Human use of antimicrobial agents.

Antibiotics have increased life expectancy. Self-medication, even over the Internet, occurs in many countries where antibiotics are classified as prescription-only medicines. Collateral damage caused by antibiotic use includes resistance, which could be reduced if the inappropriate use of antibiotics that takes place globally, especially in low-income countries, could be prevented. Surveillance of antimicrobial resistance can recognise trends in resistance patterns and novel resistances. Surveillance of antimicrobial consumption can identify and target practice areas for quality improvement, both in the community and in healthcare institutions. Antimicrobial stewardship initiatives and infection control programmes play an important role in decreasing inappropriate use and halting dissemination of resistance. Education of professionals and the public should focus on changing behaviour rather than exclusively increasing knowledge, as the latter could have a paradoxical effect by increasing demand and prescription. Behaviour change should target all prescribers, including veterinarians, since microbes know no boundaries between animals and humans and are capable of exchanging resistance genes.