Perverse incentives and inadequate information may accelerate antibiotic resistance

Keeping abreast of changing patterns of microbial resistance presents a formidable challenge to all those prescribing antibiotics. When national standards are developed for treating infectious diseases, recommendations must be transmitted to local practitioners and drug sellers. Even if there is an effective communications network this process takes time. Given that many recommended treatments are based on outdated texts or “common practices,” it is perhaps not surprising that practice changes slowly, if at all. Common practices can often be traced to the influence of one or two influential physicians whose ideas have had a disproportionate effect on the literature. For example, the overuse of metronidazole and furazolidone to treat shigella infections in Bangladesh (and many other countries) almost certainly reflects overdiagnosis of amoebiasis that 25 years ago was mistakenly considered to be the commonest cause of bloody diarrhoea.

The short report by Ronsmans et al in this week's BMJ (p 205) reveals the extent of inappropriate treatment of dysentery in Bangladesh and raises issues that are relevant …