Antibiotic Policies

Examines many of the crucial issues of resistance in a clinical context, with an emphasis on MRSA. This title explores the psychology of prescribing, modern management techniques as an adjunct to antibiotic policies, and the less obvious downsides of antibiotic use.

Antibiotic resistance has reached epidemic proportions in most hospitals and many communities around the world. While control methods have traditionally (and usually unsuccessfully) relied on preventing cross infection it is increasingly obvious that new solutions are needed. There is growing evidence that the solution will lie in more careful use of antibiotics in the future. The golden age of antibiotic therapy has gone, probably for good and prescribers (and society at large) will have to accept that, in future, antibiotics will not be the "cure all" we have been accustomed to. This book addresses many of the key issues taxing our society and hospitals in an era of epidemic resistance and shortage of new antibiotics. Written by internationally renowned experts in the field, this volume will provide practical advice and inform control strategies for the most urgent of problems related to antibiotic resistance epidemic for years to come. Antibiotic Policies: Fighting Resistance is an ideal volume for health professionals with an interest in this field.

In 1971, I started a fellowship in infectious diseases and medical microbiology at the Channing Laboratory of the Harvard Medical Service at Boston City Hospital. My mentor, Dr. Maxwell Finland, had encouraged me to return there from the Center for Disease Control (as CDC was known then), where I had studied inf- tious diseases epidemiology and hospital-associated infection epidemiology, with the idea that we would review the demographic patterns of bacteremia and several other infections during Dr. Finland’s long tenure at the hospital. We did so, but I was surprised to find that he also invited me to help with the assessment of the success or failure of the programs to control antimicrobial use that he and c- leagues had put into place at the hospital over several years. The paper describing that review finally was published in 1974, after a long and tortuous process of review at several journals. Several reviewers felt that such attempts to improve use amounted to interference with the patient’s physician to do what was best. Others felt that such programs focused incorrectly on a subject other than treating the current patient. Fortunately, today, it is clear that antimicrobial resistance results in major part, but not entirely, from the ways that we use antimicrobial agents, and that the ov- all interests of patients in general, as well as those of society, are well served by efforts to use these drugs as well as possible.