The emerging threat of antimicrobial resistance: strategies for change

An urgent warning has been issued by public health authorities worldwide about the threat of antimicrobial resistance by common community-acquired microorganisms such as Streptococcus pneumoniae. Many provider practices have been implicated in this emerging health threat by engaging in inappropriate prescriptive behaviors: imprecise infection diagnoses, "giving in" to patient requests, limiting time spent with patients, fearing liability, and inadequately controlling infections. Patient-related factors implicated in the health threat include a lack of knowledge about bacterial versus viral illness, insistence on receiving antibiotics, nonadherence to drug regimens, and exposure to resistant organisms. Antimicrobials in the environment and the adaptability of microorganisms are also factors. This article evaluates the factors promoting resistance and provides strategies for reversing the trend.