Does antibiotic restriction prevent resistance?

Antimicrobial resistance among some hospital organisms has increased to a stage where it can no longer be tolerated. The need for preventive and corrective measures is urgent. There is an association between the use of antimicrobial agents and resistance that is likely causal. Alterations in antimicrobial usage have been shown to affect antimicrobial resistance rates, particularly with use of aminoglycosides. Efforts to improve antimicrobial use through educational efforts alone have been largely ineffective, even when coupled with quality management or clinical guideline aspects. Thus, further work is urgently needed to determine the impact of antimicrobial-use controls. Additional large-scale, well controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular biological organism typing, and precise resistance mechanism analysis will be required to determine the best methods to prevent and control this problem and ensure our optimal antimicrobial-use "stewardship." Consideration of the long-term effects of antimicrobial selection, dosage, and duration of treatment on resistance development should be a part of every antimicrobial treatment decision.