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Abstract
SINCE the first antibiotic, penicillin G, was marketed in the United States in 1943, these useful and potent antimicrobial agents have been widely adopted and used in the ensuing 30 years. The purpose of this article is to review the trends of antibiotic usage in the United States and try to assess the consequences of the remarkable popularity of this class of drugs. While the value and medical usefulness of appropriate antibiotic employment in clinical practice is unquestioned, there has been a considerable controversy over both the type and extent of antibiotic prescribing and the proper indications for use. Furthermore, the ecologic consequences of this wide usage are still unclear. The following are some of the issues: Has the wide use of antibiotics led to the emergence of new resistant bacterial strains? Has the ecology of "natural" or "hospital" bacterial flora been shifted because of antibiotic use? Has the ecology of

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