The association between antimicrobial use and resistance has been documented. Ecologic studies show an association between amount of antimicrobial use in an area and rates of resistance. Cohort and case-control studies have documented significant associations between recent antimicrobial use and carriage or infection with resistant pneumococci. Longitudinal studies have found increased presence of resistant pathogens following therapeutic or prophylactic antibiotic use. A key strategy, therefore, to stop the spread of resistance is to decrease unnecessary antimicrobial use.
Antibiotics are the most commonly prescribed class of drugs in outpatient settings.
Although many of these infections are viral and antibiotics provide no benefit, these agents are prescribed because of the physician's diagnostic uncertainty or perceptions regarding patient expectations. A beginning step in reducing unnecessary antibiotic use is to consider preventing resistance and its consequences as important factors when making treatment decisions. Avoiding unnecessary antibiotic use decreases the spread of resistance in the community and benefits the patient by avoiding possible medication adverse effects and decreasing the risk of acquiring a resistant organism. Many of these principles are also relevant for infections in adults. Because patient expectations also affect physician behavior, educating patients about when antibiotics are or are not needed is important if practices are to change.