Letters Tackling antibiotic resistance

International action required

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2978 (Published 09 June 2010) Cite this as: BMJ 2010;340:c2978
  1. Michael R Millar, consultant microbiologist1
  1. 1Barts and the London NHS Trust
  1. m.r.millar{at}qmul.ac.uk

    So and colleagues suggest that we need concerted action to conserve (the function of) existing antimicrobial drugs but could have spelt out what actions are needed.1

    Antibiotic resistance shares many features with global warming. It is largely invisible, what we do today has implications for the health and wellbeing of future generations, and many uncertainties exist, including how much technological developments will rescue us.

    The outpatient use of antibiotics varies widely in Europe,2 yet life expectancy is similar across most countries in western Europe. Italy and France use more outpatient antibiotics per capita than Germany, the United Kingdom, or the Netherlands. So France and Italy may be using an unjust share of this limited resource.

    If one country uses antibiotics only when there will be a substantial benefit but another uses them for the most trivial reasons, in excessive amounts, for unnecessary durations, or to support cruel farming methods,3 then we might judge the second country less well than the first.

    To make comparisons we need to compare like with like using agreed standards for antimicrobial usage. Minimum standards for human use of antibiotics might include a doctor’s prescription and minimum requirements for evidence of benefit, and recommended doses and durations for more common conditions.

    Reliance on local policy and practice may be insufficient to deal with the problem of antibiotic resistance. International agreements do not yet exist, but perhaps, as with carbon dioxide, the control of antibiotic resistance requires such agreements.


    Cite this as: BMJ 2010;340:c2978


    • Competing interests: None declared.


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