Resistance to antibiotics in northern Nigeria: what the public should know

Antimicrobial resistance – the ability of microorganisms to resist drugs that have been developed to control them – is a severe problem in African countries. The continent has the highest global burden of antimicrobial-resistant infections, with 114.8 deaths per 100,000 people.

One of the causes of resistance is inappropriate use of antibiotics. Using the wrong antibiotic to treat an infection allows resistant bacteria to spread. It’s challenging to address the resistance problem when there are gaps in three areas:

• access to effective antimicrobial agents
• laboratory capacity to identify the source of infections
• funding to carry out planned solutions.

Identifying the type of infection present is essential so that the right antimicrobial agent can be selected. Treatment guidelines stress the importance of using laboratory data to guide treatment. Physicians need laboratory data to choose the right antibiotic, at the right dose, for the right period. This is known as antimicrobial stewardship.

But in low- and middle-income countries, hospital budgets don’t include much funding for laboratories. Laboratory data to create local treatment guidelines for doctors are scarce. Treatment choices become “empiric” – the doctor’s best guess based on the patient’s signs and symptoms and the doctor’s experience. This can lead to choosing ineffective antibiotics, which can lead to increases in resistant bacteria.

We have noted how the lack of laboratory data hinders the effective treatment of patients with infections. We have also observed that the cost of producing quality laboratory data is high and rising.

Four points are important for the public to note.

• First, similar multidrug-resistant strains of bacteria have been detected in the United States, Europe, Asia and Australia. This is a global issue.

• Second, the data could have been much worse. We did identify antibiotics that are still effective even against the most resistant bacterial strains we studied.

• Third, there are efforts in place in Nigeria and other African countries to limit the spread of resistant microorganisms.

• Fourth, there are things that everyone can do to help bring antibiotic resistance under control. For example, the US Centers for Disease Control and Prevention list five things that everyone should know about drug resistance and 10 activities to protect yourself and your family against resistance.

This is a global battle that we need to win.