Antibiotic resistance is the reason a drug that works at home can fail on the ward you are about to join. WHO reported that about one in six laboratory-confirmed bacterial infections worldwide were resistant to antibiotic treatment in 2023, and in its South-East Asia and Eastern Mediterranean Regions the share was closer to one in three. Sri Lanka, Nepal and Indonesia all sit inside that South-East Asia Region. So antibiotic resistance is not background reading for your elective. It is the clinical setting you will be standing in.
Antibiotic resistance is what happens when bacteria change so that the antibiotics designed to kill them no longer work. The patient is not resistant. The bug is. The practical consequence is that a standard first-choice drug fails, and treatment moves to something that costs more, takes longer, and carries more side effects.
WHO's antimicrobial resistance fact sheet, updated on 16 July 2026, estimates that bacterial antimicrobial resistance was associated with more than 4.7 million deaths globally in 2021. It also puts the projected cost of treating resistant bacterial infections at US$ 412 billion a year up to 2035, with a further US$ 443 billion a year in lost productivity.
Three things follow for you as a visiting student. Empirical prescribing on your host ward will not look like the algorithm in your textbook. Your own risk changes if you get sick, cut yourself, or take a needlestick. And a small number of travellers carry resistant organisms home in their gut without ever feeling unwell.
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Worse than in most of Europe, and the data says so plainly. WHO's Global Antibiotic Resistance Surveillance System pulled together figures from 104 countries for 2023, up from 25 countries in 2016. Nearly half of the world's countries, 48%, still reported nothing at all.
| Destination | WHO region | Reported bacterial infections that were resistant, 2023 |
|---|---|---|
| Sri Lanka | South-East Asia | about 1 in 3 |
| Nepal | South-East Asia | about 1 in 3 |
| Bali, Indonesia | South-East Asia | about 1 in 3 |
| Zanzibar, United Republic of Tanzania | Africa | about 1 in 5 |
Read that table carefully. Those are regional figures published by WHO, not national ones, and they describe laboratory-confirmed isolates reported by the labs that take part in surveillance. Hospital labs are over-represented in that pool, so the figures say more about sick inpatients than about everybody with a sore throat. Use them as an order of magnitude, not as a number for one hospital.
The trend line is the part that should hold your attention. Across 2018 to 2023, antibiotic resistance increased in more than 40% of the pathogen and antibiotic combinations WHO tracks, at an average of 5% to 15% a year. Nothing about that curve suggests your elective in 2027 will be easier than one in 2023.
Mostly, it looks like broad-spectrum antibiotics started early and rarely narrowed. A culture takes two or three days and may cost the family money, while the patient in front of you needs a decision now. So the broad-spectrum drug goes up, and nobody ever finds out whether the narrow one would have done.
| Pathogen | Antibiotic group | Global resistance reported for 2023 |
|---|---|---|
| Escherichia coli | third-generation cephalosporins | more than 40% |
| Klebsiella pneumoniae | third-generation cephalosporins | over 55%, and above 70% in the WHO African Region |
| Both of the above | carbapenems and fluoroquinolones | rising; WHO calls carbapenem resistance "once rare" and now "becoming more frequent" |
WHO names the drivers plainly: inappropriate use of antibiotics, poor access to clean water, sanitation and hygiene, weak infection prevention and control in homes, health facilities and farms, limited access to vaccines, diagnostics and medicines, and thin enforcement of the law on who may sell what. Read that list again and you will notice how little of it is any individual clinician's fault. That matters for how you behave as a guest, which we come back to below.
WHO sorts antibiotics into three groups under its AWaRe classification: Access, Watch and Reserve. Access antibiotics are the ones recommended as first-choice treatment for most common infections. Watch antibiotics carry a higher risk of driving resistance. Reserve antibiotics are the last-resort options you want still working in ten years.
Learn the three groups before you fly and you will read a drug chart very differently. In 2022, Access antibiotics made up only about 53% of global human antibiotic use, and Watch antibiotics roughly 45%. The global target is for at least 70% of use to come from the Access group by 2030.
Boringly, and every single time. WHO's first global report on infection prevention and control, published on 6 May 2022, found that out of every 100 patients in acute-care hospitals, 7 in high-income countries and 15 in low- and middle-income countries pick up at least one health care associated infection during their stay. On average 1 in every 10 of those patients dies. Hand hygiene is not a poster on a wall. It is the intervention.
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Six weeks is a sensible minimum for the paperwork and the jabs. Work through these in order.
Not sure what your host hospital's lab can actually do? We place students at the same partner hospitals every year and we know which ones run their own microbiology. Book a free consultation and ask us before you commit to a ward.
Sometimes, and usually without symptoms. The US CDC's Yellow Book 2024 reports a study of 412 US international travellers in which about 5% acquired bacteria carrying the mobile colistin resistance gene. In the same study, fewer than 1% of travellers to South and Southeast Asia who had no health care exposure picked up carbapenemase-producing Enterobacterales.
Gut colonisation, where it happens, can last from a few weeks to more than a year, although rates typically fall after two to three months. Colonisation is not infection. It means the organism is living in your bowel, not making you ill.
What matters is what your own hospital does with that information. CDC advises US clinicians to take an international travel history going back at least 12 months, to consider screening for carbapenem-resistant Enterobacterales after an overnight stay in a health care facility outside the country in the previous 6 months, and to consider Candida auris screening over a 12 month window. Note the trigger: an overnight stay as a patient. A student placement is not the same thing, and no international rule says otherwise.
So ask your own occupational health service what their policy is, before you go and again when you return. Some faculties screen returning students, many do not, and the decision belongs to your institution and your national regulator rather than to your host hospital or to us. The same logic applies to tuberculosis screening after an elective.
Carefully, and mostly by asking. You are a guest, you are there for a few weeks, and the constraints your team works under are structural: the lab charge, the drug supply, the patient who cannot come back for review. WHO's own list of drivers is full of systems problems, not individual failings.
A question lands better than an observation. "How do you usually decide when to send a culture?" opens a conversation. "We would de-escalate by now at home" closes one. Our guide to an ethical medical elective abroad goes deeper into the guest-not-inspector posture, and it applies to antibiotic resistance more than to almost anything else you will see.
If you want to be useful, be useful with your hands: restock the hand rub, label specimens properly, walk the sample to the lab yourself.
WHO observes World AMR Awareness Week every year from 18 to 24 November, and the theme for 2026 is "One Health, one action: Prevent AMR now". If your placement overlaps that week, ask your host whether there is teaching, an audit or a poster session attached to it. Plenty of teaching hospitals in Sri Lanka, Nepal, Indonesia and Tanzania mark it, and a visiting student who turns up with a question is usually welcome.
It is also a sensible week to write something up. A short audit of empirical prescribing on one ward, run with your supervisor's permission and properly anonymised, fits neatly into a four week placement.
More than you would expect. Culture-negative sepsis managed on clinical grounds, a resistant urinary isolate, a wound that needed three drug changes: these are the cases that teach you why stewardship exists. Log them the way you log procedures, with date, setting, supervisor and your own level of involvement. Our post on clinical skills on a medical elective covers what faculties usually want to see.
And if you are still choosing between destinations, the country guides for Sri Lanka, Nepal, Bali and Zanzibar set out the hospitals, the visas and the local health picture for each.
Medically reviewed by MUDr. Amandeep Grewal, a doctor on the travel4med team whose review scope covers vaccinations, tropical medicine, insurance and clinical content.
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