Antibiotic resistance: Some thoughts

摘要

The introduction of penicillin into therapeutics revolutionized medical practice. Successive discoveries of newer antibiotics, of different types and classes, and their chemical modification enabled the medical profession to conquer most infectious diseases. The topic has been reviewed elsewhere. Successes of the mid-twentieth century generated a feeling that the ultimate control of infections was at hand. The euphoria has now been shown to be misplaced. Studies of patterns of antibiotic resistance in large hospitals that maintain regular records reveal that multi-resistance is rampant. In the case of Gram-negative bacilli (GNB), polymixin/colistin are the only antibiotics that have retained a uniformly good level of sensitivity, apart from the very new agents such as tigecycline.In fact, the prevalence of antibiotic resistance has prompted the use of these agents (polymixin/colistin) in extreme cases with often satisfactory results and the realization that earlier fear of their high toxicity was exaggerated. Resistance to even this class of antibiotics is now present; one such case was quoted in an editorial. As a result, we are facing 'an epidemic of antibiotic-resistant infections' . This has generated numerous reports of impending doom in the print and electronic media on the subject.