title: Can we prevent antimicrobial resistance by using antimicrobials better?
abstract: Since their development over 60 years ago, antimicrobials have become an integral part of healthcare practice worldwide. Recently, this has been put in jeopardy by the emergence of widespread antimicrobial resistance, which is one of the major problems facing modern medicine. In the past, the development of new antimicrobials kept us one step ahead of the problem of resistance, but only three new classes of antimicrobials have reached the market in the last thirty years. A time is therefore approaching when we may not have effective treatment against bacterial infections, particularly for those that are caused by Gram-negative organisms. An important strategy to reduce the development of antimicrobial resistance is to use antimicrobials more appropriately, in ways that will prevent resistance. This involves a consideration of the pharmacokinetic and pharmacodynamics properties of antimicrobials, the possible use of combinations, and more appropriate choice of antimicrobials, which may include rapid diagnostic testing and antimicrobial cycling. Examples given in this review include Mycobacterium tuberculosis, Gram-negative and Gram-positive organisms. We shall summarise the current evidence for these strategies and outline areas for future development.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK. g.soothill@smd10.qmul.ac.uk.
authors.forename: Germander
authors.initials: G
authors.lastname: Soothill
authors.affiliation: Medical Microbiology, Centre for Infection, Division of Clinical Studies, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. ymhu@sgul.ac.uk.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Medical Microbiology, Centre for Infection, Division of Clinical Studies, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. acoates@sgul.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: Coates