Chronic Exposure and the Risk of Building Antibiotic Resistance in Rural Communities of the Developing World

Antibiotic resistance is a global issue, not least the question if resistance is intrinsic, acquired, or adaptive. The current scenario demands investigations to detect resistance in environments from the urban/rural nexus. The complexity of antibiotic resistance in the environment is linked with the characteristics of recipient compartments in various environmental systems. Much research focuses on resistance in point sources (hotspots) of exposure, but after release the risk of antibiotics affecting humans is quite complex. Dispersion, dilution, and concentration reduction are part of the natural cycle required to examine the fate of antibiotics in the environment. Antibiotic residues at any stage threaten public health no matter if they cause acute exposure or because of much lower concentrations persisting in sediments, soils, irrigation waters, groundwater, aerosols, and produce where they may reflect chronic exposure. In either case, human exposure is undeniable with differential impact. In view of local constraints and unintended feedback we propose a research agenda to enhance understanding the future of exposure intensity and the fate and synergistic effect of antibiotics released into the environment in developing resistance. We advocate the need to investigate sub-lethal antibiotic concentrations and human populations aimed at limiting the acute and chronic public exposure to antibiotic residues and resistant microbes from soil and water among occupational groups and rural population inhabiting resource-limited settings.

Keywords: Epidemiology; Toxicity; Antibiotic reservoirs; Residue persistence