Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies

Abstract

The emergence of antibiotic-resistant pathogens has threatened not only our ability to deal with common infectious diseases but also the management of life-threatening complications. Antimicrobial resistance (AMR) remains a significant threat in both industrialized and developing countries alike. In Africa, though, poor clinical care, indiscriminate antibiotic use, lack of robust AMR surveillance programs, lack of proper regulations and the burden of communicable diseases are factors aggravating the problem of AMR. In order to effectively address the challenge of AMR, antimicrobial stewardship programs, solid AMR surveillance systems to monitor the trend of resistance, as well as robust, affordable and rapid diagnostic tools which generate data that informs decision-making, have been demonstrated to be effective. However, we have identified a significant knowledge gap in the area of the application of fast and affordable diagnostic tools, surveillance, and stewardship programs in Africa. Therefore, we set out to provide up-to-date information in these areas. We discussed available hospital-based stewardship initiatives in addition to the role of governmental and non-governmental organizations. Finally, we have reviewed the application of various phenotypic and molecular AMR detection tools in both research and routine laboratory settings in Africa, deployment challenges and the efficiency of these methods.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…However, there can be concerns instigating ASPs, with issues of resources, manpower, and knowledge among key stakeholders especially among low- and middle-income countries (LMICs) including African countries ( Box S1—Supplementary Material ) [ 128 , 129 , 130 , 131 ]. This though is also starting to change among African countries as well as among other LMICs [ 111 , 132 , 133 , 134 , 135 , 136 , 137 ]. We are likely to see more ASPs being instigated across Africa and beyond as part of NAPs to reduce AMR, enhanced by the availability of toolkits from the WHO and others [ 67 , 70 , 132 , 137 , 138 , 139 , 140 ].…”

The dawn of repurposing vitamins as potential novel antimicrobial agents: A call for global emergency response amidst AMR crisis

“…Amidst a global AMR, efforts have been set to increase public awareness on effects of irrational use of antimicrobial agents, improve surveillance, infection prevention strategies and increase research for new antimicrobial agents 70 . However, the discovery of new antimicrobial agents has been less successful, whilst infectious diseases claim millions of lives each year 71 .…”

“…Amidst a global AMR, efforts have been set to increase public awareness on effects of irrational use of antimicrobial agents, improve surveillance, infection prevention strategies and increase research for new antimicrobial agents. 70 However, the discovery of new antimicrobial agents has been less successful, whilst infectious diseases claim millions of lives each year. 71 It is time that nutritive vitamins to be repositioned and be utilized as antimicrobial agents due to presence of promising epigenetic findings in combating infectious diseases, ability to improve the host immune response and attacking the pathogens.…”

Antibiotic resistance and the COVID‐19 pandemic: A dual crisis with complex challenges in LMICs

“…To optimize antibiotic use, focused efforts must be placed on reducing unnecessary prescriptions, enhancing monitoring mechanisms for antibiotic usage, and aligning practices with WHO's Global Action Plan on Antimicrobial Resistance. The antibiotic stewardship programs must be strengthened 17 . To accomplish this, it is vital to build mechanisms for monitoring and analyzing antibiotic usage, develop robust antibiotic policies and guidelines, and educate healthcare professionals on proper antibiotic use, considering specific challenges and existing resources within LMICs.…”

“…The escalating prevalence of AMR in LMICs is deeply concerning. A significant contributor to this issue is the scarcity of robust antimicrobial stewardship programs (ASPs) in these regions 17 . Without effective ASPs, the misuse and overuse of antibiotics become more prevalent, leading to increased resistance.…”