Table 1.

Factors and stakeholders contributing to the problem of antimicrobial resistance

Factors	Contribution	Example
Poor drug quality	Sales of counterfeit, adulterated and poor quality antibiotics	These poor quality antibiotics can produce sub-inhibitory concentration in vivo, which increases the selection of resistant strains
Regulators	While most developed countries have developed AMR action plans, this is still lacking in many developing countries especially in Africa	Most countries lack the resources to enforce policies regarding the manufacture and distribution of sub-standard drugs
Prescribers	Excessive clinical use and misuse is partially responsible for increase rate of resistance	Variation in prescription practice among health care provider. Sometimes there is prescription of a wrong drug, wrong doses, or antimicrobial not necessary at all
Dispensers	Drug vendors usually have little or no knowledge of the required dosage regimen, indication, or contraindications	Medications are usually purchased in small aliquots from roadside stall and storage and distribution is usually done under inadequate conditions
Users (patients)	High rate of self- medication and lack of treatment compliance	Patients fail to adhere to dosage regimens and discontinue treatment when symptoms subside before pathogen is eliminated
Animal industry	The use of antimicrobial drugs in agriculture or industrial settings, exerts a selection pressure which can favor the survival of resistant strains (or genes) over susceptible ones, leading to a relative increase in resistant bacteria within microbial communities	Resistant bacteria in animals can be transferred to humans through the consumption of food or through direct contact with food-producing animals or through environmental spread