Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

Antibiotic resistance: a view from the prescriber

Nature Reviews Microbiology volume 2, pages 989–994 (2004)Cite this article

Abstract

Antibiotic resistance is increasingly affecting the management of infectious diseases. The prescribing clinician is not only important to the development of the problem but also central to its solution. This article addresses the current weaknesses in the information systems and the evidence base that support prescribing. Remedies necessary for improvements in prudent prescribing include better guidance in managing specific diseases where resistance is of prognostic significance and also increasing diagnostic precision.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. American Society for Microbiology. Report of the ASM task force on antibiotic resistance. [online], <http://www.asm.org/ASM/files/CCPAGECONTENT/DOCFILENAME/ 0000005962/antibiot[1].pdf> (ASM, Washington DC, 1995).

  2. House of Lords Select Committee on Science and Technology. Resistance to antibiotics and other antimicrobial agents. [online], <http://www.parliament.the-stationery-office.co.uk/pa/ld199798/ldselect/ldsctech/081vii/st0701.htm> (The Stationery Office, London, UK, 1998).

  3. Interagency Task Force on Antimicrobial Resistance. Public health action plan to combat antimicrobial resistance. [online], <http://www.cdc.gov/drugresistance/actionplan/aractionplan.pdf> (CDC, Atlanta, 2001).

  4. EU Ministers of Health. 2188th Council Meeting. Antibiotic resistance — a strategy against the microbial threat — Council Resolution. [online], <http://ue.eu.int/ueDocs/cms_Data/docs/pressData/en/Isa/ACF152.htm> (1999).

  5. Ministry of Health, Ministry of Food, Agriculture and Fisheries. The Copenhagen Recommendations. Report from the invitational EU conference on the microbial threat. [online], <http://www.archive.official-documents.co.uk/document/cm41/4172/4172.pdf> (9–10 September, 1998).

  6. Cornaglia, G. et al. Report from the European conference on the role of research in combating antibiotic resistance, 2003. Clin. Microbiol. Infect. 10, 473–497 (2004).

    Article  CAS  Google Scholar 

  7. World Health Organization. WHO global strategy for the containment of antimicrobial resistance. [online], <http://www.who.int/emc-documents/antimicrobial_resistance/docs/EGlobal_Strat.pdf> (World Health Organization, Geneva 2001).

  8. Finch, R. G. et al. Antibiotic resistance. J. Antimicrob. Chemother. 42, 125–128 (1998).

    Article  CAS  Google Scholar 

  9. Finch, R. G. et al. Educational interventions to improve antibiotic use in the community: report from the International Forum on Antibiotic Resistance (IFAR) colloquium, 2002. Lancet Infect. Dis. 4, 44–52 (2004).

    Article  Google Scholar 

  10. Scottish Intercollegiate Guidelines Network (SIGN). Antibiotic prophylaxis in surgery. A national clinical guideline. Publication number 45 [online], <http://www.guideline.gov/summary/summary.aspx?doc_id=2911> (2000).

  11. Livermore, D. et al. Can better prescribing turn the tide of resistance? Nature Rev. Microbiol. 2, 73–78 (2004).

    Article  CAS  Google Scholar 

  12. Cars, O. et al. Variation in antibiotic use in the European Union. Lancet 357, 1851–1853 (2001).

    Article  CAS  Google Scholar 

  13. Baquero, F. et al. Antibiotic consumption and resistance selection in Streptococcus pneumoniae. J. Antimicrob. Chemother. 50, 27–38 (2002).

    Article  CAS  Google Scholar 

  14. Drusano, G. L. et al. Antimicrobial pharmacodynamics: critical interactions of 'bug and drug'. Nature Rev. Microbiol. 2, 289–300 (2004).

    Article  CAS  Google Scholar 

  15. European Antimicrobial Resistance Surveillance System. Annual Report 2003. [online], <http://www.earss.rivm.nl/> (EARSS, 2003).

  16. Annual report of the regional and national analyses of the MRSA surveillance scheme in England. The third year of regional and national analyses of the Department of Health's mandatory MRSA surveillance scheme in England: April 2001–March 2004. CDR Weekly 14, 1–6 [online], <http://www.hpa.org.uk/cdr/PDFfiles/2004/cdr2904.pdf> (2004).

  17. Ziglam, H. M. et al. Penicillin-resistant pneumococci — implications for management of community-acquired pneumonia and meningitis. Int. J. Infect. Dis. 6 (Suppl.), S14–S20 (2002).

    Article  Google Scholar 

  18. Finch, R. G. et al. Antibiotic resistance — from pathogen to disease surveillance. Clin. Microbiol. Infect. 8, 317–320 (2002).

    Article  Google Scholar 

  19. Macfarlane, J. T. et al. The British Thoracic Society guidelines for the management of community-acquired pneumonia in adults. Thorax 56 (Suppl.), S1–S64 (2001).

    Google Scholar 

  20. Mandell, L. A. et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin. Infect. Dis. 37, 1405–1433 (2003).

    Article  Google Scholar 

  21. Quagliarello, V. J. et al. Treatment of bacterial meningitis. N. Engl. J. Med. 336, 708–716 (1997).

    Article  CAS  Google Scholar 

  22. Henwood, C. J. et al. Accuracy of routine susceptibility testing of Streptococcus pneumoniae in England and Wales. J. Antimicrob. Chemother. 47, 897–900 (2001).

    Article  CAS  Google Scholar 

  23. Warren, R. E. et al. Simultaneous, bi-clonal outbreak of urinary tract infection by E. coli 025 strains with CTX-M-15: community and hospital effects in two English health districts. Abstracts of the 14th European Congress of Clinical Microbiology and Infectious Diseases, Prague, Czech Republic, Abstract P756, [online], <http://www.blackwellpublishing.com/eccmid14/abstract.asp?id=14399> (2004).

  24. Brenwald, N. P. et al. An outbreak of a CTX-M-type β-lactamase-producing Klebsiella pneumoniae: the importance of using cefpodoxime to detect extended-spectrum β-lactamases. J. Antimicrob. Chemother. 51, 195–196 (2003).

    Article  CAS  Google Scholar 

  25. Kollef, M. H. et al. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115, 462–474 (1999).

    Article  CAS  Google Scholar 

  26. Ibrahim, E. H. et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118, 146–155 (2000).

    Article  CAS  Google Scholar 

  27. Cosgrove, A. E. et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin. Infect. Dis. 36, 53–59 (2003).

    Article  Google Scholar 

  28. Melzer, M. et al. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin. Infect. Dis. 37, 1453–1460 (2003).

    Article  CAS  Google Scholar 

  29. Finch, R. G. et al. Practical considerations and guidelines for the management of community-acquired pneumonia. Drugs 55, 31–45 (1998).

    Article  CAS  Google Scholar 

  30. Metlay, J. P. et al. Outcomes in lower respiratory tract infections and the impact of antimicrobial drug resistance. Clin. Microbiol. Infect. 8 (Suppl.), S1–S11 (2002).

    Article  Google Scholar 

  31. UK Standing Medical Advisory Committee (SMAC). The path of least resistance. [online], <http://www.advisorybodies.doh.gov.uk/smac1.htm> (Department of Health, UK, 1998).

  32. Flemming, D. M. et al. The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing. Br. J. Gen. Pract. 53, 778–783 (2003).

    Google Scholar 

Download references

Acknowledgements

This article is based on an invited lecture to the 14th European Congress of Clinical Microbiology and Infectious Diseases, Prague, April 2004.

Author information

Authors and Affiliations

  1. Department of Microbiology and Infectious Diseases, Nottingham City Hospital NHS Trust, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB, UK

    Roger G. Finch

Authors
  1. Roger G. Finch
    View author publications

    Search author on:PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Related links

Related links

DATABASES

Entrez

Escherichia coli

MRSA

Streptococcus pneumoniae

FURTHER INFORMATION

The European Society of Clinical Microbiology and Infectious Diseases

Health Protection Agency

World Health Organization

EARSS

NELI

Alliance for the Prudent Use of Antibiotics

CDC Get Smart Campaign

FDA antibiotic resistance fact sheet

NIAID antibiotic resistance fact sheet

'Do bugs need drugs' project

Stop resistance

Rights and permissions

Reprints and permissions

About this article

Cite this article

Finch, R. Antibiotic resistance: a view from the prescriber. Nat Rev Microbiol 2, 989–994 (2004). https://doi.org/10.1038/nrmicro1049

Download citation

  • Issue date:

  • DOI: https://doi.org/10.1038/nrmicro1049

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing