Control of Resistance
In the past, numerous examples in the literature showed that the extent of resistance in a hospital directly reflects the extent of usage of an antimicrobic, and that withdrawal or control can lead to rapid reduction of the incidence of resistance. Although this is more difficult to demonstrate in the community setting, experience and our understanding of the mechanisms and spread of resistance indicate that certain principles can help keep the problem under control:
1. Use antimicrobics conservatively and specifically in therapy.
2. Use an adequate dosage and duration of therapy to eliminate the infecting organism and reduce the risk of selecting resistant variants.
3. Select antimicrobics according to the proved or anticipated known susceptibility of the infecting strain whenever possible.
4. Use narrow-spectrum rather than broad-spectrum antimicrobics when the specific eti-ology of an infection is known, if possible.
5. Use antimicrobic combinations when they are known to prevent emergence of resis-tant mutants.
6. Use antimicrobics prophylactically only in situations in which it has been proven valuable and for the shortest possible time to avoid selection of a resistant flora.
7. Avoid environmental contamination with antimicrobics.
8. Rigidly apply careful, aseptic and handwashing procedures to help prevent spread of resistant organisms.
9. Use containment isolation procedures for patients infected with resistant organisms that pose a threat to others, and use protective precautions for those who are highly susceptible.
10. Epidemiologically monitor resistant organisms or resistance determinants in an instituteion and apply enhanced control measures if a problem develops.
11. Restrict the use of therapeutically valuable antimicrobics for nonmedical purposes.