Antibiotic Resistance

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Abstract
Antibiotics are commonly viewed as the most important advance in the history of medicine. During the six decades that followed the introduction of sulfonamides there has been a continuous supply of new agents responsive to evolving resistance of prior pathogens and emerging new pathogens. It now appears that the microbes confronting clinicians in the 1990s pose challenges that are unprecedented in the recent past. There are examples in virtually every category: malaria, multidrug-resistantMycobacterium tuberculosis,multiply resistant gram-negative bacilli, azole-resistantCandidaspecies, and metronidazole-resistantTrichomonas.The two pathogens that are arguably the most important to otolaryngologists are vancomycin-resistantEnterococcus faeciumand penicillin-resistantStreptococcus pneumoniae.The former is a nosocomially acquired pathogen that is especially prevalent in intensive care units and usually cannot be treated with antibiotics that have established merit. Penicillin-resistantS pneumoniaeis suddenly becoming a major problem in much of the world and its frequency in the United States is escalating at an alarming rate, especially in some geographic areas. This organism will require entirely new strategies for the empiric treatment of serious infections in whichS pneumoniaeis a documented or suspected pathogen. It is premature to say that traditional approaches to sinusitis and otitis need to be changed, but many suspect this will happen. One important lesson from this experience is that extensive antibiotic use and abuse has had some devastating consequences and many now believe that these are inevitable given current usage rates. The second lesson is that, although resistance seems predictable, specific patterns are not. Virtually no one predicted the evolution ofE faeciumas an important pathogen, and penicillin-resistance byS pneumoniaecuriously took four decades to happen. (Arch Otolaryngol Head Neck Surg. 1995;121:392-396)