RESISTANCE TO ANTIMICROBIAL AGENTS - A PERSONAL VIEW

Problems of antimicrobial drug resistance are presently serious, but n ot yet desperate. The principal areas of concern are two-fold: multire sistant opportunist bacteria that affect vulnerable patients in high d ependency areas of hospitals (the most pressing problem for developed countries); and multidrug resistance among classic pathogens like Myco bacterium tuberculosis, Salmonella typhi, Shigella spp,, Neisseria gon orrhoeae and Plasmodium falciparum (mainly, although not exclusively, a problem for developing countries). The first type can be contained t o a large extent by good infection control practices and careful presc ribing based on agreed policies of antimicrobial drug use. The input o f infection control nurses and laboratory-based clinical microbiologis ts 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 dru gs. In this case the input of governments, international agencies and pharmaceutical companies is essential. Prescription-only status for an timicrobial drugs used in man and animals should be the norm. The numb er of drugs available for the treatment of viral, fungal and parasitic infections is comparatively small and much less is known about resist ance. More research in these areas would be welcome, Teaching good pre scribing habits to medical students is presently haphazard and needs t o be formalised. Surveillance needs to be improved. The second half of the 20th century has been a golden age of antibiotics, but the outloo k is uncertain. If antimicrobial chemotherapy is to have a secure futu re, prescribers must learn to use these powerful tools with greater di scretion and their use worldwide must be regulated effectively.