Arch G Mainous III and Claire Pomeroy

The rapidly expanding challenge of antibiotic resistance impacts on patients across the globe. As the new millennium dawns, drugs for the treatment of many illnesses are becoming limited, more expensive, or in some tragic cases nonexistent. As outlined in the preceding chapters, all medical practitioners must be aware of the implications of drug resistance when prescribing therapy. In its 1992 report, the Institute of Medicine identified antibiotic resistance as one of the emerging disease threats. Tuberculosis and cholera organisms once thought to be nearly eradicated have developed drug-resistant strains and threaten the health of millions of people. Bacteria such as pneumococcus, enterococcus, and Staphylococcus aureus have developed resistance at a rapid rate and across multiple antibiotics. It was reported in 1995 that antimicrobial resistance among six common bacteria in U.S. hospitals added more than $600 million per year in direct hospital charges (1).

It is becoming ever clearer that strategies to successfully deal with the rise in antibiotic-resistant pathogens must view this threat as a global problem. The rise in antibiotic resistance is directly related to many human activities. Consequently, what does the future hold for therapy for infectious diseases and antibiotic resistance if behaviors remain unchanged? The purpose of this chapter is to review factors that contribute to the rise in resistant organisms, anticipated trends for resistance in the future, and possible approaches to addressing this critical medical problem.

Many factors contribute to the spread of resistance including:

1. Overuse and misuse of antibiotics

2. Lack of regulation of antibiotic use

3. Failure of infection control procedures in hospitals and other sites such as nursing homes

4. Expanding use of antibiotics in medical settings for diseases not traditionally viewed as infections

5. Expanding use of antibiotics in nonmedical settings.

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