Intended for healthcare professionals

Education And Debate

Regulating the use of antibiotics in the community

BMJ 1998; 317 (Published 05 September 1998) Cite this as: BMJ 1998;317:663
1. Claude Carbon, chief of internal medicinea,
2. Richard P Bax, director of research and developmentb
1. aHospital Bichat, Claude Bernard, 75877 Paris Cedex 18, France
2. bSmithKline Beecham Pharmaceuticals, New Frontiers Science Park South, Harlow, Essex CM19 5AW
1. Correspondence to: Professor Carbon claude.carbon@bch.ap-hop.paris.fr

All parties perceive antibiotic resistance as a global threat.1 We examined the literature on the use of antibiotics in the community to establish how the issue of antibiotic resistance might be managed. We chose illustrative examples from recent important publications.

Summary points

• Political measures to control costs of antibiotic use generally have had a short term effect without affecting resistance

• Although the reversibility of the current situation of resistance is unknown, actions that could decrease the volume of antibiotic use without affecting quality of care should be considered

• General practitioners should help to set guidelines for selecting patients to be treated; improved treatment schedules must be researched and put into practice

• The clinical evaluation of antibiotics must be improved — to show effectiveness and effects on the ecology of resistance, as well as safety and efficacy

• The pharmaceutical industry, microbiology physicians, academia, regulators, policymakers, and healthcare providers should participate in managing the issue of antibiotic resistance

Responsibility for action

The rapid rise in resistance has led to difficult and complex questions. Who decides what to do, and on what evidence does that body base its decision? Who has the responsibility for disseminating information to professionals and the public. What is the nature of the information, who provides it, in what form is it provided, and how are the decisions implemented? These questions must be answered. There is an incomplete understanding of the relation between resistance and clinical and microbiological failure in the community. This makes us unsure of both the urgency of the problem and how to precisely manage the situation.17 Despite the multiplying problems and the gloomy prospects for their immediate solution, the fourway partnership of a vigorous pharmaceutical industry, physicians, academia, and healthcare providers is the best hope for the future. Much also depends on the attitude of governments—we must hope that they can foster social, educational, economic, and regulatory environments that encourage innovation in all aspects of control of infectious disease.18

Acknowledgments

Competing financial interest: CC has been reimbursed by SmithKline Beecham and several major international pharmaceutical companies for attending several conferences and has also received fees for speaking, funds for research and for members of staff, and fees for consulting. RPB is employed by SmithKline Beecham.

References

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