GoKawiilStreet vendors sell medicines at a market in Abobo, Côte d’Ivoire. Credit: Issouf Sanogo/AFP via Getty
At Ghana’s biggest hospital, even the strongest antibiotics are starting to fail. A big part of the reason is the rampant overprescription and overuse of these drugs in the West African country of 35 million people.
Because many Ghanaians lack access to physicians, those who fall ill often end up buying antibiotics from unauthorized sellers instead. “We have people who go around carrying all sorts of things, who would mix them as concoctions and give them to patients who have no clue what is going on,” explains Antoinette Bediako-Bowan, a surgeon at the Korle Bu Teaching Hospital in Accra. By the time a person presents at the hospital, “they really have taken quite a number of antibiotics”, Bediako-Bowan says. Such liberal use of the drugs gives bacteria the opportunity to adapt, driving resistance.
Nature Outlook: Antimicrobial resistance
The World Health Organization (WHO) divides antibiotics into three categories under its Access, Watch and Reserve (AWaRe) system. Access antibiotics are used against common infections, watch antibiotics can fight a wider range of bacteria and reserve antibiotics are held back for the most dangerous pathogens.
Bediako-Bowan says that in the hospital where she works, around 60% of patients have infections that can resist common access antibiotics, such as penicillins and first-generation cephalosporins. More worryingly, she says, around 4% of these are resistant to carbapenems, which are on the watch and reserve lists. Carbapenems are often the strongest option available in Bediako-Bowan’s hospital, so “even a small percentage is a big thing”.
In 2023, according to the WHO, one in six laboratory-confirmed bacterial infections worldwide were caused by bacteria that are resistant to antibiotics1. The burden of antibiotic resistance is highest in low- and middle-income countries (LMICs), and growing rapidly. Between 2018 and 2023, resistance to imipenem — a carbapenem antibiotic — in Acinetobacter bacteria grew faster in the eastern Mediterranean and in southeast Asia than it did anywhere else. These Gram-negative bacteria (a typing that also applies to other stubborn foes such as Escherichia coli and Klebsiella pneumoniae) are a common cause of hospital-acquired bloodstream infections.
“When resistance to carbapenems is encountered, treatment options for Gram-negative bacterial pathogens are often limited to antibiotics in the AWaRe reserve group, which are frequently unaffordable, more toxic, inconsistently available and require diagnostic confirmation that is rarely feasible in resource-limited settings,” says Silvia Bertagnolio, head of the WHO’s antimicrobial resistance surveillance, evidence and laboratory strengthening unit in Geneva, Switzerland.
Deaths attributable to antimicrobial resistance occur around the world (see ‘A global threat’). But they are close to twice as common in West Africa, at around 20 per 100,000 people, as they are in high-income countries of North America and Europe, according to data from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.
Source: Inst. for Health Metrics and Evaluation
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