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Rev Panam Salud Publica vol.2 n.6 Washington Dec. 1997
Antibiotics resistance: origins, evolution, selection and spread
Ciba Foundation Symposium 207.
Dereck J Chadwick, Jamie Goode, eds. Chichester, England: John Wiley & Sons, Inc.; 1997, 250 pp.
Ciba-Geigy Limited, an international scientific, educational, and nonprofit foundation, aims to promote international cooperation in the areas of biological, medical, and chemical research. Every year it organizes, among other activities, eight multidisciplinary symposia where important topics are discussed by a small circle of experts. The published communications resulting from these meetings comprise the Ciba Foundation Symposium series, of which this volume is a part. The book, which contains 14 chapters, presents the contents of a meeting that was held in London, England, from 16 to 18 July 1996, on the origins, evolution, selection, and spread of antibiotic resistance. Each chapter is preceded by an abstract and contains the text of a presentation on the topic, a summary of the subsequent discussion, and a list of bibliographic references.
Resistance has repeatedly been observed after prolonged use of an antibiotic in humans, farm animals, and crops. It is attributed to the loss of the proper equilibrium between resistant and nonresistant bacterial strains. At the symposium, experts from Australia, Canada, Finland, Germany, Greece, Spain, Sweden, the United Kingdom, and the United States of America concluded that this ecological imbalance results from a process in which the antibiotic acts as a selective agent, while the genes that code for resistance act as the vehicle. It is still possible to restore the efficacy of the first antibiotics and to protect that of more recently developed ones through their rational use, which allows a predominance of the susceptible bacterial flora to be established.
Several chapters of this book are devoted to basic aspects of resistance, such as its molecular and genetic foundations; others discuss its epidemiologic determinants, both in a hospital setting and in the community at large. Also outlined are the strategies that should be adopted without delay to combat resistance, such as monitoring the rational use of antibiotics, developing new antimicrobial agents, preventing infections through good hygiene and better control programs, using existing vaccines in a more efficient manner, and developing new methods of immunization.
The last chapter, which is a general summary, points to the impossibiliy of returning to the pre-antibiotic era and emphasizes the need for consumers, physicians, and the pharmaceutical industry to direct their efforts at preventing the loss of the enormous benefits provided by antibiotics. The negative consequences of using antibiotics inappropriately extend beyond the individual to society as a whole. Fortunately, steps can still be taken to keep antibiotics from losing their effectiveness and to ensure that bacterial infections do not become prominent causes of morbidity and mortality in the twenty-first century, as they were in the past. Enriched by the expertise of the symposium's participants and by the soundness of the proposals made, this book alerts readers to a serious public health problem that threatens the entire world.
This book can be obtained directly from: John Wiley & Sons, Inc., 605 Third Avenue, New York, New York 10158, USA.