The epidemiology of antimicrobial resistance

Antimicrobial resistance is increasing at an alarming rate, leading to prof ound crises in the treatment of common infectious diseases. Although bacter ia have "natural" resistance to some antibiotics, most resistance can be at tributed to over-prescription of antibiotics by physicians, over-the-counte r use of antibiotics in many countries, "indigenized" use of antibiotics in developing countries, and application of antibiotics for growth promotion and treatment and prevention of infection in animal husbandry and farm fish ing. The development of antimicrobial resistance involves four factors: mut ation, directional selection, amplification, and geographic dissemination. Although the pharmaceutical industry is endeavoring to develop new classes of antibiotics, it is unlikely that new agents alone will solve the antimic robial resistance problem. Rather, a coordinated, multidisciplinary approac h is required, including reduction in inappropriate use of antibiotics in h umans and agriculture, education of consumers, and application of establish ed infection control techniques to limit the spread of resistant microorgan isms in hospitals and other settings that favor amplification of resistance .