The failure of pharmaceuticals and the power of plants: medicinal discourse as a critique of modernity in the Amazon

Chemical Composition, Enantiomeric Distribution, Antimicrobial and Antioxidant Activities of Origanum majorana L. Essential Oil from Nepal

This study was conducted to examine the chemical constituents of Origanum majorana L. essential oils (EOs) that originate in Nepal, as well as their biological activities, antioxidant properties, and enantiomeric compositions. The EOs were extracted by the hydro-distillation method using a Clevenger-type apparatus and their chemical compositions were determined through gas chromatography and mass spectrometry (GC-MS). Chiral GC-MS was used to evaluate the enantiomeric compositions of EOs. The minimum inhibitory concentrations (MICs) of the essential oils were determined by the micro-broth dilution method, and the antioxidant activity was evaluated by the 2,2-diphenyl-1-picrylhydrazyl scavenging assay and ferric-reducing antioxidant power (FRAP). GC-MS analysis showed the presence of 50 and 41 compounds in the EO samples, (S₁) and (S₂), respectively, representing the Kathmandu and Bhaktapur districts. The oxygenated monoterpenoids, along with terpinen-4-ol, were predominant constituents in both EO samples. However, the EOs from two locations showed some variations in their major components. The chiral terpenoids for two EO samples of marjoram have also been reported in this study in an elaborative way for the first time in accordance with the literature review. A hierarchical cluster analysis based on the compositions of EOs with 50 compositions reported in the literature revealed at least 5 different chemotypes of marjoram oil. The antioxidant activity for the sample (S₂) was found to be relatively moderate, with an IC₅₀ value of 225.61 ± 0.05 μg/mL and an EC₅₀ value of 372.72 ± 0.84 µg/mL, as compared to the standard used. Furthermore, with an MIC value of 78.1 µg/mL, the EO from sample (S₂) demonstrated effective antifungal activity against Aspergillus niger and Candida albicans. Moreover, both samples displayed considerable antimicrobial activity. The results suggest that EOs of Origanum majorana possess some noteworthy antimicrobial properties as well as antioxidant activity, and hence can be used as a natural preservative ingredient in the food and pharmaceutical industries.

Factors affecting the use of herbal medicines in the universal health coverage system in Indonesia

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plants play an essential role in primary healthcare practices in Indonesia, particularly in rural areas. While medicinal plants are broadly used in Indonesia, the country has made a commitment to healthcare services based on modern medicine through the provision of universal health coverage (UHC).

AIM OF THE STUDY

In the context of the UHC system in Indonesia, we explore the utilization of medicinal plants in rural West Java by examining how herbal medicine use varies with socio-economic and demographic factors and whether herbal medicine use remains important when modern healthcare becomes available.

MATERIALS AND METHODS

A total of 634 households in the two rural communities were randomly selected to participate in the survey. A semi-structured questionnaire was administered to a randomly selected adult in each household.

RESULTS

Herbal medicine use prevalence was found to be 68% (431/634). Out of 549 total respondents with perceived illness, 40% (219/549) self-medicated with herbal medicines in the last six months. A total of 102 medicinal plant species belonging to 43 families were reported, each with their local names, medicinal use, and parts used. We found that herbal medicine use was significantly associated with the area of residence, age, education level and occupation, and was not correlated to gender or health insurance possession.

CONCLUSION

Medicinal plant remains a significant aspect of healthcare for rural communities in the West Java area. The presence of healthcare services under the UHC system is not a critical determining factor for treatment-seeking and may have less impact on the pervasive practice of herbal medicine use in rural areas.

Factors affecting the use of medicinal plants by migrants from rural areas of Brazilian Northeast after moving to a metropolitan region in Southeast of Brazil

BACKGROUND

Ethnopharmacological studies about migrants reveal a dynamic process of knowledge and use of medicinal plants. In this study, we sought to elucidate quantitative and qualitatively the main factors influencing the use of medicinal plants by migrants from rural areas to an urban region in Brazil with traces of remnant natural vegetation.

METHODS

Seven Northeastern individuals who migrated to the Southeastern Region of Brazil (Bororé Peninsula, in the city of São Paulo) were selected to participate in semi-structured interviews regarding the use of medicinal plants throughout their lives, and indicated an inhabitant in their hometown that would be able to accompany the field collections in each area. Socioeconomic, educational, family structure, and use of Western medicine data were provided during interviews with the individuals from their hometowns. Plant samples cited by the interviewees were collected both at the current place of residence and in their hometowns.

RESULTS

The participants cited 131 plants and 315 recipes, being the main indications related to the gastrointestinal system, respiratory problems, and pain and inflammatory processes. We observed that most plant uses were maintained after migration. Higher percentages of maintenances and incorporations in plant uses occurred to exotic species, while replacements happen mainly to native plants. The introduction of new species into the migrants' therapeutics occurred mainly by observations of organoleptic similarities between the substituted plant and the incorporated species, conversations with neighbors, and contact with the television and print media. In addition, the public health system allowed the interviewees access to prophylactic drugs, leading to the discontinuation of certain recipes used in endemic diseases.

CONCLUSION

Migrants were exposed to information about new plants and their uses, new diseases, and socioeconomic and cultural differences that impacted their use of medicinal plants. Although migration to a more developed city facilitated access to public health and education, on the other hand, it made access to fresh medicinal plants difficult, causing some medicinal plants to be replaced or ceased to be used.

Risk Factor Assessment of Hospice Patients Readmitted within 7 Days of Acute Care Hospital Discharge

Factors surrounding readmission rates for hospice patients within seven days are still relatively unknown. The present study specifically investigates the seven-day readmission rate of patients newly discharged to hospice, and the predictive factors associated with readmission for this population. In a retrospective case-control study, we seek to identify potential predictors by comparing the characteristics of patients discharged to hospice and readmitted within one week to patients who were not readmitted. Cases (n = 46) were patients discharged to home hospice and readmitted to the hospital within seven days. Controls (n = 117) were patients discharged to home hospice and not readmitted to the hospital within seven days. Significant risk factors for readmission within seven days were found to be: age (p < 0.01), race (p < 0.001), language (p < 0.001), and insurance (p < 0.001). Further study of these predictors may identify opportunities for interventions that address patient and family concerns that may lead to readmission.

Medical pluralism and livestock health: ethnomedical and biomedical veterinary knowledge among East African agropastoralists

BACKGROUND

Human and animal health are deeply intertwined in livestock dependent areas. Livestock health contributes to food security and can influence human health through the transmission of zoonotic diseases. In low-income countries diagnosis and treatment of livestock diseases is often carried out by household members who draw upon both ethnoveterinary medicine (EVM) and contemporary veterinary biomedicine (VB). Expertise in these knowledge bases, along with their coexistence, informs treatment and thus ultimately impacts animal and human health. The aim of the current study was to determine how socio-cultural and ecological differences within and between two livestock-keeping populations, the Maasai of northern Tanzania and Koore of southwest Ethiopia, impact expertise in EVM and VB and coexistence of the two knowledge bases.

METHODS

An ethnoveterinary research project was conducted to examine dimensions of EVM and VB knowledge among the Maasai (N = 142 households) and the Koore (N = 100). Cultural consensus methods were used to quantify expertise and the level of agreement on EVM and VB knowledge. Ordinary least squares regression was used to model patterns of expertise and consensus across groups and to examine associations between knowledge and demographic/sociocultural attributes.

RESULTS

Maasai and Koore informants displayed high consensus on EVM but only the Koore displayed consensus on VB knowledge. EVM expertise in the Koore varied across gender, herd size, and level of VB expertise. EVM expertise was highest in the Maasai but was only associated with age. The only factor associated with VB expertise was EVM expertise in the Koore.

CONCLUSIONS

Variation in consensus and the correlates of expertise across the Maassi and the Koore are likely related to differences in the cultural transmission of EVM and VB knowledge. Transmission dynamics are established by the integration of livestock within the socioecological systems of the Maasai and Koore and culture historical experiences with livestock disease. Consideration of the nature and coexistence of EVM and VB provides insight into the capacity of groups to cope with disease outbreaks, pharmaceutical use patterns, and the development of community health interventions.

Treating infants with frigg: linking disease aetiologies, medicinal plant use and care-seeking behaviour in southern Morocco

BACKGROUND

Although most Moroccans rely to some extent on traditional medicine, the practice of frigg to treat paediatric ailments by elderly women traditional healers known as ferraggat, has not yet been documented. We describe the role of these specialist healers, document the medicinal plants they use, and evaluate how and why their practice is changing.

METHODS

Ethnomedicinal and ethnobotanical data were collected using semi-structured interviews and observations of medical encounters. Information was collected from traditional healers, namely ferraggat, patients, herbalists and public health professionals. Patients' and healers' narratives about traditional medicine were analysed and medicinal plant lists were compiled from healers and herbalists. Plants used were collected, vouchered and deposited in herbaria.

RESULTS

Ferragat remain a key health resource to treat infant ailments in the rural High Atlas, because mothers believe only they can treat what are perceived to be illnesses with a supernatural cause. Ferragat possess baraka, or the gift of healing, and treat mainly three folk ailments, taqait, taumist and iqdi, which present symptoms similar to those of ear infections, tonsillitis and gastroenteritis. Seventy plant species were used to treat these ailments, but the emphasis on plants may be a recent substitute for treatments that used primarily wool and blood. This change in materia medica is a shift in the objects of cultural meaningfulness in response to the increasing influence of orthodox Islam and state-sponsored modernisation, including public healthcare and schooling.

CONCLUSIONS

Religious and other sociocultural changes are impacting the ways in which ferraggat practice. Treatments based on no-longer accepted symbolic elements have been readily abandoned and substituted by licit remedies, namely medicinal plants, which play a legitimisation role for the practice of frigg. However, beliefs in supernatural ailment aetiologies, as well as lack or difficult access to biomedical alternatives, still underlie the need for specialist traditional healers.

Patient Assessment of Effectiveness and Satisfaction With Traditional Medicine, Globalized Complementary and Alternative Medicines, and Allopathic Medicines for Cancer in Pakistan

Background: Virtually no research has been conducted on patient assessments of traditional medicines and allopathic medicines for cancer care in poorer countries marked by pluralistic medical environments. Pakistan represents an excellent case for such a study because of the coexistence of culturally and historically specific indigenous traditional medicine, the strong presence of allopathic medicine, and, to a lesser extent, the availability of some globalized complementary and alternative medicines. Aim:To gain a preliminary understanding of cancer patients' perceptions of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicine, and allopathy in the context of a pluralistic medical environment. Study Design:Structured survey of 362 cancer patients, from diverse regions in the Punjab province and Northwest Frontier province, who were being treated in 4 different hospitals in Lahore, Pakistan. Results:Use of traditional medicine remains high among cancer patients, with traditional healers used by the majority of those surveyed. Although patients’ perceptions of the overall effectiveness of traditional medicines for treating cancer are low, those patients who do use traditional medicines still have high levels of satisfaction with these modalities. This is distinct from levels of satisfaction with, and perceptions of effectiveness of, Western cancer treatments, which were synonymous in this group of patients. Important differences in patient perceptions were found within groups (eg, between different forms of traditional healers) as well as between them. Conclusion: This study showed considerable support for complementary and alternative medicine/traditional medicine but also significant variation in usage of and perceptions of local traditional medicines. More research needs to be done to explore the social processes underlying this variation in cancer patients’ preferences for particular traditional medicines.

An ethnomedicinal survey of a Tashelhit-speaking community in the High Atlas, Morocco

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional knowledge about medicinal plants from a poorly studied region, the High Atlas in Morocco, is reported here for the first time; this permits consideration of efficacy and safety of current practises whilst highlighting species previously not known to have traditional medicinal use.

AIM OF THE STUDY

Our study aims to document local medicinal plant knowledge among Tashelhit speaking communities through ethnobotanical survey, identifying preferred species and new medicinal plant citations and illuminating the relationship between emic and etic ailment classifications.

MATERIALS AND METHODS

Ethnobotanical data were collected using standard methods and with prior informed consent obtained before all interactions, data were characterized using descriptive indices and medicinal plants and healing strategies relevant to local livelihoods were identified.

RESULTS

151 vernacular names corresponding to 159 botanical species were found to be used to treat 36 folk ailments grouped in 14 biomedical use categories. Thirty-five (22%) are new medicinal plant records in Morocco, and 26 described as used for the first time anywhere. Fidelity levels (FL) revealed low specificity in plant use, particularly for the most commonly reported plants. Most plants are used in mixtures. Plant use is driven by local concepts of disease, including "hot" and "cold" classification and beliefs in supernatural forces.

CONCLUSION

Local medicinal plant knowledge is rich in the High Atlas, where local populations still rely on medicinal plants for healthcare. We found experimental evidence of safe and effective use of medicinal plants in the High Atlas; but we highlight the use of eight poisonous species.

Migrant care workers and rehospitalization among older patients discharged from acute care hospitals

AIM

The relationship between support at home and rehospitalization has not been extensively studied until now. In particular, little is known about the impact of being assisted by migrant care workers (MCW) and rehospitalization. We aimed at investigating such a relationship in a population of older patients discharged from hospitals.

METHODS

Our series consisted of 506 patients aged 65 years or older consecutively enrolled in a prospective observational study involving 11 acute care medical wards throughout Italy. The outcome of the study was the occurrence of at least one rehospitalization during 1-year follow up. Information derived from comprehensive geriatric assessment, discharge diagnoses and prescribed drugs were collected during the index hospitalization. Data about formal and informal assistance (spouse, son, other relative, MCW, home nursing) were collected. The relationship between study variables and rehospitalization was assessed using logistic regression.

RESULTS

Being assisted by MCW was independently associated with the outcome (OR 2.04, 95% CI 1.10-4.37), as were complete dependency (OR 2.49, 95% CI 1.28-5.79) and overall comorbidity (OR 1.23, 95% CI 1.10-1.43). Older age was associated with a lower likelihood of rehospitalization (age 75-84 vs <75 years OR 0.51, 95% CI 0.30-0.92; age≥85 vs <75 years OR 0.30, 95% CI 0.12-0.65).

CONCLUSIONS

Being assisted by MCW could contribute to an increase in the rate of use of hospital resources for older complex patients. This finding raises the need for educational efforts targeting MCW.

Length of residence, age and patterns of medicinal plant knowledge and use among women in the urban Amazon

BACKGROUND

This paper explores patterns of women's medicinal plant knowledge and use in an urban area of the Brazilian Amazon. Specifically, this paper examines the relationship between a woman's age and her use and knowledge of medicinal plants. It also examines whether length of residence in three different areas of the Amazon is correlated with a woman's use and knowledge of medicinal plants. Two of the areas where respondents may have resided, the jungle/seringal and farms/colonias, are classified as rural. The third area (which all of the respondents resided in) was urban.

METHODS

This paper utilizes survey data collected in Rio Branco, Brazil. Researchers administered the survey to 153 households in the community of Bairro da Luz (a pseudonym). The survey collected data on phytotherapeutic knowledge, general phytotherapeutic practice, recent phytotherapeutic practice and demographic information on age and length of residence in the seringal, on a colonia, and in a city. Bivariate correlation coefficients were calculated to assess the inter-relationships among the key variables. Three dependent variables, two measuring general phytotherapeutic practice and one measuring phytotherapeutic knowledge were regressed on the demographic factors.

RESULTS

The results demonstrate a relationship between a woman's age and medicinal plant use, but not between age and plant knowledge. Additionally, length of residence in an urban area and on a colonia/farm are not related to medicinal plant knowledge or use. However, length of residence in the seringal/jungle is positively correlated with both medicinal plant knowledge and use.

CONCLUSIONS

The results reveal a vibrant tradition of medicinal plant use in Bairro da Luz. They also indicate that when it comes to place of residence and phytotherapy the meaningful distinction is not rural versus urban, it is seringal versus other locations. Finally, the results suggest that phytotherapeutic knowledge and use should be measured separately since one may not be an accurate proxy for the other.

Triggers, symptoms, and treatment in two populations of migraneurs in Brazil and Spain. A cross-cultural study

BACKGROUND AND AIM

Cultural variation in pain and headache presentation may exist. The objective of this study was to assess cross-cultural differences in the use of drugs commonly managed to treat and prevent migraine, and to analyze the awareness about symptoms and triggers between two populations of migraneurs in Brazil and Spain.

METHODS

International cross-cultural study. Patients answered a socio-demographic questionnaire that included questions about trigger factors, and use of drugs to treat and prevent migraine attacks.

RESULTS

292 patients (mean age 34.6 years; 80% females) were included in the study. Most common identified triggers in Brazilian and Spanish patients were: food (30.5% vs 12.6%), sleep (56.7% vs 28.5%), odors (52.5% vs 9.3%), stress (73.1% vs 46.4%), and menstrual period (55.6% vs 38.1%), all p<0.01. Analgesics and anti-inflammatory drugs were the most commonly used drugs to treat migraine attacks. Brazilian migraneurs used less commonly triptans (16.3% vs 47%; p<0.0001). Prophylactic drugs were used less frequently in Brazil than in Spain (21.9% vs 52.9%; p<0.0001). Calcium-antagonists, tricyclic anti-depressives, beta-blockers, and anti-epileptic drugs were significantly more used in Spanish migraineurs (p<0.01).

CONCLUSIONS

Brazilians migraneurs are more often undertreated for migraine, and underutilization of triptans and preventatives was observed.

Medicinal Plants Used in Mapuche Traditional Medicine in Araucanía, Chile: Linking Sociocultural and Religious Values with Local Heath Practices

The vast majority of the medicinal plants in Chile have been studied from a pharmacological point of view. These studies, although giving important insights into the understanding of the Mapuche’s traditional medicine in terms of the therapeutical value of the plants, fail, however, to portray the numerous sociocultural and symbolic aspects of this form of medicine. This article aims to overcome this shortcoming by analyzing the sociocultural and religious values of medicinal plants among the Mapuche’s rural communities in Araucanía, Chile, as well as their role in traditional medicine. The methods utilized combined participant observation with individual interviews with local shamans (machi) and villagers. Data from free-list interviews and conversations with research participants were used to develop a series of semi-structured interview questions on knowledge of herbal medicines and plants. Data show that the therapeutic efficacy of Mapuche medicine is not only based on ‘‘active agents’’ but is also related to the symbolic and religious meaning attributed to the treatments by healers and patients. The article concludes that in order to fully understand the therapeutic efficacy of the plants, it is thus necessary to comprehend the sociocultural context in which they are used.

Regimen complexity and medication nonadherence in elderly patients

Objective:

To assess whether the number of daily administrations of individual drugs, as a measure of regimen complexity, contributes to the profile of an elderly patient who adheres poorly to the prescribed therapy.

Population:

Six hundred ninety patients over 64 years who were consecutively admitted to 11 acute medical care and three long term/rehabilitation wards in Italy.

Main outcome measure:

Self-reported adherence to drugs taken at home before admission was measured by a single question assessment for each listed drug supplemented with a latter question about the circumstances of the missed administration. For cognitively impaired patients the question was put to patients’ relatives or caregivers.

Methods:

A structured multidimensional assessment was performed to identify nonadherence and its potential correlates. Correlates of nonadherence were identified by multivariable logistic regression.

Results:

We recorded 44 cases (6.4%) of nonadherence to at least one drug. Being assisted by foreign caregivers (OR 2.17; 95% CI 1.02–4.63) and the use of at least one multiple daily dosing drug (OR 2.99; 95% CI 1.24–7.17) were significant independent correlates of medication nonadherence, while age, selected indexes of frailty and the cumulative number of prescribed drugs were not.

Conclusion:

Regimen complexity and type of assistance are independent correlates of medication nonadherence.

How scientific is the science in ethnopharmacology? Historical perspectives and epistemological problems

This commentary is based on a general concern regarding the low level of self-criticism (-evaluation) in the interpretation of molecular pharmacological data published in ethnopharmacology-related journals. Reports on potentially new lead structures or pharmacological effects of medicinal plant extracts are mushrooming. At the same time, nonsense in bioassays is an increasing phenomenon in herbal medicine research. Only because a dataset is reproducible does not imply that it is meaningful. Currently, there are thousands of claims of pharmacological effects of medicinal plants and natural products. It is argued that claims to knowledge in ethnopharmacology, as in the exact sciences, should be rationally criticized if they have empirical content as it is the case with biochemical and pharmacological analyses. Here the major problem is the misemployment of the concentration-effect paradigm and the overinterpretation of data obtained in vitro. Given the almost exponential increase of scientific papers published it may be the moment to adapt to a falsificationist methodology.

Modernization and medicinal plant knowledge in a Caribbean horticultural village

Herbal medicine is the first response to illness in rural Dominica. Every adult knows several "bush" medicines, and knowledge varies from person to person. Anthropological convention suggests that modernization generally weakens traditional knowledge. We examine the effects of commercial occupation, consumerism, education, parenthood, age, and gender on the number of medicinal plants freelisted by individuals. All six predictors are associated with bush medical knowledge in bivariate analyses. Contrary to predictions, commercial occupation and consumerism are positively associated with herbal knowledge. Gender, age, occupation, and education are significant predictors in multivariate analysis. Women tend to recall more plants than do men. Education is negatively associated with plants listed; age positively associates with number of species listed. There are significant interactions among commercial occupation, education, age, and parenthood, suggesting that modernization has complex effects on knowledge of traditional medicine in Dominica.

An anthropological study about headache and migraine in native cultures from Central and South America

OBJECTIVE

To describe the ritual and ethnobotanical treatments about migraine performed by shamans from several native cultures.

METHODS

Anthropological field study conducted with Tzeltal Maya (Mexico), Kamayurá (Brazil), and Uru-Chipaya (Bolivia) American Indians.

RESULTS

Migraine is called yaxti-wanjol chawaj by Tzeltal shamans. They wash the head of the patient with an herbal solution to treat headache. The boiled leaves of a shrub called payté wamal (Tagetes nelsonii) are used to relieve migraine. Migraine is called monkey's disease by Kamayurá natives. The disease is originated by the revenge of the killed monkey's spirit, striking to Kamayurá hunter on his head. It is treated with an herbal infusion applied in the eyes of the patient. Migraine is called eskeclamix by Chipaya people, and is treated by drinking the cañahua plant (Chenopodium palludicale) boiled with water. The patient's head may also be washed with shaman's fermented urine.

CONCLUSIONS

Cultural equivalents of migraine exist in the healing system of isolated American cultures.

Mexican migrant ethnopharmacology: pharmacopoeia, classification of medicines and explanations of efficacy

This paper describes the ethnopharmacological knowledge of women in an urban Mexican migrant community in Athens, GA, USA. Data were collected using free-list, pile-sort and semi-structured interviews. The pharmacopoeia of this community includes herbal remedies, over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and prescription medicines. Multi-dimensional scaling analysis of pile-sort data revealed that Mexican women living in Athens classify medicines into four categories: herbal remedies, salves, pastillas (pills-both prescription and non-prescription) and other commercial preparations. Herbal remedies are viewed as natural and safe while pastillas are thought to be dangerous and potentially addictive. Comparisons of Mexican explanations for the actions of five medicines (Matricaria recutita L. [Asteraceae], Mentha spp. L. [Lamiaceae], Ruta spp. L. [Rutaceae], Ocimum basilicum L. [Lamiaceae] and paracetemol) with the pharmacological literature show several similarities and confirm that migrant women use these medicines effectively. Mexican migrant women use medicinal plants in combination with commercially produced medicines, but most have a strong preference for the herbal remedies that they make themselves, over drugs prescribed by physicians. Some of their descriptions of the actions of medicines are supported by the pharmacological literature, but ethnopharmacologists have not fully investigated all of the attributes that migrant women ascribe to them.

Antimicrobial resistance in developing countries. Part II: strategies for containment

The growing threat from resistant organisms calls for concerted action to prevent the emergence of new resistant strains and the spread of existing ones. Developing countries have experienced unfavourable trends in resistance-as detailed in part I, published last month--and implementation of many of the containment strategies recommended by WHO is complicated by universal, as well as developing country-specific, factors. The control of selective pressure for resistance could potentially be addressed through educational and other interventions for orthodox and unorthodox prescribers, distributors, and consumers of antimicrobials. At national levels, the implementation of drug use strategies--eg, combination therapy or cycling--may prove useful to lengthen the lifespan of existing and future agents. Programmes such as the Integrated Management of Childhood Illnesses (IMCI) and directly observed short-course therapy (DOTS) for tuberculosis are prescriber-focused and patient-focused, respectively, and have both been shown to positively influence factors that contribute to the selective pressure that affects resistance. The institution of interventions to prevent the transmission of infectious diseases could also lead to beneficial effects on the prevalence of resistance, as has vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae. There has been an upsurge in the number of organisations and programmes that directly address issues of resistance, and collaboration could be one way to stem the dire trend. Additional factors such as unregulated drug availability, inadequate antimicrobial drug quality assurance, inadequate surveillance, and cultures of antimicrobial abuse must be addressed to permit a holistic strategy for resistance control.