Evolution of antimicrobial resistance: impact on antibiotic use

During the past 50 years, the permanent increase in bacterial resistance to antibiotics has led to modifications in therapeutic recommendations. Despite evidence that antimicrobial exposure of human populations is the most important driving force for the continuous increase in bacterial resistance, the studies of the impact of bacterial resistance on antibiotic use have, during the past, focused on clinical efficacy of individual treatments rather than on collective control of resistance. There are current changes in this attitude, mainly in hospitals, probably because hospital prescribers have experienced the consequences of resistance on their patients. However, in the community such an awareness is not likely to develop in the near future. Therefore, there is a need for public health decision makers to become more involved in prevention of the impact of resistance in antibiotic use.