The Use and Abuse of Antibiotics and the Development of Antibiotic Resistance

There is clear evidence that antibiotic resistance develops under antibiotic pressure. While this may not be the only factor contributing to the development of antibiotic resistance and reduction in antibiotic use may not always be followed by a decrease in resistance, a decrease in antibiotic overuse will remain the number one intervention in our attempts towards slowing down the development of antimicrobial resistance. There are multitudes of patient and provider related factors that drive antibiotic use and overuse. While even the prudent, rational and judicious use of antibiotics can eventually lead to the emergence of antibiotic resistance in many cases, we can at least limit the development and spread of antibiotic resistance in clinical pratice by avoiding the unnecessary and inappropriate use of these important drugs. A number of interventions have been tried to promote judicious use of antibiotics around the world. many of them are discussed in the WHO Global strategy for containment of antimicrobial resistance (http://www.who.int/drugresistance/WHO-Global- Strategy-English.pdf). The applicability of these interventions differs not only based on the clinical setting of antibiotic use i.e. management of acute infections in an outpatient setting vs. inpatient setting vs. treatment of chronic infections, but also on a number of other factors such as site characteristics (private practise vs. academic setting), available resources (such as electronic data management and electronic prescriptions) and patient characteristics (literacy, cultural beliefs, socioeconomic status). No single intervention is likely to have a significant impact by itself and a combined approach using multiple interventions is necessary. Additionally, while the enormity of the problem and the degree to which it has become pervasive in society, especially in some countries maybe daunting, every effort that is made to promote judicious antibiotic use will have some benefit. © Springer Science+Business Media, LLC 2010.