have been abandoned as clinical trials have failed to show their benefit.26
There is often intense broad-spectrum antimicrobial use in critical care and haematology/oncology units, where patients have an increased likelihood of both severe infection and resistant organisms. These patients must receive early empiric broad-spectrum antimicrobial therapy when infection is suspected.58–60
further promotes high rates of antimicrobial resistance. To address this problem, appropriate microbiology diagnostic tests should be obtained prior to initiating antimicrobial therapy, with rapid reporting of results to allow modification of the antimicrobial course, preferably to a less broad-spectrum agent, as quickly as possible.57
A second apparent contradiction is the recommendation for the treatment of infection with more than one antibiotic. For some infections, particularly tuberculosis, the use of more than one agent is itself part of a strategy to decrease the development of resistance. For other organisms, such as treatment of presumed P. aeruginosa infection, however, the widespread use of multiple antibiotics is not supported by clinical evidence and should be discouraged.57
Antimicrobial and Vaccine Development The historical approach to managing antimicrobial resistance relied on the continuing development and introduction of new antimicrobials. There is currently limited antimicrobial development
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The emergence of resistance to new antimicrobials has been consistently described shortly following their introduction. The development of new antimicrobials therefore remains important, but by itself cannot address the problem of the current and potential therapeutic limitations attributable to antimicrobial resistance. Other technological approaches, such as the development of vaccines for important pathogens such as S. aureus, or of biofilm-resistant biomaterials, must also be pursued.
Antimicrobial resistance is an important, continually evolving clinical problem. Resistance is a predictable response to antimicrobial use and ensuring optimal antimicrobial use in all settings is the most important strategy to address the problem. It is important to continue to monitor the development and dissemination of new resistance. Other strategies include public health measures, infection control and antimicrobial development. Critical evaluation of the effectiveness of any intervention must also be pursued to support the utility of current or proposed practices. n
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by the pharmaceutical industry, raising concerns about the availability of effective antimicrobial therapy in the future.61,62 inhibitors are being developed63
Some β-lactamase and older agents such as fosfomycin64
and colistimethate are being reassessed for use in treating infections with resistant organisms. Drugs such as quinupristin/dalfopristin, linezolid, daptomycin, tigecycline and ceftaroline have been developed to treat MRSA and some other resistant organisms.
EUROPEAN INFECTIOUS DISEASE
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