Microbial resistance to drugs--a universal problem in urgent need of a comprehensive approach

The last two decades have seen an increase in bacterial resistance to commonly used antibiotics all over the world. In the past five years the emergence of vancomycin-resistant Enterococcus and multidrug-resistant Streptococcus pneumoniae was particularly notable. Several factors have contributed to this, including inappropriate use of readily available antibiotics, survival of high-risk patients in critical care units, burn wards and cancer centres following treatment with multiple antibiotic combinations, increasing poverty and worsening of living conditions. The data available from South-east Asia, albeit limited, indicate that prevalence of antibiotic resistance in bacteria isolated from human and animal sources is higher than that reported from western countries. To combat this global problem, a multi-pronged approach is needed. Accurate antibiotic susceptibility data will be required to define the extent of the problem. Medical experts and scientific organizations will have to develop guidelines for the use of antibiotics in ambulatory, inpatient and animal husbandary areas. Cooperation between the medical community, regulating agencies and pharmaceutical industry will be needed to define policies governing the sale of antibiotics, drug promotional materials, physician education programmes and consumer education regarding the hazards of inappropriate antibiotic use. For long term control of infectious diseases, it is imperative that existing vaccines be appropriately utilized and new vaccines developed.