1887

Abstract

Problems of antimicrobial drug resistance are presently serious, but not yet desperate. The principal areas of concern are two-fold: multiresistant opportunist bacteria that affect vulnerable patients in high dependency areas of hospitals (the most pressing problem for developed countries); and multidrug resistance among classic pathogens like spp., and (mainly, although not exclusively, a problem for developing countries). The first type can be contained to a large extent by good infection control practices and careful prescribing based on agreed policies of antimicrobial drug use. The input of infection control nurses and laboratory-based clinical microbiologists is crucial and these services deserve full support. The second type additionally requires coordinated action to regulate more effectively the manufacture, availability, promotion and use of antimicrobial drugs. In this case the input of governments, international agencies and pharmaceutical companies is essential. Prescription-only status for antimicrobial drugs used in man and animals should be the norm. The number of drugs available for the treatment of viral, fungal and parasitic infections is comparatively small and much less is known about resistance. More research in these areas would be welcome. Teaching good prescribing habits to medical students is presently haphazard and needs to be formalised. Surveillance needs to be improved. The second half of the 20th century has been a golden age of antibiotics, but the outlook is uncertain. If antimicrobial chemotherapy is to have a secure future, prescribers must learn to use these powerful tools with greater discretion and their use worldwide must be regulated effectively.

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1998-09-01
2022-08-19
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References

  1. O’Grady F., Lambert H. P., Finch R. G., Greenwood D. (eds) Antibiotic and chemotherapy: anti-infective agents and their use in therapy 7th edn New York: Churchill Livingstone; 1997
    [Google Scholar]
  2. British Medical Association and the Pharmaceutical Society of Great Britain British National Formulary Number 35. (March 1998)
  3. Goldmann D. A., Weinstein R. A., Wenzel R. P. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA 1996; 275:234–240
    [Google Scholar]
  4. World Health Organization World malaria situation in 1994 Part 1. Population at risk. Wkly Epidemiol Rec 1997; 72:269–274
    [Google Scholar]
  5. Borst P., Ouellette M. New mechanisms of drug resistance in parasitic protozoa. Annu Rev Microbiol 1995; 49:427–460
    [Google Scholar]
  6. Taylor M. A. Anthelmintic resistance in helminth parasites of domestic animals. Agric Zool Rev 1992; 5:1–49
    [Google Scholar]
  7. Roos M. H. The molecular nature of benzimidazole resistance in helminths. Parasitol Today 1990; 6:125–127
    [Google Scholar]
  8. Chadwick D. J., Goode J. (eds) Antibiotic resistance: origins, evolution, selection and spread Ciba Foundation Symposium no. 207 Chichester: John Wiley and Sons; 1997
    [Google Scholar]
  9. Amyes S. G. B., Gemmell C. G. (eds) Antibiotic resistance. J Med Microbiol 1997; 46:436–470
    [Google Scholar]
  10. Swartz M. N. Use of antimicrobial agents and drug resistance. N Engl J Med 1997; 337:491–492
    [Google Scholar]
  11. Schrag S. J., Perrot V. Reducing antibiotic resistance. Nature 1996; 381:120–121
    [Google Scholar]
  12. Greenwood D. (ed) Antimicrobial chemotherapy. 3rd edn Oxford: Oxford University Press; 1995
    [Google Scholar]
  13. Davey P., Hudson S., Ridgway G., Reeves D. A survey of undergraduate and continuing medical education about anti-microbial chemotherapy in the United Kingdom. Br J Clin Pharmacol 1993; 36:511–519
    [Google Scholar]
  14. Greenwood D. What’s the use of susceptibility testing?. Chemotherapy 1997; 9: Suppl 17–12
    [Google Scholar]
  15. WHO Antimicrobial Resistance Monitoring Programme website http://www.who.ch/programmes/emc/amr/amrfacts.htm
  16. Anonymous The WHO network on antimicrobial resistance monitoring. Wkly Epidemiol Rec 1996; 71:185–187
    [Google Scholar]
  17. Anonymous Over-the-counter drugs. Lancet 1994; 343:1374–1375
    [Google Scholar]
  18. Pringle M. Access to antibiotics: a case for a change in category. J Antimicrob Chemother 1995; 36:577–579
    [Google Scholar]
  19. Reeves D. S., Lewis D. A. Over the counter anti-infectives—of benefit to whom?. J Antimicrob Chemother 1995; 36:579–584
    [Google Scholar]
  20. Agricultural Research Council and Medical Research Council Report of the Joint Committee on antibiotics in animal feeding. London: HMSO; 1962
    [Google Scholar]
  21. Swann Report Joint Committee on the use of antibiotics in animal husbandry and veterinary medicine. London: HMSO; 1969
    [Google Scholar]
  22. Melrose D. Bitter pills: medicines and the Third World poor. Oxford: Oxfam; 1982
    [Google Scholar]
  23. Chetley A. A healthy business?. World health and the pharmaceutical industry London: Zed Books; 1990
    [Google Scholar]
  24. Chetley A. Problem drugs. London: Zed Books; 1995
    [Google Scholar]
  25. Anonymous Quality control and essential drugs. Lancet 1997; 350:601
    [Google Scholar]
  26. Kunin C. M. Resistance to antimicrobial drugs—a worldwide calamity. Ann Intern Med 1993; 118:557–561
    [Google Scholar]
  27. Billstein S. A. How the pharmaceutical industry brings an antibiotic drug to market in the United States. Antimicrob Agents Chemother 1994; 38:2679–2682
    [Google Scholar]
  28. Chopra I. Approaches to antibacterial drug discovery. Expert Opinion on Investigational Drugs 1997; 6:1019–1024
    [Google Scholar]
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