Acquired resistance and prescription of antibiotics in Africa: a critical assessment.

Antibiotics are among the most frequently used drugs in Africa. This abusive utilisation is not without consequence, and several studies have examined the increase in drug resistance in Africa. certain drug resistance rates are similar to those in industrialised countries. However, it is very difficult to obtain a precise and overall view of the degree of resistance in this continent. The present study questions whether it is possible to establish a comparison between in vitro results and drug prescriptions, and thereby determine an improved therapeutic strategy that is better adapted to this complex situation. The authors emphasise the importance of the latter and suggest that multicentric studies and a more realistic assessment of the situation in the country and the means available could be of assistance. They note that the prescription of antibiotics does not take into account the information obtained via in vitro studies. Etiological diagnosis of infectious diseases is not made as the infrastructure is not available, both as regards laboratories and also because physicians do not consider it necessary to provide a medical report of infections. The official recommendations given in the context of WHO programmes are frequently not adapted to the local situation in Africa. There is an excessive use of certain drugs, which are not always the most suitable. The cost/efficacy ratio is also not sufficiently considered. Primary antibiotic therapy does not take into account the existence of hospital infections. Nosocomial infections are rarely reported. Moreover; new molecules, such as the third-generation cephalosporins, are more expensive and therefore less available to patients. Multicentric studies between countries are advocated to better adapt therapeutic strategy to local conditions, as is a standardisation of study and laboratory methods for improved treatment and monitoring of multiresistant strains. (C) 2000 Editions scientifiques et medicales Elsevier SAS.