Appropriate Use of Antibiotics

Abstract

Antibiotic resistance is the inevitable consequence of antibiotic use. This has been a painful lesson for virtually all treatable microbes, including all major categories: bacteria, fungi, viruses, and parasites. In general, there needs to be a sharp distinction between the resistance problems in the health care setting (nosocomial infections) and those encountered in the community (community-acquired infections) based on vast differences in pathogens and resistance patterns. Nevertheless, there has recently been the development of a hybrid form, referred to as "healthcare-associated infections" in reference to patients who have frequent contact with the medical care system, as with a chronic care facility or on outpatient basis. A fundamental principle is the concept that in all settings, extensive use of antibiotics will lead to resistance ("use it and lose it"). Despite the rule, history has taught that we have great difficulty in predicting evolutionary patterns of resistance. This review will concentrate on practical issues for consideration by primary care physicians for their role in the prevention of resistance in their management of community-acquired acute respiratory infections.