In low-income countries, the issue of antibiotic overuse is complicated by that many patients lack access to antibiotics even when they really need them. Nathalie Arnqvist studies Global Health at Uppsala University and is writing her master thesis in collaboration with the Foundation to Prevent Antibiotic Resistance, and her topic is pneumonia among children in Kenya.

In rich countries we are most familiar with the narrative of antibiotics as a story of excess, where we use too much antibiotics for minor conditions and thereby cause resistance. Yet while the consequences of excess are expected to cause millions of deaths in future patients, today more people die from not having access to antibiotics than from infections that have become resistant to them. It may appear to be two separate problems, but they are closely connected.

Ensuring access to antibiotics to everyone who needs it while restricting use for everyone else requires a strong and well-functioning healthcare system. A study from 2014 interviewed stakeholders in the health systems of various low- and middle-income countries, and illustrates how antibiotic stewardship in these settings becomes a difficult trade-off between present and future patients. When antibiotics are easily available to buy without prescription, this results in misuse and overuse and causes rapid development of resistant infections. On the other hand, stewardship measures modelled on high-income countries where antibiotics require a physician’s prescription may result in many patients having no access to antibiotics at all. In many rural areas there might not be any physician who could prescribe. When there is a licensed prescriber, it may still be the case that not all patients are able to afford getting the prescription – even if they could afford buying the drug itself. 

Nathalie Arnqvist is writing her master thesis in Global Health at Uppsala University on pneumonia among children in Kenya. Pneumonia is one of the most common causes of death among children under five, and most of the cases could be treated with antibiotics if they were accessible.