title: Strategies for minimizing antimicrobial resistance.
abstract: Various interventions for reducing antimicrobial resistance are described. Prudent and appropriate use of antimicrobials may help reduce the selective pressure that promotes the emergence of resistance. Limiting antimicrobial use for the promotion of growth in animals may also decrease the potential for transmission of resistant microorganisms to humans through the food supply. Clinical practice guidelines provide a standard of care for the use of antimicrobials in specific infectious syndromes, promoting appropriate antimicrobial use. Excluding certain antimicrobials from institutional formularies and restricting prescribing of some agents or classes of agents included in the formulary may reduce the emergence of resistance. Therapeutic failure can be avoided by considering pharmacokinetic and pharmacodynamic factors when selecting an antimicrobial regimen. A sufficient dose and an appropriate administration interval are necessary to ensure that the antimicrobial concentration at the site of infection is high enough to kill or inhibit the growth of the pathogen. Routine antimicrobial susceptibility surveillance can detect the emergence of resistant pathogens and allow for prompt intervention. Implementation of infection control practices can prevent or stem outbreaks of infection caused by resistant microorganisms. Vaccinations may reduce antimicrobial resistance indirectly by decreasing the need for antimicrobial therapy. Antimicrobial resistance can be reduced through a combination of interventions. The management of antimicrobial resistance requires a multidisciplinary approach, including participation from physicians, nurses, pharmacists, and infection control and housekeeping staff.
authors.affiliation: Division of Infectious Disease, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. pflommj@mskcc.org
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Pflomm
mesh_terms: D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000592:standards; D005569:Formularies as Topic / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods; D011008:Pneumococcal Infections / Q000188:drug therapy; D017410:Practice Guidelines as Topic / Q000592:standards; D014611:Vaccination
chemical_list: D000890:Anti-Infective Agents