Antibiotic resistance in the tropics. Epidemiology and surveillance of antimicrobial resistance in the tropics.

Antimicrobial resistance is threatening to undermine many of the health care improvements achieved in the tropics in the past 2 decades. While only limited data are available, there is evidence from most tropical areas of the spread of resistant bacterial strains in diseases from typhoid and bacillary dysentery to tuberculosis and, as in industrialized countries, multiply resistant hospital pathogens including methicillin-resistant Staphylococcus aureus (MRSA). Attempts to control the spread of resistant bacteria are limited by the lack of surveillance data at both the local and international level. For effective surveillance programmes to be implemented, the strengthening of laboratory services at district and national level, with a long-term commitment to resources, training and quality control, is essential.