in humans in almost all countries, and *Salmonella enterica ssp. enteritidis*, followed by *typhimurium*, represent the most frequently isolated serotypes [9]. The most common disease syndromes caused by *Salmonella* serotypes in humans are typhoid fever and enteritis [10], and in avian species, *Salmonella* organism causes fowl typhoid and pullorum disease [11]. *Salmonella typhimurium* and *S. dublin* appear to be the commonest serotypes isolated from cattle, although the distribution of these 2 serotypes differs between countries, and the *Salmonella* organism predominantly causes bovine salmonellosis [12]. *S. aureus* causes superficial skin lesions and localized abscesses in a wide range of host animals. *S. aureus* causes deep-seated infections, such as osteomyelitis and endocarditis and more serious skin infections [13]. *S. aureus* is a major cause of hospital-acquired (nosocomial) infection of surgical wounds and, with *S. epidermidis*, causes infections associated with indwelling medical devices [14]. It also causes food poisoning by releasing enterotoxins into animal originated food. *S. aureus* causes toxic shock syndrome by release of superantigens into the blood stream. *S. saprophiticus* causes urinary tract infections in human, frequently in female population [15]. Over the past decade, the changing pattern of resistance against bacteria has depicted the need for new antimicrobial agents [2]. Developing countries are more vulnerable to antimicrobial resistnace issues for their underprivileged health care infrastructure, unregulated agricultural production process, poor sanitation facilities and widespread misuse of antibiotics. In addition, weak monitoring system and improper implimentation of legislative practices on antibiotic sell and uses in the agriculrural production systems, increases the possibilities of registant bacteria in the developing countries. The senario of antibiotic resistance pattern worsen in developing countries as they use antibiotic indiscriminately in clinical treatments and food animal production system as well. With many bacterial causing diseases in human and animal in developing countries, this chapter will be focusing on three most common genera of bacteria viz. Escherichia, *Salmonella* and *Staphylococcus* that are posing threat to public health by gradually getting resistance against many antibiotics. The aim of this chapter is to identify the scenario of antibiotic resistance pattern in developing countries based on published literature (**Table 1**) and compile them to find out the overall spectrum of antibiotic resistance.

**Country**

**175**

Pakistan

 Human

 Amoxicillin,

 Ampicillin,

Cephalosporin,

Ciprofloxacin,

 Floroquinol, Trimethoprim-sulfamethoxazole

Poultry and

Ampicillin,

Tetracycline

Ciprofloxacin,

 Colistin,

Pefloxacin

poultry

products

Livestock

India

 Human

 Amikacin, Ampicillin, Cefepime, Cefoxitin,

Cefotaxime,

Ceftriaxone,

 Colistin,

Cephalosporins,

trimoxazole,

Gentamycin,

Nitrofurantoin,

Streptomycin,

Poultry and

Amoxicillin,

Cefoxitin,

Chloramphenicol,

 Neomycin,

 Ampicillin,

 Cephalexin,

 Colistin,

Sulphamethizole,

Ceftazidime,

Oxytetracycline,

 Nalidixic acid

Chloramphenicol

 Amikacin

Penicillin, Erythromycin

Amoxicillin,

Cefoxitin Novobiocin,

Erythromycin

 Oxacillin

Polymyxin-B,

 Ampicillin,

 Tetracycline

Ciprofloxacin,

Tetracycline,

[36–47]

poultry

products

Ciprofloxacin,

Amoxicillin,

Streptomycin,

Sulfamethoxazole,

Tetracycline,

 Gentamicin

 Nalidixic acid,

Doxycycline,

Erythromycin,

 Rifamycin,

Co-trimoxazole,

Trimethoprim,

Sulfamethoxazole,

 Tetracycline

Norfloxacin,

 Piperacillin,

 Imipenem,

 Nalidixic acid,

 Ertapenem,

Meropenem,

Ciprofloxacin,

 Co-

 Quinolones,

Cefuroxime,

Ceftazidime,

 Ampicillin,

 Augmentin,

Ampicillin,

Cephalosporins,

Fluoroquinolones,

Trimethoprim

Chloramphenicol,

Azithromycin,

 Ceftriaxone,

Cefoperazone,

 Cefotaxime,

 Ceftriaxone

 Aztreonam,

 **Host**

 **Bacteria** *Escherichia*

 *coli*

*Salmonella* **spp.**

*Staphylococcus*

Amoxicillin,

 Ampicillin,

Chloramphenicol,

Clindamycin,

Erythromycin,

Penicillin, Teicoplanin,

Levofloxacin,

Cefoxitin, Gentamicin,

Levofloxacin,

Amikacin, Amoxicillin,

Oxacillin, Augmentin,

Chloramphenicol,

Clindamycin,

Fosfomycin,

Linezolid, Ofloxacin, Penicillin, Rifampicin,

Teicoplanin,

Ciprofloxacin,

Erythromycin,

 Gentamicin

Clindamycin,

Co-trimoxazole,

[25–35]

Trimethoprim,

Vancomycin

Gentamycin,

 Kanamycin,

Enrofloxacin,

Erythromycin,

Ciprofloxacin,

 Cefoxitin, Ampicillin,

[23, 24]

> Cefotaxime,

Moxifloxacin

 Oxacillin, Penicillin,

[19–22]

*Scenario of Antibiotic Resistance in Developing Countries*

*DOI: http://dx.doi.org/10.5772/intechopen.94957*

 Linezolid,

 Tigecycline, Vancomycin

 Fusidic acid, Gentamicin,

Co-trimoxazole,

Doxycycline,

Ciprofloxacin,

 Amikacin, Cefoxitin,

[16–18]

 **spp.**


#### *Scenario of Antibiotic Resistance in Developing Countries DOI: http://dx.doi.org/10.5772/intechopen.94957*

antibiotics in the domestic animal-wildlife-environmental niche via food chain to humans in most developing countries, including Bangladesh [3]. Resistance bacteria are found in the stool and as intestinal flora of healthy individuals that are serving as reservoirs for resistance to multiple antimicrobials [4]. Antibiotics are a mainstay in the treatment of bacterial infections, and thus the worldwide increase in antibioticresistance bacteria is of major concern. The problem of antibiotic resistance is not restricted to pathogenic bacteria—it also involves the commensal microbiota, which may become a major reservoir of resistance strains of bacteria [5]. *Escherichia coli* is commonly found in the intestinal tract of humans and animals and can also be concerned with human and animal infectious diseases. Animal food products are important sources of *E. coli* as fecal contamination of processed animal carcasses at the slaughterhouse is frequently occurred. These resistance microorganisms and their possible resistance determinants may be transmitted to humans if these animal origin foods are improperly washed, cooked, or otherwise mishandled [6]. Although most isolates of *E. coli* are nonpathogenic, they are considered an indicator of fecal contamination in food. About 10 to 15% of intestinal coliforms are opportunistic and pathogenic serotypes and cause a variety of lesions in immunocompromised hosts such as animals and humans [7]. Among the diseases that they cause, some are often severe and sometimes lethal such as- meningitis, endocarditis, urinary tract infection, septicemia, and epidemic diarrhea in human, and yolk sac infection, omphalitis, cellulitis, swollen head syndrome, coligranuloma, and colibacillosis in birds [8]. Furthermore, salmonellosis is one of the most frequent foodborne diseases in humans in almost all countries, and *Salmonella enterica ssp. enteritidis*, followed by *typhimurium*, represent the most frequently isolated serotypes [9]. The most common disease syndromes caused by *Salmonella* serotypes in humans are typhoid fever and enteritis [10], and in avian species, *Salmonella* organism causes fowl typhoid and pullorum disease [11]. *Salmonella typhimurium* and *S. dublin* appear to be the commonest serotypes isolated from cattle, although the distribution of these 2 serotypes differs between countries, and the *Salmonella* organism predominantly causes bovine salmonellosis [12]. *S. aureus* causes superficial skin lesions and localized abscesses in a wide range of host animals. *S. aureus* causes deep-seated infections, such as osteomyelitis and endocarditis and more serious skin infections [13]. *S. aureus* is a major cause

*Antimicrobial Resistance - A One Health Perspective*

of hospital-acquired (nosocomial) infection of surgical wounds and, with *S.*

find out the overall spectrum of antibiotic resistance.

**174**

*epidermidis*, causes infections associated with indwelling medical devices [14]. It also causes food poisoning by releasing enterotoxins into animal originated food. *S. aureus* causes toxic shock syndrome by release of superantigens into the blood stream. *S. saprophiticus* causes urinary tract infections in human, frequently in female population [15]. Over the past decade, the changing pattern of resistance against bacteria has depicted the need for new antimicrobial agents [2]. Developing countries are more vulnerable to antimicrobial resistnace issues for their underprivileged health care infrastructure, unregulated agricultural production process, poor sanitation facilities and widespread misuse of antibiotics. In addition, weak monitoring system and improper implimentation of legislative practices on antibiotic sell and uses in the agriculrural production systems, increases the possibilities of registant bacteria in the developing countries. The senario of antibiotic resistance pattern worsen in developing countries as they use antibiotic indiscriminately in clinical treatments and food animal production system as well. With many bacterial causing diseases in human and animal in developing countries, this chapter will be focusing on three most common genera of bacteria viz. Escherichia, *Salmonella* and *Staphylococcus* that are posing threat to public health by gradually getting resistance against many antibiotics. The aim of this chapter is to identify the scenario of antibiotic resistance pattern in developing countries based on published literature (**Table 1**) and compile them to


**Country**

**177**

 **Host**

 **Bacteria** *Escherichia*

Food and

Erythromycin,

Novobiocin,

Tetracycline,

 Ceftriaxone,

 penicillin,

Vancomycin,

Ampicillin,

Doxycycline,

Novobiocin,

Amoxicillin,

Erythromycin,

Sulfamethoxazole,

 Bacitracin

Vancomycin,

 Rifampicin,

Erythromycin,

Tetracycline,

Oxytetracycline,

 Cephradine,

Sulphonamide,

Azithromycin,

Azithromycin,

Erythromycin,

Ampicillin,

Oxytetracycline,

Erythromycin,

Amoxicillin,

Penicillin,

Erythromycin

Trimethoprim,

 Gentamicin,

 Oxacillin,

Oxytetracycline,

 Amikacin,

Ciprofloxacin,

Chloramphenicol,

Nitrofurantoin,

[69–74]

food

products

Ampicillin,

Kanamycin,

Environment

Ceftazidime,

Imipenem, Amoxycillin,

Streptomycin,

Cefixime

Thailand

 Human

Amoxicillin,

Cefotaxime,

Cefixime, Cefalexin, Nalidixic acid,

Ciprofloxacin,

Doxycycline,

Oxacillin, Amikacin, Aztreonam,

Meropenem,

Amoxycillin,

Livestock Food and

Ampicillin,

Aztreonam,

Gentamicin,

Nalidixic acid, Amoxicillin,

Cefepime, Amikacin,

Tetracycline,

Colistin sulfate, Cefoxitin,

Ciprofloxacin,

Enrofloxacin,

Co-trimoxazole,

 Amoxicillin,

 Ceftriaxone,

 Ampicillin,

Doxycycline,

Ceftazidime,

 Imipenem,

 Cefotaxime,

Cefpodoxime,

food

products

Cotrimoxazole

 Piperacillin,

Chloramphenicol,

Nitrofurantoin,

 Ampicillin,

 Cefotaxime,

Norfloxacin,

 Ofloxacin,

Ceftazidime,

 Ceftriaxone,

 Gentamicin,

 Cefazolin,

Trimethoprim/sulfamethoxazole,

 Colistin,

Trimethoprim-Sulfamethoxazole,

Ceftazidime,

Norfloxacin,

Gentamicin,

 Ampicillin,

Chloramphenicol,

Cotrimoxazole

Ciprofloxacin,

 Nalidixic acid,

 Ceftriaxone,

Ceftazidime,

Tetracycline,

 Cefotaxime,

Fosfomycin,

Oxacillin, Mupirocin,

Cotrimoxazole,

Chloramphenicol,

Cephalexin,

Ampicillin,

Cloxacillin,

Piperacillin,

Erythromycin

Methicillin,

Tetracycline,

Linezolid, Kanamycin,

Ciprofloxacin,

Levofloxacin

[89, 90]

 Gentamicin,

Trimethoprim,

Erythromycin,

 Cefoxitin,

Clindamycin,

 Oxacillin,

[88]

 Penicillin, Rifampin, Novobiocin,

 Gentamicin,

 Ofloxacin,

 Cefotaxime,

Meropenem,

 Amoxicillin,

Tetracycline,

Trimethoprim,

 Amikacin,

 Cefazolin,

Clindamycin,

Ciprofloxacin,

 Methicillin,

 Cefoxitin, Penicillin,

[78–87]

 Rifampicin,

Norfloxacin,

 Cefepime,

Erythromycin,

Azithromycin,

Ciprofloxacin,

Chloramphenicol,

Gentamycin,

Tetracycline,

Ceftazidime,

Ciprofloxacin,

Tetracycline,

 Rifampicin,

 Ampicillin

Chloramphenicol,

 Cefoxitin,

Gentamycin,

 Imipenem,

Ceftazidime,

Tetracycline,

 Imipenem,

Chloramphenicol,

 Methicillin,

Vancomycin

Gentamycin,

Azithromycin,

[75–77]

*Scenario of Antibiotic Resistance in Developing Countries*

*DOI: http://dx.doi.org/10.5772/intechopen.94957*

Ciprofloxacin,

 Nalidixic acid,

Azithromycin,

 Bacitracin, Sulfamethoxazole

 *coli*

*Salmonella* **spp.**

*Staphylococcus*

 **spp.**


#### *Scenario of Antibiotic Resistance in Developing Countries DOI: http://dx.doi.org/10.5772/intechopen.94957*

**Country**

**176**

 **Host**

 **Bacteria** *Escherichia*

Livestock

Pet animals

Meropenem,

 Imipenem, Ertapenem

 *coli*

*Salmonella* **spp.**

*Staphylococcus*

Methicillin,

Cefotaxime,

Amoxicillin,

Cloxacillin,

Cefuroxime,

Neomycin,

Nitrofurantoin,

Oleandomycin,

Lincomycin,

Sulfadiazine,

Vancomycin

Oxacillin, Cefoxitin, Penicillin G, Cephalexin,

[53–56]

[57–60]

Ampicillin,

Gatifloxacin,

Ciprofloxacin

 Methicillin,

 Kanamycin,

Food and

Colistin, Cefotaxime,

Gentamicin,

Tetracycline,

 Amoxicillin

Ceftazidime,

food

products

Environment

 Amoxicillin, Ceftazidime,

Cefuroxime,

Ceftazidime,

Trimethoprim

Bangladesh

 Human

 Colistin, Nalidixic Acid, Cefixime, Co-

trimoxazole,

Amikacin, Imipenam,

Azithromycin,

Ceftriaxone,

Levofloxacin,

Poultry

 Ampicillin, Nalidixic acid

Tetracycline,

Trimethoprim,

 Meropenem

Meropenem,

Nitrofurantoin,

Cefuroxime,

 Cefotaxime,

Ceftazidime,

 Gentamicin,

Ciprofloxacin,

Clindamycin

 Ceftriaxone,

Azithromycin,

Nalidixic Acid, Cefixime,

Oxacillin, Gentamicin,

Tocefoxitin,

Ciprofloxacin,

Clindamycin,

 Cefotaxime,

Levofloxacin

[7]

Chloramphenicol,

 Etracylcin, Cefoxitin,

 Ceftazimid,

Meropenem,

[13, 14,

61–68]

Ciprofloxacin,

 Cefotaxime,

 Gentamicin,

Erythromycin,

Tetracycline,

Cephalosporin,

 Penicillin,

Ciprofloxacin,

 Nalidixic acid,

Chloramphenicol,

 Novobiocin,

Clindamycin,

Sulfafurazole,

Azithromycin,

 Doripenem,

Ciprofloxacin,

Erythromycin,

Streptomycin,

Furazolidone,

*Antimicrobial Resistance - A One Health Perspective*

 Ceftriaxone,

Clavulanate,

 Ampicillin,

Cephalothin,

[50, 52]

 Penicillin G, Methicillin,

Sulphadizine

 Amoxicillin

 Penicillin, Ampicillin,

 Kanamycin,

[48–51]

 **spp.**


**Country**

**179**

 **Host**

 **Bacteria** *Escherichia*

Poultry

Tetracycline,

 Ampicillin

Chloramphenicol,

Amoxicillin,

Tetracycline,

Erythromycin,

Livestock

 Cloxacillin,

 Penicillin, Teicoplanin,

Sulphadimidine,

Nalidixic acid,

Environment

Ceftazidime,

Cefotaxime,

Lipocaine, Augmentin,

Cefuroxime,

 Ampicillin,

Amoxicillin-clavulanic

Ampicillin,

Brazil

 Poultry Human Food and

food

products

**Table 1.** *Summary of antibiotic resistance scenario of three bacteria in different samples from selected developing*

 Augmentin,

 Gentamicin

 acid,

Ciprofloxacin,

Chloramphenicol,

 Cephalexin,

Ceftazidime,

Tetracycline,

 Cephalexin,

 Ceftriaxone,

Gentamycin,

Ciprofloxacin,

Lipocaine, Cefotaxime,

Augmentin,

Ofloxacin, Nitrofurantoin

Amoxicillin,

Gentamicin,

Sulfafurazole,

Spectinomycin,

Ampicillin,

 Ampicillin,

Chloramphenicol,

Tetracycline,

Sulfonamides,

Gentamicin,

 Ceftriaxone,

 *countries.*

Trimethoprim

Streptomycin,

Tetracycline,

Trimethoprim

Ciprofloxacin,

Enrofloxacin

 Ceftriaxone,

 Ceftiofur,

[135]

[136, 137]

Trimethoprim

Enrofloxacin,

Sulfonamide,

Chloramphenicol,

Tetracycline,

 Ceftiofur,

Trimethoprim,

 Ceftazidime

Ciprofloxacin,

[133, 134]

Cotrimoxazole,

Ciprofloxacin,

Cefuroxime,

 Ampicillin,

 Colistin,

 Cefotaxine,

 Cephalexin,

Ceftazidime,

 Ceftriaxone,

Tetracycline,

 Pefloxacin,

 Ofloxacillin,

Amoxycillin,

Ceftazidime,

Cephalexin,

Amoxicillin

Tetracycline,

 Lipocaine,

 Cephalexin,

 Ceftriaxone,

[126–132]

 Ampicillin, Trimethoprim

Tetracycline,

Amoxicillin,

Enrofloxacin

Cotrimoxazole,

 Nalidixic Acid

Streptomycin,

 Gentamicin,

 Cloxacillin,

 Augmentin,

 Penicillin, Ampicillin,

Nitrofurantoin,

 *coli*

*Salmonella* **spp.**

*Staphylococcus*

Penicillin, Ampicillin,

Augmentin,

Gentamicin

Erythromycin,

Amoxicillin,

Ampicillin

[124, 125]

*Scenario of Antibiotic Resistance in Developing Countries*

*DOI: http://dx.doi.org/10.5772/intechopen.94957*

 Ceftriaxone

Cefuroxime,

 Cefoxitin,

Chloramphenicol,

 Ofloxacin,

Tetracycline,

Streptomycin,

 Amoxicillin,

 Cloxacillin,

[121–123]

 **spp.**


**Table 1.** *Summary of antibiotic resistance scenario of three bacteria in different samples*

 *from selected developing*

 *countries.*
