Antibiotic prescribingare there lessons for physicians?

In 1968, L.P. Garrod wrote \`no one recently qualified, even with the liveliest imagination, can picture the ravages of bacterial infection which continued until more than 30 years ago'. Since then, although many new antimicrobials have been developed, we are once again warned of an imminent \`post antibiotic era' as a consequence of the rapid emergence of resistant bacteria. This problem has recently culminated in the publication of an excellent report from the House of Lords Select Committee on Science and Technology on `Resistance to Antibiotics and the other antimicrobial agents'.1 The subsequent plethora of editorials2,,3 in the medical press and `sensationalist' coverage in the media has brought this important subject to the attention of the non-specialist medical community as well as the public domain. This increased concern has culminated in the British Medical Journal devoting a whole issue to this subject ( Br Med J 1998; 317 ) and the occurrence of an important meeting on this subject of medical officers from throughout Europe in Copenhagen, September 1998. The failure to implement basic infection control practices, the excessive use of antimicrobials in veteriniary practice, and the excessive and inappropriate use of antimicrobials are the principle causes of the emergence and dissemination of resistant organisms.3–,6 In this article, we concentrate on the prescribing of antibiotics, primarily in hospital, and their role in controlling the emergence and spread of resistance. Antibiotics remain the single most abused privilege doctors have.7 Those of us practising infection have known for many years the hazards of uncontrolled and inappropriate antibiotic prescribing. In general practice, where the bulk of antibiotic prescribing occurs (80% of all human antibiotic prescribing occurs in the community; 80% of these prescriptions are for respiratory tract infections), there are apparently wide variations in practice; for example …