Economic evaluations of antibiotic use and resistance--a perspective: report of Task Force 6

The economic consequences of antibiotic prophylaxis and therapy for bacterial infections in humans are profound. The reduction in real-dollar terms in the amount of illness and disability resulting from the use of developed and marketed antibiotics far outweighs costs of adverse effects, including resistance. Although bacterial infections continue to cause substantial mortality and morbidity worldwide, standard criteria for assessing the relation of infection to death or the contribution of resistance to mortality and morbidity do not exist. While local outbreaks of resistance may have serious consequences, bacterial susceptibility to antimicrobial therapy has remained virtually unchanged nationally where studied. Nevertheless, discriminating use of antimicrobial agents is held widely to be the keystone for minimizing resistance. It is not clear whether risk of selecting resistance is lowered by current community or clinical practices. Some analysts concentrate on the "problem" and "cost" of resistance and forget the benefits of the use of antibiotics. Development of resistance is a natural consequence of antibiotic use, but further quantification of this relation is required. Reports that resistance is increasing worldwide have presented a scientific challenge and economic opportunity to the pharmaceutical industry for the development of new antimicrobial agents. However, if a reasonable rate of return cannot be foreseen, capital for research and development is likely to be invested in areas that appear more financially attractive.