New intervention strategies for reducing antibiotic resistance.

Rising antibiotic resistance rates among bacterial pathogens have resulted in increased morbidity and mortality from nosocomial infections. Widespread use of certain antibiotics, particularly third-generation cephalosporins, has been shown to foster development of generalized beta-lactam resistance in previously susceptible bacterial populations. Reduction in the use of these agents (as well as imipenem and vancomycin) and concomitant increases in the use of extended-spectrum penicillins and combination therapy with aminoglycosides have been shown to restore bacterial susceptibility. Studies have shown that education-based methods, as opposed to coercive measures, are effective in changing the prescribing habits of physicians. Cooperative interaction among infectious-disease physicians, clinical pharmacists, microbiology-laboratory personnel, and infection-control specialists is essential to provide useful suggestions regarding antibiotic choice and dosing to the prescribing physician in real time. Several hospitals have implemented antimicrobial resistance management programs based on these findings. The results of these programs validate the use of a multidisciplinary, education-based, antibiotic-resistance management approach.