Principles and Strategies 
 Intended to Limit the Impact of Antimicrobial Resistance          
August, 2001

The development of antimicrobial agents (antibacterials, antivirals, antifungals and antiparasitics) to treat infections has been one of the most notable medical achievements of the past century.  These advances in medical care are now threatened by increasing resistance among all microorganism classes, but particularly resistance among bacteria to antibiotic agents. The seriousness of antimicrobial resistance is reflected in the:

·         steadily increasing frequency of resistance over time among individual pathogens

·         increased presence of resistance among critical bacterial species causing common infections

·         global extent of the resistance problem 

The rate of resistance has become so high that there are no longer effective agents to treat some pathogens.

The manageable causes of antimicrobial resistance are diverse and include:

·         overuse and misuse of antimicrobial agents in humans, food animals, agriculture and consumer products

·         increased pressure to prescribe antimicrobial agents as a result of advances made in the use of invasive medical technology and indwelling prosthetic devices

·         transmission of antimicrobial-resistant organisms because of inadequate infection control practices

·         insufficient development and application of immunization as a preventive strategy

·         government policies that permit direct over-the-counter purchase of antimicrobial agents by consumers

The relative contribution of each of these factors to the overall problem of antimicrobial resistance is not known.  Some antimicrobial resistance is expected to develop over time as a consequence of any antimicrobial use (even appropriate use) as microorganisms mutate and adapt in response to exposure to the drug.  It is not realistic to expect that antimicrobial agents can be used indefinitely without eliciting any resistance. However, appropriate use will slow the development of resistance.  As a result, it is imperative that antimicrobial agents be used responsibly in the treatment of individual patients to preserve their utility and value as agents for treating others in the future, recognizing that use of antimicrobial agents incurs societal as well as individual effects.  The Infectious Diseases Society of America is committed to defining and promoting those strategies most likely to prevent and reverse antimicrobial resistance in order to better manage the problem.  

The Society delineates two major principles to limit the impact of antimicrobial resistance:

Good Antimicrobial Stewardship: Good antimicrobial stewardship is the optimal selection of antimicrobial agents for the appropriate indication, dosage and duration of therapy that results in the maximum benefit and minimum of adverse events for the patient and minimizes the development of antimicrobial resistance.

Control and Prevention: This includes the consistent development and application of infection control and immunization policies and practices to prevent transmission and infection caused by resistant organisms. 

The Society also gives high priority to the following strategies in the belief that support for these efforts will most rapidly achieve control of the problem of antibiotic resistance and/or provide the scientific basis to manage it in a rational manner:

• Rigorous measurement of antimicrobial agent usage and antimicrobial agent resistance in human, animal, plant and inanimate applications
  
  

• Continued availability of high quality diagnostic microbiology laboratories in human and animal health care facilities
  
  

• Improved diagnostic testing in humans and in animals to aid practitioners in better identifying those subjects with infections who will and who will not benefit from antimicrobial treatment
  
  

• Steadfast and unfailing support for infection control programs in al health care settings
  
  

• Education of the public and of professionals to change expectations and to increase awareness of the risks of antimicrobial resistance when these agents are used
  
  

• Development of decision support tools for clinicians including computer and Internet technology to deliver best practice information at the time the clinical antimicrobial treatment decision is made
  
  

• Development and application of vaccines to prevent infections caused by a broader array of organisms, thus reducing the need for the use of antimicrobial agents
  
  

• Development of new antimicrobial agents for the treatment of antimicrobial-resistant microorganisms
  
  

• Responsible marketing and promotion of antimicrobial agents that incorporate concern about the potential for development of antimicrobial resistance
  
  

• Support for good antimicrobial stewardship and improved hygiene in food animal production that promotes animal health
  
  

• Support for better production methods and growth promotion alternatives to replace the subtherapeutic use of antimicrobial agents in food animals
  
  

• Increased research funding for:
  
  Basic mechanisms of antimicrobial resistance
  
  Vaccine development
  
  New antimicrobial development
  
  Biotherapy and biointerference strategies to replace antimicrobial use
  
  Improved infection control methods
  
  Better diagnostic methods for detection of infectious organisms
  
  More rapid, sensitive and specific tests for antimicrobial resistance
  
  Effective educational methods to reach the public and professionals
  
  Antimicrobial use strategies to minimize resistance development
  
  Use of technology for antimicrobial decision support
  
  Alternatives to antimicrobial agents for growth promotion in food animals