Antibiotic resistance and prescribing in the community

Increasing antibiotic resistance in human infection is causing concern. The underlying molecular mechanisms of resistance and the in-vitro molecular biology of resistance genes are well documented. However, the epidemiology and ecology of resistance has received less attention and many questions essential to the rational design of interventions to control resistance remain unanswered. Evidence for a link between resistance levels and antibiotic consumption is considerable, but fragmentary and mostly anecdotal. Theoretical models of the dynamics of changing resistance levels exist, but lack confirmatory evidence from longitudinal field studies. Evidence for the effect of decreasing consumption is contradictory, and few factors other than concurrent antibiotic consumption have been investigated for their effects. This review discusses the many problems involved in work on resistance in the community, factors involved in its epidemiology and strategies for control, along with possible solutions and pathways for future research. (C) 2001 Lippincott Williams & Wilkins.