Symposium Lectures

In the UK, approximately 5,000 hospital patients per year die of nosocomial infection. A significant proportion of these cases is caused by antimicrobial-resistant pathogens, in particular methicillin-resistant Staphylococcus aureus (MRSA), now endemic in British hospitals. Alarmingly, other bacteria, such as vancomycin-resistant enterococci (VRE) and penicillin-resistant pneumococci (PRP), are increasingly prevalent. Worldwide, antimicrobial resistance is widespread and has been documented in all of the major classes of pathogens. In some European countries, parts of the US and many developing nations, common community-acquired pathogens (e.g. Streptococcus pneumoniae) are frequently resistant to ‘traditional’ first-line therapy. This global ecological problem has evolved through the acceleration of Darwinian natural selection among bacteria. The widespread use of broad-spectrum antimicrobial agents, in both human and veterinary medicine, continues to fuel this process. Increasingly, national and international organisations are recognising the clinical impact of pathogen resistance and have published recommendations. It is against this background, and in a climate of limited health care resources, that policy-makers, hospital managers and clinicians have become increasingly aware of the high costs, financial and otherwise, of antimicrobial therapy. Strategies, such as intravenous to oral switch therapy, are being developed to try and curb the inappropriate use of antimicrobials and thereby improve the quality of patient care whilst reducing the costs of antimicrobial prescribing. Ongoing ecological changes and a lack of oral narrow-spectrum antimicrobials for resistant pathogens, however, are likely to result in the increased use of broadspectrum intravenous agents, further perpetuating the resistance problem and hampering the impact of antibiotic control interventions. In this environment, appropriate and responsible antibiotic prescribing, both in the community and in hospitals, is increasingly important. This paper summarises the symposium Appropriate Antibiotic Prescribing, run jointly by the Royal College of Physicians of Edinburgh and the Royal Pharmaceutical Society of Great Britain.