The first clinically manifest resistance observed was at a low MIC level and was accommodated by increasing the recommended dose of antimicrobial administered. These strains, where identified, were those classified as 'less susceptible' in Table 2. Subsequently, strains with higher MICs were detected and these were not amenable to therapy with currently available quinolones, even with higher dose regimens. These isolates are shown in Table 2 as the 'resistant' group. In 1996, one particular feature has been the increase or maintenance of high numbers of strains with fully developed quinolone resistance.
Some interest remains in the extent and type of resistance to the penicillins.
The clinical usefulness of this group of antimicrobials has decreased significantly in the WPR, but this group of agents was still used effectively in a number of specific settings. There was no resistance detected to the later generation cephalosporins and little to the injectable agent spectinomycin. Significant levels of spectinomycin resistance were recorded in the region some years ago, but only sporadic resistance is now observed and in very few isolates. The inappropriate use of antimicrobials in the informal health sector has been a contributor to the development of antibiotic resistance in the past. In theory at least, the availability of oral third generation cephalosporins increases the chances of inappropriate use.