## 6 Strategies for Combating Antibiotic Resistance: New Drugs and Alternative Therapies
### Antimicrobial Stewardship  
The choice of antibiotics, their dosage, and the route of administration are critical factors influencing antibiotic efficacy and resistance development. In the United States, up to 50% of antibiotic consumption is considered excessive, contributing significantly to resistance. Overuse stems from various factors, including prescribing antibiotics without sufficient evidence of bacterial infection, treating suspected non-bacterial infections, and a lack of stringent regulations requiring a prescription for antibiotic purchase. The ease of access and patient demand also exacerbate misuse [66]. Defined daily doses (DDDs) serve as a standardized metric to evaluate antibiotic usage, reflecting the average daily dose for adults for a drug's primary administration. For example, the recommended DDD for amoxicillin is 1.5 g per day administered orally. Analyzing DDDs allows for the assessment of antibiotic usage trends at the hospital or national levels. In 2015, the United Kingdom reported an average antibiotic consumption rate of 8696 DDDs per 1000 individuals per day, translating to 8696 DDDs per individual daily. Unlike some other countries, antibiotics in the UK are strictly available by prescription from licensed professionals, and national initiatives to reduce their inappropriate use have been pivotal in curbing resistance [66; 88]. Turkey, by contrast, has one of the highest global rates of antibiotic consumption, recorded at 18,095 DDDs per 1000 individuals daily. Factors contributing to this elevated usage include insufficient medical education on antibiotic stewardship, aggressive marketing by pharmaceutical companies, and inadequate regulatory frameworks. Amoxicillin remains the most widely consumed antibiotic in Turkey, reflecting its widespread application and the challenges associated with regulating broad-spectrum antibiotics. Nevertheless, Turkey has made strides in addressing overuse through campaigns aimed at raising awareness of antimicrobial resistance and the implementation of policies to control antibiotic sales and prescriptions. The choice of antibiotic--whether narrow-spectrum or broad-spectrum--plays a pivotal role in determining its impact on resistance development. Broad-spectrum agents, like amoxicillin, are often overprescribed, even when narrower-spectrum alternatives might suffice. Similarly, inappropriate dosage--whether too low or excessively high--can either fail to eradicate the pathogen or promote resistance. The route of administration, whether oral, intravenous, or intramuscular, also influences treatment outcomes. Intravenous antibiotics, for instance, are typically reserved for severe infections, but their misuse in non-critical cases can unnecessarily increase resistance risks. In brief, the interplay of antibiotic selection, dosage, and administration underscores the complexity of combating resistance. Countries like the UK have shown progress through strict prescription policies and stewardship programs, while high-consuming nations such as Turkey highlight the urgent need for global action. Addressing these variables comprehensively is essential to reducing resistance rates and preserving antibiotic efficacy worldwide [66; 88]. The emergence of antibiotic resistance can be traced back to the early days of antibiotic discovery. A key factor contributing to the rapid rise of antibiotic resistance is the ability of bacteria to exchange genes instantly with one another, facilitating the sharing of resistance. In hospitals, the occurrence of resistant staphylococcus infections surged by 14% from 1946 to 1948. Upon discovering bacteria that could survive penicillin treatment, scientists worked on creating methicillin, a new antibiotic designed to fight these resistant strains. Initially, methicillin showed promise in treating infections that did not respond to penicillin, but it was not long before methicillin-resistant strains, referred to as MRSA, emerged [32].