EDITORIAL.

Abstract

Antibiotics are such a vital part of modern medicine that it is difficult to envisage how we could manage without them. However, the widespread appearance of antibiotic resistance amongst almost all medically important species of bacteria and the slow development of new antibiotics capable of overcoming such resistance is threatening our complacency and is leading to a reassessment of the ways in which we make use of these essential drugs. In the animal field, we are seeing moves to restrict use of certain antibiotics in farming and there are those who wish to reduce and restrict general veterinary use to a substantial degree. These moves are prompted principally by concerns over the use of growth promoters in agriculture and especially the possible development of resistance to vancomycin, one of the few antibiotics to which some epidemic hospital methicillin-resistant Staphylococcus aureus (MRSA) strains are sensitive. The risks, potential or real, posed by farming and large animal veterinary use of antibiotics are currently a matter of considerable discussion and study. As yet there is little evidence of a significant risk to man. Indeed, it is the use of antibiotics in hospitals and their repeated use amongst chronically sick individuals in the community that appear to pose the greatest threat in the development of antibiotic resistance. Furthermore, some recent instances of MRSA infection in veterinary cases have shown links to health care workers indicating a risk to animals from human medicine. Evidence of transfer of antibiotic resistance to animals from man is scant and little work has been performed in this area as yet. However, the paper, by Patel, Lloyd and Lamport in this issue, on antibiotic resistance amongst feline staphylococci,1 provides indications that resistance selection pressure from human rather than veterinary sources is involved. More studies are needed to demarcate more clearly the role of veterinary and human antibiotic use in the development and spread of antibiotic resistance and to indicate how such spread can be minimized. The threat posed by antibiotic resistance was evaluated, with special reference to the situation in Europe, at a conference sponsored by the European Union and entitled ‘The Microbial Threat’ in Copenhagen in September 1998. The conference produced seven recommendations aimed at the development of new strategies for the use of antimicrobials and for the defence of public health. These recommendations, which are detailed and reviewed by Midtvedt in Micro-bial Ecology in Health and Disease,22 are as follows: 1 The European Union and member states must recognize that antimicrobial resistance is a major European and global problem. 2 Pharmaceutical companies should be encouraged to develop new antimicrobial agents but these will not solve the problem in the near future. 3 The European Union and member states should set up a European surveillance system of antimicrobial resistance. 4 The European Union and member states need to collect data on the supply and consumption of antimicrobial agents. 5 The European Union and member states should encourage the adoption of a wide range of measures to promote prudent use of antimicrobial agents. 6 The European Union, member states and national research councils should make coordinated research on antimicrobial resistance a high priority. 7 A way should be found to review progress with these recommendations and proposals. Veterinary dermatology represents one of the major uses of antibiotics in small animal practice and this special issue is designed to help meet the objectives of recommendation five, promotion of prudent use of antibiotics. The reviews of the main groups of antibacterial antibiotics used in our dermatological practice, presented in this issue, gather together the essential information required by both practitioner and specialist to make best use of their capabilities. In reviewing the ‘Copenhagen Recommendation’, Midtvedt has proposed the following additional recommendation. ‘The European Union should allow individual nations to have their own rules for consumption of antimicrobial agents and for control of over-the-border spreading of resistant organisms.’ He makes the point that the Scandinavian countries have far less antimicrobial resistance than the rest of Europe and suggests that this is a consequence of their enlightened policies regarding antibiotic use and importation of foods. I wonder if we are yet ready for the stringent controls that such an approach might require.