Antimicrobial resistance

Is a major threat to public health

There is an incoming tide of concern about the problems of antimicrobial resistance. For several years alarm has been expressed in the United States,1 and the past 12 months have seen two World Health Organisation meetings prompted by increasing anxieties about the role of antimicrobials in animal husbandry2 a report by Britain's House of Lords on antimicrobial resistance; and a report from the US Institute of Medicine on emerging infections.3 This week the Danish Chief Medical Officer, Einar Krag, has called together colleagues from the European Union and their advisors for a conference on “the microbial threat” to “assess the strategies to prevent and control the emergence and spread of antimicrobial resistant micro-organisms.” Is all this activity warranted? We believe it is: in the words of the House of Lords' report, “Resistance to antibiotics … constitutes a major threat to public health and ought to be recognised as such more widely than it is at present.” This issue of the BMJ is helping to broadcast this message.

The causes of these problems and gloomy portents are not difficult to find. In the past 50 years people in both the developed and developing worlds have accepted antibiotics as their right — to obtain a prescription at the first sign of a trivial infection or treat themselves with a handful of cheap antibiotics. We cannot conceive a return to the pre-antibiotic days, yet the unbridled use of these agents in man and animals is inexorably propelling us …