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- The challenge of antibiotic resistance: Need to contemplate

If an infection is addressed in a comprehensive and timely manner, resistance can be contained. Appropriate use of antibiotics will delay and in many cases prevent the emergence of resistance. Historically, several approaches to antibiotic prescribing have been employed to address antimicrobial resistance64. One approach is to use a newer more potent antimicrobial in settings where resistance has emerged to an older agent. However, if newer agents are overused or used inappropriately, resistance will invariably develop to the newer drug64. Another approach to combating resistance is to continue using older agents as first line choices, in preference to newer, more potent drugs, in an effort to preserve the activity of the new drugs. Thus the newer agents are reserved for infections caused by mutated multiresistant strains65. However, as resistance continues to increase to the first line agents, poor outcomes and secondary costs associated with clinical failures increase. Efforts to overcome bacterial resistance range from judicious and rationale use of antibiotics, effective hospital infection control programme and research in the field related to development of newer antibiotics66. The use of antibiotics in the community can be restricted by implementing laws to stop over the counter sale of antibiotics. Another approach is to use a combination therapy.

The most recent interest has been in rotating use of antibiotics. Some studies have suggested the usefulness of this strategy67 but this has to be done with close microbiological monitoring. Appropriate antimicrobial use is an integral component of any programme to slow the emergence and spread of antimicrobial resistant microorganisms in the health care setting. Though many possible interventions have been proposed, deciding which one is the most effective in a particular setting can be difficult. Despite guidelines from governmental and professional groups, many hospitals have yet to institute any antimicrobial use policies or programmes to improve antimicrobial agent prescribing.

Limiting the spread of antibiotic resistant bacteria in hospitals now invesages restrained and limited use of antimirobial agents and improve hospital hygiene - both easier to state than to implement. Hospital infection control will prevent the spread of infection and colonization of patients especially in high risk areas with multi drug resistant strains of bacteria. This will minimize the use of antibiotics in hospitals. More importantly, rationale policies are urgently needed to promote rational use of antibiotics in poultry, animal husbandry and agriculture.

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