Trends of Antibiotic Use In the United States

Abstract

To the Editor.— Simmons and Stolley refer to shift of the bacterial ecological equilibrium to selectively ecovor the Gram-negative organisms. But the commentary en bloc does not emphasize and analyze the microbiological basis of the Gram-negative bacterial disease problem. This omission is regrettable because the problem, once generated, may not readily disappear in response to legislative or committee actions. A large part of the problem is multiple chemotherapeutic drug resistance of Gram-negative bacteria. During the first two decades of the sulfonamide-antibiotic era, bacterial resistance to single chemotherapeutic drugs was seen as the result of selective breeding of spontaneous chromosomal bacterial mutants under drug pressure. This entailed cross-resistance only to drugs that were closely related in chemical structure and mechanism of action. The last decade, however, has witnessed a worldwide emergence of multiresistance of Gram-negative bacteria caused by extrachromosomal elements of bacterial heredity, the R-factors. Under pressure of one drug,