Bacterial genetics, antibiotic usage, and public policy: the crucial interplay in emerging resistance.

Abstract

From politicians to physicians to the general public, there is a growing awareness that bacterial resistance to antibiotics is an expanding prob- lem. Sometimes the setting in which the problem is presented is the emergence of superbugs, such as vancomycin resistant enterococci that are essentially untreatable and tend to cause problems in hospital- ized people who are already quite ill. In other cases, the issue relates to the greater difficulty/expense/toxicity associated with treatment strate- gies for more common bacteria, such as Haemophilus influenzae (one of the most common causes of ear and sinus infections in children) now being resistant to ampicillin. And sometimes the problem has elements of both, such as the spread of multiply resistant (including penicillin and erythromycin resistant) Streptococcus pneumoniae. S. pneumoniae is the most common cause of bacterial pneumonia and a common cause of ear and sinus infections in children and adults. The association of resis- tance with an unfettered use of antimicrobials has been postulated, and much experimental evidence has been accumulated in support of this connection. We struggle as a society to make'policy decisions to forestall or to minimize the impact of serious infections caused by difficult-to- treat bacteria without exposing individuals to harm from undertreat- ment. Analysis and debate about the bacterial resistance problem in general-interest, wide-circulation periodicals such as Time (1) and U.S.